Autologous Breast Reconstruction (DIEP Flap)

There are several different options for breast reconstruction. Breast reconstruction following mastectomy can be performed using the patient’s own tissue (autologous reconstruction) or with breast implants, and sometimes a combination of both. Breast reconstruction can take place in a single surgery immediately following a mastectomy known as immediate reconstruction, or any time thereafter referred to as delayed reconstruction. Immediate breast reconstruction has the significant psychological benefit of a patient forgoing a period of time being without a breast mound. Sometimes though, for reasons related to a patient’s breast cancer, it may be preferable to delay breast reconstruction.

What is autologous breast reconstruction?

There are several techniques that can be used for breast reconstruction. An autologous reconstruction is a form of breast reconstruction that replaces the surgically removed breast with your own tissue from another part of your body. Potential donor sites include the abdomen, back, or thighs – with the abdomen typically being the most preferred option. Autologous reconstruction typically requires microsurgical techniques, and a longer hospital stay, but this method provides a lifelong result and studies have shown higher patient satisfaction.

What is a DIEP flap?

A DIEP flap, or Deep Inferior Epigastric Perforator flap, is when the tissue transferred to reconstruct the breast comes from the abdomen, and is the gold standard in autologous breast reconstruction. This procedure removes the skin and fat that is commonly removed in an abdominoplasty, or tummy tuck, and transfers that tissue to the chest wall to reconstruct a breast. This sophisticated method of breast reconstruction involves identifying and saving the small blood vessels that keep that tissue from the abdomen alive, and reconnecting these blood vessels in the chest to re-establish blood flow and keep the tissue healthy. By removing the tissue from the abdomen, and using it to reconstruct the breast, the patient has the benefit of improving the contour of their abdomen while undergoing breast reconstruction.

What are the benefits of a DIEP flap breast reconstruction?

DIEP flap breast reconstruction allows for reconstruction of the breast in a natural way with a patient’s own tissue. This avoids the need for a foreign body such as a breast implant, and therefore avoids any concerns that a patient may have related to an implant. This also avoids the need for multiple surgeries and implant maintenance over time. The tissue used to reconstruct your breast is your own body, and therefore it will grow and age with you, like normal. Your reconstructed breast will gain or lose weight with you naturally. DIEP flap breast reconstruction allows for excellent symmetry when only reconstructing one breast, as the natural fat used to reconstruct the breast can take on a natural shape similar to the unaffected breast. DIEP flap breast reconstruction is often indicated in patients who have failed prior implant-based reconstruction, or patients who have a history of prior radiation. Furthermore, techniques used in DIEP flap breast reconstruction by our board-certified surgeons can help to improve the sensation in your reconstructed breast compared to implant-based reconstruction.

What are the limitations of a DIEP flap breast reconstruction?

DIEP flap breast reconstruction requires a larger up-front commitment on the part of the patient. This is a more complicated form of breast reconstruction and there is more of a recovery involved. The procedure is technically challenging to perform, so it is important that a patient seeks out a reconstructive microsurgeon who is comfortable performing this type of breast reconstruction. There are multiple surgical sites involved (the breast as well as the site where the tissue is taken from), and both sites need to heal and there are surgical risks at both sites. There is also a chance that a blood clot could form in the small blood vessels that are connected to re-establish blood flow when transferring the tissue. If such a blood clot were to form, which happens about 1% of the time, this poses a risk to the survival of the transferred tissue and can necessitate an emergency surgery to try to fix this problem.

Am I a good candidate for a DIEP flap breast reconstruction?

Breast reconstruction is always an elective procedure, and therefore a patient needs to be an appropriate candidate from a medical perspective to undergo any form of reconstruction. Having significant medical comorbidities, such as obesity, diabetes, heart disease, pulmonary disease, etc. can result in a patient being a poor candidate for reconstruction.

In autologous reconstruction, particular considerations include a patient’s personal or family history of blood clots. If a patient is more likely to form blood clots, this can create an increased risk of flap failure which may make the patient a poor candidate. Patient’s also need to have an appropriate amount of tissue to transfer from their abdomen to be a good candidate for a DIEP flap. Patients who have a thin abdomen but extra tissue elsewhere, such as their thighs, can be evaluated for transferring tissue from other parts of the body.

It is important to recognize that having prior implant-based breast reconstruction does not prevent a patient from having autologous reconstruction. Many patients who have determined they no longer want implant-based reconstruction elect to have their implants removed and their breasts reconstructed with their own tissue.

How is a DIEP flap breast reconstruction performed?

This procedure removes the skin and fat that is commonly removed in an abdominoplasty, or tummy tuck, and transfers that tissue to the chest wall to reconstruct a breast. This sophisticated method of breast reconstruction involves identifying and saving the small blood vessels that keep that tissue from the abdomen alive, and reconnecting these blood vessels in the chest to re-establish blood flow and keep the tissue healthy. By removing the tissue from the abdomen, and using it to reconstruct the breast, the patient has the benefit of improving the contour of their abdomen while undergoing breast reconstruction.

What is a DIEP flap breast reconstruction recovery like?

Patients who undergo a DIEP flap breast reconstruction will spend a minimum of two nights in the hospital. This is done to allow for the nurses to check the transferred tissue every hour and ensure that the tissue has good blood flow and a blood clot has not formed which could compromise the tissue. Patients will have surgical drains in the breast and abdomen that will need to be taken care of. These drains are typically removed within 1-2 weeks after surgery, depending on fluid output. Patients will be up and walking the day after surgery and will shower 2 days after surgery, prior to leaving the hospital. After they go home, patients will continue to gradually increase their activity and will be monitored closely by our team. The expected recovery time is approximately 6 weeks.

What will the scarring look like?

Scarring on the breast in DIEP flap breast reconstruction can vary depending on the shape and size of a patient’s breast prior to mastectomy, as well as factors involving their cancer – such as if a patient is a candidate for a nipple-sparing mastectomy. Usually, a small island of skin is transferred from the abdomen to the breast, at least temporarily, for monitoring of the transferred tissue. There will also be scars on the abdomen in DIEP flap breast reconstruction, corresponding to the tissue that was taken from this donor site. This scar is typically horizontal from hip to hip and is kept as low as possible to allow for patients to hide this scar.

Can my unaffected breast be addressed to improve symmetry?

Yes! As a part of the 1998 Women’s Health and Cancer Rights Act, healthcare insurers must cover any surgery needed to the unaffected breast (i.e. lift, reduction or augmentation) to obtain symmetry in women who have undergone a mastectomy.

Will insurance cover my DIEP flap breast reconstruction? 

Breast reconstruction is not only an option, but a right, for women seeking to rebuild one or both breasts following surgical treatment of breast cancer, including lumpectomies and mastectomies. These surgical services are typically covered by insurance as the 1998 Women’s Health and Cancer Rights Act specifies that healthcare insurers must cover breast reconstruction following mastectomy. It also stipulates that any surgery needed to the opposite breast (i.e. lift, reduction or augmentation) to obtain symmetry will also be covered.

Click Here for Autologous Breast Reconstruction Before and After photos.

Why should I have my DIEP flap breast reconstruction performed at Samra Plastic Surgery?

Our team of board-certified* plastic surgeons have trained at the best programs in the country, including the top cancer hospitals, and are very experienced in performing this type of breast reconstruction at a high volume. Dr. Fares Samra also completed an extra year of fellowship training to be an expert in microvascular surgery, performing hundreds of these cases. Our team will work closely with your breast surgeon who is performing the mastectomy to give you the best possible outcome and maximize your patient experience.

Contact us to set up a personal or virtual consultation with one of our board-certified plastic surgeons today.