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What is DIEP flap surgery?
There are two main types of breast reconstruction. Surgeons can use a ‘flap’ of your own tissues from elsewhere on your body, known as an autologous reconstruction, or use a breast implant to recreate the volume of the missing breast.
DIEP flap surgery involves taking tissue from the abdomen with its blood supply to reconstruct the breast. Its advantages include replacing like with like tissues that have the same consistency and feel as your own breast tissue. Furthermore, the tissues will change as your body gains or loses weight. In contrast, a breast implant reconstruction may eventually need replacing as it is a foreign body.
As a patient at St John & St Elizabeth Hospital, you’ll experience exceptional care. By combining the latest microsurgical techniques with a patient-centred approach, our dedicated team provides exceptional outcomes at our state of the art facilities in north-west London. Contact the team to find out more or to book an appointment to see a breast reconstruction consultant.
Microsurgical breast reconstruction after cancer
In many cases the reconstruction can be done immediately with the mastectomy, although you may prefer to have your mastectomy first and wait for your breast reconstruction. The advantage of an immediate approach is that your own skin can preserved over the DIEP flap. The DIEP skin paddle is larger in the delayed group as the mastectomy skin flaps are not preserved.
When having DIEP flap reconstruction, microvascular surgery is used to join the blood vessels. It is a technique that uses magnification microscopes and specialised surgical instruments to reconnect the small blood vessels.
How to pay for your treatment
If you’re… paying for yourself
Did you know you don’t need private medical insurance to come to St John & St Elizabeth Hospital? As a self-pay patient, you can access safe, outstanding quality health care at times to suit you.
For scans and tests, as well as to see most consultants, you’ll still need to be referred by a medical professional like your GP, but as a self-pay patient, the process is more straightforward. You won’t need authorisation from an insurance provider, and you’ll have greater choice of consultant and appointment times.
If you’re… insured
St John & St Elizabeth Hospital is approved by all major medical insurance companies. If you have a personal private health insurance policy, or your company provide it for you, you can use it to pay for your care from your initial consultation through to treatment, surgery and aftercare such as physiotherapy.
Not all private health insurance plans cover the same things. It’s very important to check exactly what you are covered for with your insurance provider.
Frequently asked questions about DIEP flap surgery
There are two main types of breast reconstruction that patients can have:
- A breast implant to recreate the volume of the missing breast
- A flap surgery where tissue is taken from elsewhere in the body (with its blood supply) to reconstruct the breast
With a DIEP flap surgery, the tissue is taken from your abdomen and used to reconstruct the breast. Its advantages include replacing like with like tissues that have the same consistency and feel as your own breast tissue. Furthermore, the tissues will change as your body gains or loses weight. In contrast, a breast implant reconstruction may eventually need replacing as it is a foreign body.
This procedure usually involves two surgeons. A breast surgeon will remove your breast – a mastectomy – and a plastic surgeon will take excess tissue from your abdomen, preserving the muscle, to make the flap to reconstruct your new breast. In some cases, the blood supply from both sides of the abdomen can also be taken to make the flap, called a Bipedicled DIEP.
This enables the use of the entire abdomen to reconstruct the breast, however usually just half or a portion of the abdomen is needed in most cases.
Following the removal of the flap, the abdomen is closed leaving a scar that extends from hip to hip but will be covered by underwear. If the DIEP flap muscle has not been taken with the blood supply, a mesh may be needed to support the abdominal wall. The mesh will support the abdominal wall’s integrity and reduce the risk of Hernia.
Blood vessels in the chest, which transport blood throughout your body, are connected to the blood vessels from the DIEP flap using small stitches under a microscope. Often a small portion of your rib, about 2-3cm, needs to be removed to access these internal mammary vessels in the chest.
Your in-patient stay can be up to five days but in many cases you may be well enough to go home after three days.
On the first night after your operation, the DIEP flap breast reconstruction is checked frequently. This can often be the most sleepless and difficult night. After 48 hours, these checks are less frequent.
On the second day, most patients will have their urinary catheters removed. This is a tube used to empty the bladder into a bag. You are also likely to be sitting up out of bed and able to walk around the ward. Small plastic tubes placed underneath the skin of the abdomen where the surgery was performed, called pain catheters, are used to relieve pain and are usually kept in for 48 hours.
DIEP breast reconstruction is the biggest operation you will undergo in the journey to rebuild your breast after cancer. Depending on what you want in terms of size, we often try to match the new breast with the existing one. This sometimes is not possible and smaller secondary procedures are needed. Patients will often need a second operation to reduce and lift the existing breast, called a breast reduction or mastopexy. If there are any irregularities in the shape of the reconstructed breast, these can also be addressed in smaller operations.
There is a 1% risk of total failure of the reconstruction; this is usually due to a blockage in the blood vessels that are connected to the chest. This risk is increased in patients with a high BMI weight. There are also risks of infection, wound breakdown at the breast and abdomen and poor scarring. Some patients will need to go back to theatre in the acute period for any of these risks and also if there is compromise to the blood supply of the DIEP flap. In rare cases you may get an abdominal bulge called a hernia due to a weakness in the abdominal wall. If troublesome it may require surgery.
Nipple reconstruction can be performed as the final stage of the breast reconstruction journey after your DIEP flap surgery. A new nipple can be made from local tissues over the DIEP flap under a local anesthetic. Once the new nipple has healed the areola, the small circular area around the nipple, can be tattooed to match the existing breast. If the colour fades, this procedure can be repeated.
A well fitted sports bra is recommended to support the reconstructed breast. We also recommend well fitted pants to support the abdomen which will be bruised and somewhat tender in the first couple of weeks after surgery.
Medically reviewed by Mr Dariush Nikkhah - BM MSc FRCS (Plast) on 22/11/2024