Speak About It! | DIEP flap breast reconstruction: What is it and how to find a DIEP flap surgeon | Breast, Reconstruction, Diep, Flap, Surgery

DIEP flap breast reconstruction: What is it and how to find a DIEP flap surgeon

Written by Minas Chrysopoulo, MD

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Every woman has a right to breast reconstruction. Breast reconstruction is not a form of cosmetic surgery. Breast reconstruction restores something that nature has provided but breast cancer has taken away. Almost any woman who loses her breast to breast cancer can have it rebuilt through reconstructive plastic surgery. The DIEP flap procedure is rapidly becoming the latest gold standard in breast reconstruction surgery after mastectomy. What are the reasons for all the hype and how do you find a top DIEP flap surgeon?

If you are a woman facing mastectomy you have a decision to make: do you want breast reconstruction? If the answer is "yes", plastic surgery holds the key. Although reconstruction cannot replace the breast(s) you were born with or allow you to breastfeed, it can restore your natural silhouette and make you feel "whole" again following mastectomy.

Depending on your health, breast reconstruction can be performed immediately after your mastectomy surgery so you can wake up with new breasts already in place. While the cosmetic results with immediate reconstruction are generally superior, breast reconstruction can also be performed at a later time once the cancer treatment has been completed.

DIEP flap breast reconstruction (often pronounced "DEEP" flap) is today's gold standard in reconstructive breast surgery. Advances in breast reconstruction have made it possible to use excess skin and fat from the abdomen (rather like the tissue removed during a tummy tuck) to construct a new breast without the need for implants or the sacrifice of abdominal muscle. The DIEP (Deep Inferior Epigastric Perforator) flap is a sophisticated modification of an existing procedure known as the TRAM (Transverse Rectus Abdominus Myocutaneous) flap.

TRAM flap breast reconstruction is a common breast reconstructive technique that requires the rectus abdominus (sit-up) muscle to be sacrificed and relocated to the upper abdomen. Unfortunately, this technique can be associated with significant post-operative pain, prolonged recovery, loss of abdominal muscle strength (up to 20%), abdominal bulging (or "pooching"), and even abdominal hernia.

DIEP flap surgery is similar to TRAM flap surgery but spares the rectus abdominus muscle. Skin and fat ONLY are removed from the abdomen, transplanted to the chest and connected using microsurgery to create the new breast. NO muscle is sacrificed. As the sit-up muscle is left behind in its natural place many of the above complications are avoided and the patient essentially receives a tummy tuck at the same time as the breast reconstruction. There also tends to be far less pain following the DIEP procedure, and a quicker recovery time.

Knowing the significant advantages of the DIEP flap it is easy to understand the reason for all the hype, especially for active individuals who do not want to sacrifice the strength of their abdomen. A breast that has been reconstructed with fat and skin will also look and feel more natural than an implant reconstruction and will last longer. Unlike an implant, the reconstructed breast also ages like a natural breast.

As with all types of breast reconstruction however, 2 or 3 procedures performed a few months apart are often required to complete the reconstruction process and to obtain the best cosmetic result.

Unfortunately, due to the complexity of the DIEP procedure very few centers in the US perform DIEP flap surgery so many patients will have to travel for the procedure. The good news is that many of these DIEP flap centers will accommodate out-of-state and even international patients.

To learn if a breast center or plastic surgeon near you offers DIEP flap breast reconstruction, please check the following websites: www.diepbreastreconstruction.org/diepdocs1.htm , www.breastrecon.com/id10.html , and www.diepsisters.com/diepdoctors.html.

The lists on these websites seem fairly thorough but there are plastic surgeons out there who perform DIEP breast reconstruction that have not made the lists (for whatever reason). Having said that, currently there are only about 40 plastic surgeons in the US that routinely perform the DIEP flap procedure. Before choosing a plastic surgeon ensure that he/she is certified by the American Board of Plastic Surgery and has extensive experience with the DIEP flap procedure. Ask about the success rate of the procedure in their hands (most DIEP flap specialists boast a flap survival rate of 97% to 99%+) and how many DIEP flaps they have performed.

Insurance companies are federally mandated to pay for the cost of breast reconstruction. Unfortunately, some patients will still face difficulties in gaining access to a DIEP flap surgeon and the procedure. Here again it pays to seek out plastic surgeons who specialize in the DIEP procedure as typically insurance specialists are available to help patients with insurance issues.

Learn more about breast reconstruction options after mastectomy including the DIEP flap procedure here.

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Minas T Chrysopoulo, MD. Plastic, Reconstructive and Microsurgical Associates (PRMA). 9635 Huebner Road San Antonio, TX 78240. Tel: (210) 692-1181, Toll Free: (800) 692-5565. Please visit Dr Chrysopoulo's Breast Cancer Reconstruction Blog for the latest news in breast reconstruction surgery after mastectomy.