Breast reconstruction using the DIEP flap is a modern plastic surgery procedure in which the body’s own tissue is used to reconstruct the breast. In this procedure, skin and fatty tissue are harvested from the lower abdomen without damaging the muscles. This form of reconstruction is considered particularly gentle and aesthetically pleasing.
Following a mastectomy, a new breast can be reconstructed that feels natural and remains stable over the long term. The patient also often benefits from a tummy tuck-like effect. The microsurgical technique requires a great deal of experience but offers excellent functional and cosmetic results.
The DIEP flap is therefore a proven option for breast reconstruction using the patient’s own tissue.
When is breast reconstruction necessary?
Every year, 45,000 women in Germany are diagnosed with breast cancer. Of these women, approximately 70 percent can undergo breast-conserving surgery and treatment.
However, in about 30 percent of cases, the breast must be completely removed. For many women, the removal of a breast is a significant loss, as their breasts are an important part of their self-image as women. For them, the decision to undergo breast reconstruction is also a crucial step toward a new quality of life.
Breast Reconstruction Using the Patient’s Own Tissue with the DIEP Flap Method
The goal of breast reconstruction is to achieve a permanently natural shape and soft texture of the breast. Various procedures are available for this purpose. Breast reconstruction is most successful when performed using the patient’s own tissue.
In the past, either the latissimus dorsi muscle or the rectus abdominis muscle was used for this purpose. Today, however, at specialized centers, it is no longer necessary to sacrifice a muscle. Instead, a skin and fat flap from the lower abdomen—the so-called DIEP flap (Deep Inferior Epigastric artery Perforator flap)—is used.
Who is a good candidate for DIEP flap surgery?
Cancer treatment should be completed before DIEP flap surgery (except for hormone therapy).
The DIEP flap procedure is a lengthy and technically very demanding surgery. Therefore, patients must not have any significant limitations in cardiovascular or pulmonary function. If necessary, they should undergo further specialized examinations and receive medication for these conditions prior to DIEP flap surgery.
Nicotine impairs blood circulation. Therefore, it is recommended to quit smoking at least 3 months before DIEP flap surgery. Certain medications should not be taken before surgery—after consulting with the treating physician.
Patients should inform their treating physician of any allergies and all known comorbidities and previous abdominal surgeries (e.g., liposuction).
Procedure for DIEP Flap Surgery
The DIEP flap procedure is performed under general anesthesia. The breast is reconstructed using subabdominal skin and adipose tissue while preserving the abdominal wall muscles.
Small blood vessels measuring 1 to 2 mm are responsible for the blood supply to the lower abdominal skin and fat tissue. These small blood vessels are dissected and exposed using microsurgical techniques. They also give this flap its name: DIEP flap—Deep Inferior Epigastric artery Perforator flap.
During the DIEP flap procedure, this lower abdominal skin and fat flap is completely detached from the abdominal wall. It is then used to reconstruct the breast. The surgeon connects the small blood vessels to those of the chest wall under a microscope.
The DIEP flap procedure results in a defect in the lower abdomen. This is closed by tightening the skin of the upper abdomen—as in an abdominoplasty. With this modern DIEP flap method, the abdominal muscles are no longer involved. The navel is repositioned within the tightened skin. Nipple reconstruction is performed at a later date.
Pre- and Post-operative Care for a DIEP Flap Surgery
Autologous blood donation is offered 4 and 8 weeks before surgery. Patients also begin practicing specific isometric muscle exercises at this time.
Before the procedure, the patient has a detailed consultation with the surgeon. This includes a thorough explanation of the potential surgical risks associated with the DIEP flap method.
The day before the DIEP flap surgery, necessary preoperative examinations are conducted at the clinic. This often includes an ultrasound examination of
- breast,
- chest wall, and
- abdominal wall
. During this procedure, the doctors use duplex sonography to identify the perforator vessels and mark them accordingly.
After the DIEP flap surgery, patients must remain on bed rest for 5 days. They are given medications to improve blood circulation. Even during bed rest, they should continue performing their isometric muscle exercises. The drains are removed after an average of 3 to 5 days. If the recovery proceeds normally, patients can be discharged home 10 to 14 days after the DIEP flap surgery.
The time required for complete recovery after a DIEP flap surgery depends on the individual case. Patients should take it easy physically for 8 to 12 weeks. After that, physical activity can be gradually increased.
Most skin sutures are made of absorbable suture material that is broken down by the body. Only the sutures around the navel are removed after about 2 to 3 weeks. Scar care and massage with oil-based ointments, such as panthenol, are recommended. Fresh scars should be protected from UV light.
Breast reconstruction using the DIEP flap is a technically very demanding procedure. The advantages include natural-looking results and a generally uncomplicated long-term outcome. Post-tumor follow-up can be easily performed using ultrasound or, in special cases, magnetic resonance imaging (MRI).
What complications and risks are associated with DIEP flap surgery?
The main risk associated with the DIEP flap procedure is inadequate blood flow to the DIEP flap. In this case, loss of the lower abdominal skin-fat flap is likely. This complication occurs in 1 to 2 percent of patients.
Otherwise, as with other surgeries, general surgical risks apply, such as
- wound infections,
- bleeding,
- bruising,
- injury to adjacent structures,
- scarring,
- sensory disturbances,
- lymphatic drainage disorders,
- risk of thrombosis and embolism, etc.
Revision surgery is often necessary after a DIEP flap procedure to achieve an optimal aesthetic outcome.
Conclusion
Breast reconstruction following a mastectomy using the DIEP flap procedure is a well-established method in which tissue harvested from the lower abdomen is transplanted as part of the reconstruction process using the patient’s own tissue. In this procedure, a tissue flap consisting of skin, subcutaneous fat, and blood vessels is harvested, and the artery and vein are microsurgically anastomosed to supply blood to the tissue. This form of breast reconstruction using autologous tissue preserves the abdominal muscles, maintains the natural shape of the breast, and ensures that the breast is contoured and feels natural.
Breast reconstruction using autologous tissue is particularly suitable for slender women and offers an alternative to silicone implants, as both breasts can be adjusted to be symmetrical. Plastic surgeons use ultrasound-guided techniques to plan the tissue harvest, taking potential complications into account and recommending a compression bra for postoperative care. This procedure is well-established in breast cancer treatment, as breast reconstruction offers both aesthetic and functional benefits and the breast feels natural after the procedure. In aesthetic surgery, the DIEP is considered a modern procedure that is performed with surgical precision, requires a healing period of 6 to 8 weeks, and can also be combined with a TMG flap if necessary.
FAQ
What is a DIEP flap?
The DIEP flap is a microsurgical flap procedure for breast reconstruction in which skin and fat tissue are harvested from the lower abdomen and used to reconstruct the breast.
Who is a good candidate for DIEP flap breast reconstruction?
This method is suitable for patients who have undergone a mastectomy, have sufficient lower abdominal tissue, and wish to undergo reconstruction without implants.
What are the advantages of reconstruction using the body’s own tissue?
The new breast looks natural, ages naturally with the body, and there is no risk associated with implants. Additionally, the abdominal muscles are spared.
How is the surgery performed?
During the procedure, tissue is harvested from the lower abdomen; the supplying blood vessels are connected to the breast using microsurgical techniques; and the breast is reshaped.
How long does recovery take after a DIEP flap surgery?
The initial recovery phase lasts several weeks—usually about six to eight weeks—including follow-up care and rest.
About the medical author
Asst Lect. Dr Klaus Exner
Medical Author · Senior Consultant · Frankfurt am Main
PD Dr. med. Dr. h.c. Klaus Exner – author: Explore expert medical articles in the Leading Medicine Guide.
