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DIEP Flap Reconstruction Austin

Perforator flaps represent the state of the art in breast reconstruction. Replacing the skin and soft tissue removed at mastectomy with soft, warm, living tissue is accomplished by borrowing skin and fatty tissue from the abdomen.

A slim incision along the bikini line is made much like that used for a tummy tuck. The necessary skin, soft tissue, and tiny feeding blood vessels are removed. These tiny blood vessels are matched to supplying vessels at the mastectomy site and reattached under a microscope.

Unlike conventional TRAM flap reconstructions, use of our refined perforator flap techniques allow for collection of this tissue without sacrifice of underlying abdominal muscles. This tissue is then surgically transformed into a new breast mound. The abdomen is the most common donor site, since excess fat and skin are usually found in this area. In addition to reconstructing the breast the contour of the abdomen is often improved much like a tummy tuck.

Restoration of the nipple and areola follow. Scars fade substantially with time. For many women the reconstructed breast may be firmer and have a more youthful appearance than their natural breasts.

DIEP flap breast reconstruction results in the creation of a “natural” breast without muscle removal. One in nine women develops breast cancer with some requiring mastectomy for treatment. Psychological and emotional benefits associated with breast reconstruction are huge.

Implant reconstruction superficially appears simple, however, the body’s reactions to an implant and consequences thereof frequently require further surgery. Additionally, the safety of breast implants is controversial.

Click here for before & after photos

With the Deep Inferior Epigastric Perforator no muscle is removed. The perforating vessels with the overlying flesh are removed and the muscle is left in place. Patients recover quickly with usually only a three-day hospital stay. The abdominal scar is placed low on the abdomen because no muscle is removed. The perforator blood vessel dissection increases operating time but the body tolerates superficial surgery well.

There are very few surgeons who are capable of performing this reconstruction and Dr. Snyder is proud to be one of the pioneers in this new technique.

FREQUENTLY ASKED QUESTIONS ABOUT DIEP FLAP RECONSTRUCTION

What is DIEP flap breast reconstruction?

DIEP flap breast reconstruction surgery is a procedure that involves taking skin and fat from the abdomen, along with the corresponding blood vessels, and transplanting this tissue to create breasts. This procedure is for women who have lost their breasts due to mastectomy or other reasons.

Why is it called a free flap?

It is considered a free flap procedure because the abdominal tissue is freely separated from the body, reconnected to the body by establishing a new blood supply and then fashioned into new breasts.

Does this procedure require the removal of my abdominal muscle?

DIEP flap reconstruction is unique because it does not use any muscle. The rectus abdominus remains intact which allows for patients to still use full strength of the muscle.

Are there specific tests required prior to procedure?

At the time of your pre-op appointment you will be sent with orders for a CTA (“CAT Scan”) of the abdomen. A CTA is an image that is sued to view suitable blood vessels in preparation for procedure. The image will help map out the blood supply from the abdominal wall. Not all of the blood supply will be removed from the rectus abdominus (six pack muscle). An appointment will need to be made in advance to schedule the study.

Why does blood supply need to be dissected?

The new breast will need blood supply to survive. The blood supply to this skin is within the muscle beneath. A portion of this blood supply is removed from or dissected from the abdominal muscles. The blood vessels used are connected to the vessels at the mastectomy site. The small blood vessels are carefully reattached under a microscope.

Where is the incision site for the removal of a flap?

The incision is usually along the bikini line. The incision site is similar to a tummy tuck (abdominoplasty) allowing for the abdomen to be contoured. The incision is usually hidden under normal clothing. The length of the incision is from hip to hip along the lower abdomen.

How long is the procedure?

A mastectomy is usually performed prior to reconstruction during the initial procedure. The overall procedure may last between 10-12 hours. Unilateral DIEP breast reconstruction ranges from 4-7 hours in length. Bilateral DIEP breast reconstruction ranges from 5-10 hours in length. Your family will be given a report on the progress periodically.

I have a port in place. Can it be used?

Patients with a port implants for chemotherapy may be used during surgery.

Will I be admitted into the hospital?

Admission into the hospital following reconstruction is appropriate and necessary. Expect to be admitted into ICU for a total of 4 days following the procedure. The reason for being admitted into ICU is not because you are ill but because it is the only unit capable of checking the breast flaps hourly. On a regular floor at the hospital the staff is not given the opportunity to give the demanding care that is needed. Checking the flaps hourly allows us to monitor the progress and survival of the flaps. Special equipment is used to ensure the flap is allowing blood supply to flow freely throughout.

Before you are discharged you will need to perform activities such as sitting up, walking and eating. Usually, you will be sent home directly from the ICU the day of your discharge (day 4).

Is it necessary to have radiation treatment prior to reconstruction?

Radiated skin is usually tighter and darker than non radiated skin. The discoloration and tightness are due to radiation treatments. The results of breast reconstruction is more successful if all treatments are completed prior to the reconstruction.

What will happen to my belly button?

Abdominal skin will be excised from the low part of your abdomen, making it necessary to relocate the belly button. There are scars but they are generally hide well within the belly button.

Will I have a nipple?

After DIEP breast reconstruction you will not have a nipple. Approximately 2 months following breast reconstruction you will be a candidate for nipple reconstruction. Nipple reconstruction is commonly an office procedure. Patients are measured for symmetry and a small portion of skin from your new breasts is used to create a nipple. Sutures in place will be removed in 2 weeks.

What prescriptions are given to control pain?

You will be given pain medication through your IV after surgery. During your hospital stay, you will be switched to pain medication given by mouth. There are many options we can use for pain control. This will be discussed in further detail if desired. It is important to inform the physician if you have any drug allergies.

Will I need to discontinue the use of Tamoxifen?

In preparation for surgery it is important to stop all hormone treatments. Tamoxifen has a common side effect that causes blood clotting. To reassure the procedure is successful please discontinue the use of Tamoxifen 1 month if possible and at least 1 week prior to procedure Discontinuing the use of Tamoxifen will not effect any treatments from cancer. After your month off you may take as directed by the prescribing doctor.

Will I have drains?

Drains are placed during the surgery to avoid fluid accumulation underneath skin and tissue. Drains will be located on each side of the abdominal incision site an additional drain under each axilla (armpit_ of the reconstructed breast. It is important to record the amount of drainage that is released into the bulb every 12 hours The amount of drainage is important because it helps determine when the drains are ready for removal.

The drainage will be dark red in color at first. As you start to heal the drainage may be a lighter red then eventually turn yellow or brown in color. Drains are usually ready for removal after they produce less than 30cc in a 24 hour period. An estimated time for drains to stay in place is 1-3 weeks.

What is the recovery period?

Recovery periods vary for each patient. Typically, you are sore and tire easily for the first 1-2 weeks after surgery. After two weeks, you will notice an increase in energy levels each day. Generally, heavy lifting or strenuous activity should be avoided for at least 4-6 weeks after the procedure. You will need to consult the physician for clearance to begin exercising, traveling, etc..

It is important to surround yourself in a non-smoking environment. Not being exposed to smoke will allow you to heal appropriately. It is important that you are a non-smoker in regards to healing. You will not be a candidate for procedure if you use tobacco in any form including patches, pills and gums.

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