Breast Reconstruction

Breast Reconstruction: Microsurgery

DIEP (Deep Inferior Epigastric Perforator) Flap Breast Reconstruction

The DIEP flap procedure is one of the most advanced form of breast reconstruction surgery available today. It uses the patient's own abdominal tissue to reconstruct a natural, soft breast after mastectomy without sacrificing any abdominal muscle. Most practioners who perform all types of breast reconstruction believe that in the right patient this provides the best long-term natural looking breast.

The DIEP flap is similar to the muscle-sparing free TRAM flap except that all the abdominal muscle is preserved. Only abdominal skin and fat are removed. The blood vessels ("perforators") required to keep the skin and fat alive lie just beneath or within the abdominal muscle. A small incision is made in the abdominal muscle to access these vessels.

After the skin, tissues and perforators (collectively known as the "flap") have been dissected, the tissue is transplanted and connected to the patient's chest using microsurgery. The surgeons then shape the tissue to create the new breast. As all abdominal muscle is preserved patients experience less pain after the surgery, enjoy a faster recovery and maintain their abdominal strength long-term with decreased incidence of abdominal hernia.

Many women who undergo this operation enjoy the added benefit of a flatter abdomen with results that mimic a “tummy tuck” procedure. The risk of abdominal complications such as bulging and hernia is also very small, much smaller than with the TRAM method of breast reconstruction.

The DIEP flap is one of the most common method of breast reconstruction performed by Dr. Williams. There are many doctors in the United States performing reconstructive breast surgery, however only about 100 US plastic surgeons routinely perform the DIEP procedure due to the technical difficulty of the surgery.

It is important to recognize that secondary to the complexity of these surgeries not everyone will be a candidate. Previous abdominal surgery, a history of smoking, other medical issues and many other factors can make other breast reconstruction options more appropriate. Dr. Williams will take the time to discuss each patient's options in detail.