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
|The following is an article published in Hartford Courant
about one of Dr. Soltanian's Patients.
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.
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.
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
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
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
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
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