DIEP Flap Richmond
What is a DIEP Flap?
A DIEP flap is a form of autologous tissue breast reconstruction. That means it uses your own tissue, from another area of your body, to make a new breast. It is named for the small blood vessel that runs through the flap, the deep inferior epigastric artery perforator. This is the tissue located in the lower abdomen, between the belly button (umbilicus) and the lower fold of skin at the pubic bone. It represents the most common and state-of-the-art type of autologous tissue technique in use today. Unlike the older TRAM flap, the DIEP flap preserves the muscle and fascia (the strength layer) in the abdominal wall. Your risk for a hernia or a bulge in the tummy after surgery is much, much lower. Also, since the muscle is still in its correct location in the abdomen, your strength is not reduced like it might be with a TRAM flap.
How is a DIEP flap performed?
The tissue of the DIEP flap from the lower abdomen is actually completely removed from your body, along with the blood vessels (at least one artery and one vein) that supply the tissue. Then it is reattached in your chest by sewing together the tiny, 2-3 millimeter-wide blood vessels, under the microscope. The good blood vessels in your chest run underneath the ribs. So a short piece of cartilage is removed from one rib per side to give access to these blood vessels. After the DIEP flap is reattached to your chest, it becomes a natural new breast, since it is your own tissue.
What can I expect in the hospital?
Because the operation is very complex and technically demanding, DIEP flap surgery is longer than surgery for implants or tissue expanders. One side might take 6 hours, and two sides could be 8-12 hours. Is it safe to be under anesthesia for this long? The short answer, for most patients, is yes. Patients with significant medical problems, such as coronary heart disease or end stage renal disease on dialysis, would not be candidates for DIEP flap surgery.
The connections of the tiny blood vessels are very important. If either one develops a blood clot, it could result in losing the entire flap of tissue. The risk is highest in the first two days. Because of that, a special laser monitor is attached to the flap to measure oxygen in the skin. The nurses check it once an hour for the first two days. Dr. Hubert can also follow the measurements in real time on an app on his smartphone. If there is a problem, sometimes it requires an urgent trip back to the operating room to try to fix it and save the flap. Most women spend about three days in the hospital.
What are the benefits of a DIEP flap?
It is your own tissue! There is no foreign material from a breast implant in your body. A DIEP flap tends to have a more natural sag than an implant. It brings in healthy, non-radiated tissue to make a new breast. This is especially important if you had previous reconstruction that was radiated during breast cancer treatment and did not do well. And it’s a permanent result. You don’t have to worry about any of the long-term issues that implants present, such as what to do if they break, when to get routine imaging, or what if scar tissue forms around the implant. Interestingly, many women who have DIEP flap surgery eventually refer to their new breasts as their “breasts.” However, some women who have implant reconstruction will always refer to their reconstructed breasts as their “implants,” since they might never feel completely like a part of them.
What are the risks of a DIEP flap?
While a DIEP flap is a great option for many women, you should make sure you are choosing the best option for you. Compared to implant breast reconstruction, DIEP flap surgery involves a longer surgery, longer hospital stay, longer recovery, and the risk of losing the entire flap of tissue due to a blood clot. There are also potential issues at the donor site of the abdomen, including a scar from hip to hip and the possibility of muscle and abdominal wall weakness producing a bulge. Dr. Hubert will talk with you about whether you may be a candidate for DIEP flap surgery and what your best options are.
Dr. Hubert’s Qualifications
Darrin Hubert MD is one of a small number of plastic surgeons in the entire state to offer this reconstructive surgery, and he performs this operation routinely. In fact, Dr. Hubert learned this technique during his Ivy League plastic surgery residency training in Philadelphia at the prestigious University of Pennsylvania. He worked for years directly with one of the true pioneers in this field, his mentor and friend, Dr. Joseph Serletti. The surgery is very specialized and technically demanding, and it requires the use of the operating microscope to sew together the tiny blood vessels using stitches smaller than a human hair. This is one of the reasons that Dr. Hubert is among very few plastic surgeons who have the ability and the clinical volume to offer this breast reconstruction technique to patients outside a major academic medical center. But since no two breast cancer patients are the same, this means that all of your breast reconstruction options are on the table, and we will work with you to come up with the best plan for your individual situation. Dr. Hubert is an active member of the American Society of Reconstructive Microsurgery, a professional organization of surgeons from around the world who meet to share ideas and techniques related to these very complex microsurgical operations.
If a DIEP flap is the right choice for you, then as a patient, you want to make sure you have a surgeon who has the capability and experience to offer you the best result. Dr. Hubert has literally performed hundreds of DIEP flap operations and currently is able to offer this advanced technique at several hospitals throughout the Richmond, Virginia, metro area: St. Francis Medical Center and Johnston Willis Hospital in Midlothian, Henrico Doctors Hospital (Forest Campus) in Henrico, and Memorial Regional Medical Center in Mechanicsville.
46 year old woman with breast cancer on the left. She had chemotherapy before surgery. Her bra size was 36DDD, and she wanted to be smaller after her surgery.