DIEP Breast Reconstruction Surgery

As part of our ongoing mission to take the mystery out of breast cancer, we shine the light on the DIEP breast reconstruction procedure. DIEP stands for Deep Inferior Epigastric Perforator – which is an advanced microsurgical technique in breast reconstruction that creates breasts lost to mastectomy with living fat transplanted from the lower abdomen. DIEP flap reconstruction utilizes excess fat and skin from the lower abdomen, without sacrificing muscles to construct the breasts. Women who undergo the DIEP flap procedure also benefit from improved abdominal contouring, much like a “tummy tuck”.
The tissue is transferred to the chest where the surgeon attaches the donor tissue blood vessels to the mastectomy site forming a living filler for the breast tissue removed by mastectomy.  The APEX Flap (Abdominal Perforator Engineered Vascular Exchange) is the latest refinement of this technique and provides another level of sophistication to the options available to women facing mastectomy.  While there are several choices when it comes to reconstructive breast surgery, the DIEP and APEX flap procedures represent the most advanced surgical technology available.  In cases when the patient lacks enough abdominal tissue to create a new breast, there are additional options, including the Stacked DIEP Flap, BodyLift® Perforator Flap and the Hip Flap procedures to complete a set of options for all body types.
The DIEP procedure, perfected at the Center for Restorative Breast Surgery, is just one of the many options available to mastectomy patients. Unlike a TRAM flap procedure, (Transverse Rectus Abdominis Muscle) which uses the abdominal muscle between your lower abdomen and your pubic bone, the DIEP procedure does not use muscle and as such most patients recover more quickly and have a lower risk of losing abdominal muscle strength with the DIEP. 
Candidates for the procedure are those with breasts lost to cancer, preventive mastectomy, developmental defects, and deformities associated with previous surgery. However, patients who lack enough extra belly tissue, who have had some prior abdominal surgery, or whose abdominal blood vessels are small, or not in the best location for a DIEP may not be candidates. 
As with any surgical procedure there are always risks involved. Some of those potentially associated with this procedure include:  tissue breakdown, (due to poor blood circulation), lumps in the reconstructed breast, (due to fat necrosis from poor blood circulation resulting in scar tissue), and a small risk of hernia.
We spoke with two former patients who had the DIEP procedure done, JoAnne and Marcia. Both stated they were very pleased with their results.  JoAnne stated that unlike implants, her reconstructed breasts were warm to the touch due to the fact that a blood supply is maintained to the transplanted tissue and fat harvested from the stomach. Marcia agreed, stating that even before her mastectomy she had decided this was the procedure she wanted to have if she needed it. Both agreed the recovery was long but the benefits obtained were worth it. 
“Your breasts age like natural breasts, they will have a natural, albeit slower sag, and will look and feel real.” Marcia stated. Marcia also said that with whatever procedure you choose, the expertise of the surgeon is of upmost importance. If complications arise, you need a doctor that is going to know what to do and how to deal with things. “This procedure is challenging. Your surgeon has to be up to the task.” 
JoAnne agreed and added, “This feels the most like my old breasts did. They move like my old breasts and that was very good for my mental healing.” 
For more on this procedure and other reconstruction procedures visit www.breastcancer.org 


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