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Tel: 01245 463439

Fax: 01245 461569

Email: plasticsurgery@ramakrishnan.co.uk

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For more information please feel free to contact Mr Ramakrishnan's office:

Tel: 01245 463439

Fax: 01245 461569

Email: plasticsurgery@ramakrishnan.co.uk

or fill in the form on the right

Call Us: 01245 463439
Request a call back
Enquire Now

Providing expert care
in Reconstructive and
Cosmetic Surgery

Delayed DIEP Flap Reconstruction

DIEP flap (using abdominal tissue)

Delayed Reconstruction

Using Abdominal Fat and Skin
(DIEP Flap Reconstruction- Deep Inferior Epigastric Perforator)

The DIEP flap is regarded as the gold standard procedure for breast reconstruction. This method of reconstruction when used for a delayed reconstruction that is some time after the mastectomy uses skin and fatty tissue from the abdomen to restore the breast. The abdominal skin becomes the breast skin. The abdominal tissue used to rebuild the breast is reattached via blood vessels using microsurgery. The result in the abdomen is similar to that of a tummy tuck meaning that the abdominal contour is usually improved as well. One huge advantage of the DIEP procedure is that it does not affect the muscles of the abdomen.

Several days before the operation the patient will have an anaesthetic assessment to establish that they are fit for the lengthy procedure. This will take into account the patients medical history and their general health.

A CT scan is always carried out prior to surgery. This is used to visualise and assess the flow patterns of arteries and veins and provides information about the best place to the take the tissue from before the operation begins.

There are ‘pros’ and ‘cons’ to this surgery. To help give you an overview the main ones are listed below.

Pros

  • Uses your own tissue (fat) which means that your new breast will usually closely resemble the normal breast in texture and movement and in shape and ‘fall’.
  • The reconstructed breast will change with the opposite breast If you put on weight the breast will increase in size and similarly a loss of weight will mean the breast will reduce – it will alter and age as you alter and age in shape and size as it is living tissue.
  • This form of reconstruction usually improves over time.
  • Can leave the patient with a flatter tummy.
  • Abdominal muscle is left intact, only fatty tissue is taken from donor site
  • One main operation.

Cons

  • It is an operation, usually 5-6 hours of surgery and a 6-7 night hospital stay.
  • The flap is monitored every hour for the first three days in a High Dependency Unit (HDU). There is a small risk of failure of the flap at this stage and this could result in emergency surgery.
  • 2 month recovery period.
  • There will be an abdominal scar similar to that following a ‘tummy tuck’
  • The failure rate is increased by factors such as obesity, smoking, diabetes, radiotherapy and other medical conditions.
  • The skin on the reconstructed breast is abdominal skin so will still have any defects originally there i.e. stretch marks
  • Secondary operation for nipple reconstruction, and in some cases re-sculpturing of the breast with liposuction or auto fat injections to gain symmetry between the breasts.

Facts at a glance

Surgery time 5-6 Hours
Hospital stay 6-7 Days
Anaesthetic assessment Yes, you will meet the anesthetist prior to surgery
Bladder Catheter Yes
Confined to bed 2 Days
Up and walking 3rd or 4th day
Reasonably mobile 1 week
Full recovery 6 – 8 weeks
Time off work 6 weeks
Bras and garments Abdominal binder and bra worn for 2 weeks
Possible reconstruction issues Failure rate of less than 0.5% i.e. 1 in 200
Long term issues Very few
Secondary surgery Nipple reconstruction. Possible liposuction and/or auto fat injections. Possible surgery to opposite side to achieve symmetry

Images

Case 1

DELAYED DIEP FLAP BILATERAL BREAST RECONSTRUCTION with NIPPLE RECONSTRUCTION and NIPPLE TATTOOING

Case 2

DELAYED DIEP FLAP LEFT BREAST RECONSTRUCTION and NIPPLE RECONSTRUCTION