Breast Reconstruction DIEP
Women who decide to continue with breast reconstruction surgery after their mastectomies have one of two options: They can elect to have a plastic surgeon recreate the contour of their natural breast using either autologous tissue (in other words, their own tissues) or prosthetic materials.
There are several different procedures for autologous breast reconstruction:
TRAM (transverse rectus abdominus myocutaneous) Flap: A procedure which uses abdominal muscle, fat and skin to reconstruct the new breast mound.
Latissimus Dorsi Tissue Flap: A procedure which uses muscle and skin from the back to reconstruct the new breast mound.
SGAP (superior gluteal artery perforator) Flap: A procedure which uses fat and skin from the upper part of the buttocks to reconstruct the new breast mound.
DIEP Flap: A microvascular procedure similar to the TRAM flap except that it only uses blood vessels, fat and skin, thereby preserving the integrity of the rectus abdominus muscles. Blood vessels are dissected through the rectus abdominis and tissue is taken from the abdominal wall.
A muscle sparing procedure very similar to DIEP is the GAP (Gluteal Artery Perforator) Flap in which the gluteal artery is dissected from the underlying gluteus maximus and fatty tissue for transplantation is taken from the buttocks.
DIEP Flap reconstruction is rapidly becoming the breast reconstruction method of choice for many plastic surgeons. For one thing it is associated with shorter hospital stays: It is far less invasive and far less painful than conventional TRAM Flap reconstruction and has far fewer complications. The incidence of abdominal wall hernias is much lower following the procedure, as is the incidence of subsequent fatty tissue necrosis. Essentially, the DIEP flap procedure is the same procedure as performing a tummy tuck so many women find that the appearance of their abdomen has been improved.
As with other microvascular procedures, there is a risk of total flap loss, generally assessed as being between 1% and 2%. Additionally, 2% to 3% of DIEP patients report bulging of the abdominal wall following the procedure; this is still far lower than the 15% of TRAM flap cases that report this outcome.
DIEP Flap surgery isn't appropriate for all mastectomy patients. It only works well for women who have enough fatty abdominal tissue to recreate a breast mound. DIEP Flap surgery may also be problematic for women who have had previous abdominal surgeries such as hysterectomy, c-section, appendectomy, bowel resection or liposuction; however, it is not absolutely precluded: Plastic surgeons evaluate each candidate individually.
Increasingly DIEP Flap surgery is being combined with skin-sparing mastectomies. In this procedure, the entire breast is not removed; rather, the breast tissue is removed and the breast integument is left intact which can then be filled with the fatty transplant tissue, creating a reconstructed breast which is very close in appearance to your original breast. Some surgical teams are able to perform nipple sparing mastectomies.
Before you decide upon a DIEP Flap reconstruction, ask your plastic surgeon how frequently he or she performs this procedure and its success rate.
If your insurance covers your mastectomy, by law it must also cover your reconstruction method of choice. The costs of DIEP Flap surgery are typically higher than the cost of conventional TRAM Flap surgery, and some plastic surgeons will ask patients to pay the difference between the insurance reimbursement and their fee.