DIEP Flap Surgery is considered to be a type of breast reconstruction and not necessarily cosmetic surgery. Our surgeons remove blood vessels and skin from a patient’s lower abdomen and transfer it to the chest in order to reconstruct a breast after a mastectomy.
Candidacy for DIEP Flap Breast Reconstruction
The Deep Inferior Epigastric Perforator (DIEP) flap is the procedure of choice for breast reconstruction using the patient’s own tissue. Despite its versatility and excellent cosmetic results, the DIEP flap may not be ideal in patients with history of a tummy tuck or abdominal hernia repair. Also very thin patients may not qualify. Other reconstruction techniques will be recommended for patients who do not qualify.
DIEP Flap Breast Reconstruction Procedure
This technique utilizes the lower abdominal skin and fat to reconstruct the breast. The major benefit is that most patients who come for breast reconstruction will have extra tissue in the abdomen that can be used for breast reconstruction. The patients get a “tummy tuck,” but instead of throwing that tummy tuck tissue away, our surgeons use it for reconstruction.
Additionally, this technique leaves patients with a tighter and flatter abdomen, in addition to a natural feeling autologous breast reconstruction. Also, this breast reconstruction tends to be soft and supple though somewhat fuller, higher and “perkier” than a natural breast. The reconstruction moves none of the muscle and therefore the patients are left with almost no complications.
Integrity is Key
Integrity in DIEP flap surgery is paramount. As the popularity of the DIEP flap has become more widespread, an unfortunate side note is surgeons stating that they perform a DIEP flap when in reality, they are performing a Transverse Rectus Abdominis Muscle (TRAM) flap. During a TRAM procedure, muscle is removed from the abdomen and the patient is left with a weak spot in the abdominal musculature, resulting in a propensity for bulging and pain.
At My Houston Surgeons, all patients have access to a photograph of the flap showing that no muscle is taken. This is unique amongst other surgeons, as our surgeons can definitely, without a question, guarantee that no muscle will be taken in during this type of flap-based reconstruction.
Further excellence is noted in the fact that no rib is removed during this type of procedure. Many surgeons, when performing flap-based reconstruction, remove a section of the rib in order to attach the vessels that supply the blood to the flap. This, like the removal of the abdominal muscles, leaves the patient with long term pain and deformity of the chest. By avoiding this, patients are left with less pain and almost no long-term problems in the chest. Furthermore, if you have any questions, you can ask your surgeon more about rib removal at your consultation for DIEP flap breast reconstruction.
Benefits of DIEP Flap Breast Reconstruction
The procedure can provide:
- Rebuilt breasts after mastectomy
- Natural looking and feeling breasts
- Restored femininity and sexuality
Recovery after DIEP Flap Breast Reconstruction
The recovery after microvascular breast reconstruction with the deep inferior epigastric perforator (DIEP) flap can be a daunting experience for many patients. Typically, patients are told that they will have to spend five to six days in the hospital following their surgery, with a recovery period of up to 8 weeks before returning to a normal life without hindering their activities.
This is not the experience at My Houston Surgeons. We have pioneered surgical techniques which have dramatically reduced hospitalization and recovery times, a testament to a less painful experience which renders an earlier return to daily activities. Some of the methods that we have developed regarding our enhanced recovery protocol is the microfascial incision technique. This unique procedure allows our surgeons to obtain blood vessels located underneath the muscles of your abdomen, required to maintain a healthy DIEP flap, with an incision that averages 1.5 centimeters (about half inch) and no longer than 2.5 centimeters (roughly an inch). In comparison, traditional “fascial” incisions remain between ten to fifteen centimeters (4 to 6 inches). By reducing the size of the incision in your abdomen, the experience of our patients is dramatically improved, allowing them to walk a few hours after their surgery with minimal pain.
Our improved recovery protocol can be analogous to the transition seen in laparoscopic gallbladder removals from the more traditional open approach. With an open removal, the incision was typically around seven to eight centimeters, while laparoscopic incisions are around one and a half centimeters. The smaller incisions result in less pain and a significantly fast recovery, as evidenced by the fact that patients used to stay in the hospital for a week after traditional gallbladder removal, and now are being discharged within an hour of their laparoscopic removal.
In addition to the microfascial incision, portions of the rib are not removed during our procedures. This is in opposition to the traditional methods that require rib removal in order to access the blood vessels located in the chest, which are eventually connected to the flap to provide oxygen and nutrients.
The combination of these two techniques reduces the stimulus for pain at the chest and abdomen. Furthermore, we perform aggressive nerve blocks with long-lasting medications during surgery in addition to enhanced recovery protocols, allowing our patient to use minimal narcotics and anti-inflammatory medications post-operatively.
Our patients are typically discharged the next morning after surgery, resuming 80% of normal activities within 2 weeks and 90% of normal activities within 3 weeks.
Why Choose My Houston Surgeons for Breast Reconstruction?
Dr. Sean Boutros, the senior surgeon at My Houston Surgeons, has been a leader in DIEP flap breast reconstruction. He had presented at national and international meetings about DIEP flap breast reconstruction for many years. He has published numerous papers about the DIEP flap breast reconstruction in both national and international journals. His lead article in the March 2014 plastic and reconstructive surgery is the largest series ever published in DIEP flap. Dr. Boutros has personally performed over 1300 DIEP flaps giving him one of the highest success rates ever reported amongst any surgeon.
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