Breast Reconstruction with DIEP flap

Breast cancer will affect 1 in 8 women over the course of their lifetime. Surgical excision of the concerning area remains a mainstay treatment for breast cancer. This excision may involve only a portion of the breast (lumpectomy) or all of the breast tissue (mastectomy). Lumpectomy and mastectomy are procedures performed by a Breast Surgeon. Dr. Pierce works collaboratively with multiple Breast Surgeons in southern Colorado to assist with breast reconstruction.

Options for breast reconstruction after mastectomy include using an implant or using the patients own tissue (autologous reconstruction). Autologous reconstruction is less common than implant-based reconstruction but is a better, long-term reconstruction for certain patients. This technique usually involves multiple stages to complete the reconstruction. The first stage of reconstruction begins at the same time as the mastectomy with placement of a tissue expander. A tissue expander is a temporary implant that allows Dr. Pierce to determine to ideal location of the final breast reconstruction and slowly expand the remaining breast skin to the desired reconstructed size. The second stage of reconstruction occurs 4-6 months after the initial surgery and involves removal of the tissue expander and creation of the breast mound using the patient’s own tissue.

Dr. Pierce performs autologous reconstruction with a DIEP (deep inferior epigastric perforator) flap which is currently considered the gold standard for autologous breast reconstruction. Tissue for a DIEP flap is taken from the lower abdomen and is the same area that is removed during a tummy tuck. The tissue is elevated with the blood vessels that keep this area alive. The blood vessels are then cut and the tissue is brought up to the chest. The blood vessels are then stitched to completely different blood vessels in the chest under a microscope. This transferred tissue then lives on the chest creating a breast mound. This type of surgery is extremely complex involving multiple surgical sites, tedious dissection, and microsurgical repair of blood vessels. Dr. Pierce is the only private plastic surgeon in southern Colorado performing DIEP flap reconstruction.

Other factors that may affect your options for breast reconstruction include:

  • Patient’s desires and expectations of reconstruction

  • Location of breast cancer

  • Size of breast cancer

  • Type of breast cancer

  • Current size of breasts

  • Prior surgery of the breasts, abdomen, or back

  • Prior radiation to the chest

  • Possibility of post-operative radiation to the chest

  • Body habitus or weight

  • Other medical issues

Ultimately, the decision to proceed with breast reconstruction should involve a discussion between the patient, the breast surgeon, and the plastic surgeon.

Frequently Asked Questions:

  • Am I a candidate for breast reconstruction?

    • Women who are undergoing mastectomy for breast cancer and are in otherwise reasonable medical health are candidates for breast reconstruction.

  • Is breast reconstruction with DIEP flap covered by insurance?

    • Breast reconstruction with DIEP flap is sometimes covered by insurance. Our office will be able to help determine if this procedure is covered by your particular insurance plan.

  • Can I have a breast reconstruction if I am currently smoking cigarettes?

    • No, smoking cigarettes or any form of nicotine consumption significantly increases your risk of issues with wound healing and infection. You should be without nicotine for 6 weeks prior to and 6 weeks after your surgery. Your breast reconstruction can begin once you have discontinued any nicotine.

  • How is a breast reconstruction with DIEP flap surgery performed?

    • The first stage of reconstruction involves placement of a tissue expander and is usually performed a the same time as the mastectomy. The second stage of reconstruction involves removal of the tissue expander and creation of a breast mound with a DIEP flap. Tissue for a DIEP flap is taken from the lower abdomen and is the same area that is removed during a tummy tuck. The tissue is elevated with the blood vessels that keep this area alive. The blood vessels are then cut and the tissue is brought up to the chest. The blood vessels are then stitched to completely different blood vessels in the chest under a microscope. This transferred tissue then lives on the chest creating a breast mound.

  • Where are the incisions located for a breast reconstruction with DIEP flap?

    • Because breast reconstruction with DIEP flap uses tissue from another part of your body, you should plan to have incisions on both the abdomen and breast. The final breast incisions will depend on where the original mastectomy incisions are placed. The abdominal incision is located from hip bone to hip bone and typically sits just below a normal bikini line. Please visit our breast reconstruction with DIEP flap gallery to see typical incisions after this type of breast reconstruction.

  • How long does breast reconstruction with DIEP flap surgery take?

    • Because of the complexity of the procedure, a typical DIEP flap surgery will take 5-6 hours per side. So, a bilateral breast reconstruction with DIEP flap can take 10-12 hours to complete.

  • Will I have drains after a breast reconstruction with DIEP flap?

    • Yes, you will have 2 drains in the abdominal surgical site and 1 drain in each breast surgical site. The drains will be removed in the office 1-2 weeks after surgery.

  • How do you control pain during and after surgery?

    • Dr. Pierce uses an evidence-based approach to pain management for surgery called the ERAS (Enhanced Recovery After Surgery) protocol. This protocol uses a combination of local numbing medication, anesthesia blocks, anti-nausea medication, scheduled non-narcotic pain medication, and narcotic pain medication as needed to decrease the surgical pain and speed up your recovery.

  • Where do you perform breast reconstruction with DIEP flap surgery?

    • Dr. Pierce performs breast reconstruction with DIEP flap surgery in a hospital setting. You will be admitted for 2-3 days following the procedure to help with recovery and allow Dr. Pierce to monitor the flap and ensure that the blood supply is healthy.

  • What are the risks and complications associated with breast reconstruction with DIEP flap?

    • The most concerning risk for this type of procedure is poor blood supply to the DIEP flap most commonly related to a blood clot at the site where the blood vessels have been stitched together. Although the chances of this happening are rare (less than 5% of the time), it must be identified quickly and may require a return to the operating room to revise the blood vessel stitches and restore healthy blood supply to the flap. If blood supply is not restored, the flap must be removed and an alternative method of reconstruction used. Other common risks associated with breast reconstruction are pain, bleeding, infection, delayed wound healing, scarring, and asymmetry.

  • When can I return to work after breast reconstruction?

    • You can return to desk work 2-3 weeks after surgery. If you have a job that requires heavy lifting, we ask that you request to return to work with modified duties until 6 weeks after surgery.

  • When can I return to exercise after breast reconstruction with DIEP flap?

    • You can resume low-impact exercise (ex: walking, stationary bike, elliptical) at 2-3 weeks after surgery. You can resume high impact exercise (ex: running, cycling, weight lifting) at 6-8 weeks after surgery.