Breast Reconstruction - DIEP Flap

Deep Inferior Epigastric Perforator (DIEP) flap is a modification of the classic TRAM flap. DIEP flap utilizes the skin and fatty tissue from the lower abdomen to recreate a new breast mound. The blood vessels responsible for perfusion of this tissue are freed from within the rectus muscle (the six-pack muscle) in front of the abdomen without sacrificing the muscle. These vessels are reconnected to recipient vessels on the chest to re-establish blood supply to the tissue. Microsurgical techniques are used to reconnect the vessels. The donor site on the abdomen is closed similar to a tummy tuck procedure. Dr. Soltanian routinely performs DIEP flap reconstructions. He was the first surgeon in the region to perform this procedure (Media).

Ideal Candidates:

Ideal candidate should not have any severe medical conditions such cardiac disease, pulmonary disease, or clotting abnormalities. The ideal patient has moderate degree of lower abdominal skin and fat laxity to allow for harvest of adequate volume of tissue for breast reconstruction. Patients who have had previous abdominal surgeries including tummy tuck and liposuction may not be a candidate for this type of reconstruction. Please review your previous surgeries with Dr. Soltanian during your consultation.

Preoperative visit:

During the first visit, pertinent data regarding the cancer history, cancer treatments, past medical and surgical history are collected. After the physical examination, Dr. Soltanian will provide you with an overview of breast reconstruction options for your particular case. He will review anatomic illustrations, before and after pictures with you. It is not uncommon to have more than one consultation before finalizing the decision for the DIEP flap procedure. We encourage the patients to review the information at home and record their questions for the second preoperative visit. Quite often it is helpful to discuss the issues and concerns with close family members and friends. Upon request, our previous patients are available to share their experience with you.

Operative Procedure:

An elliptic portion of the abdominal skin and fatty tissue is separated from the muscle layer and harvested along with the vessels. This tissue is transferred to the chest and reconnected to the blood circulation.

A small drain (plastic tubing) is placed in the breast area. Two small drains are used for the abdominal area. A pain pump is used to help control the pain in the abdominal area. It administers a continuous flow of a local anesthetic medication to reduce the need for narcotic pain killers.

Recovery:

After the surgery, the flow of the blood into the tissue will be monitored closely for 2-3 days. Patients will leave the hospital after 3-4 days. The drains are removed within 7-10 days after discharge from the hospital. Patients who undergo a DIEP flap reconstruction generally have a lesser degree of abdominal discomfort and muscle pain due to less traumatic nature of the procedure. The level of activity is gradually increased over the following 4-6 weeks. Patients should avoid heavy lifting for 6-8 weeks after surgery. An abdominal binder or other compression garment is used over the abdomen to help with the healing process.

Results:

The swelling in the reconstructed breast will gradually subside. This may take up to 3 months. We allow for complete healing of the reconstructed breast prior to any “touch-up” or nipple and areola reconstruction. It may take up to 4 months for the tissue to regain its natural consistency and feel. Additional procedures will be scheduled accordingly (Pictures).

All the required procedures are covered by the health insurances, including matching procedures on the uninvolved breast (''Women's Health and Cancer Rights Act of 1998''). We participate in many insurance plans. Our office staff will help you with the forms and correspondence with your insurance. We will keep your out of pocket expenses to a minimum. For travel and other support information visit our Patient Support page.