DIEP flap offers Breast Cancer Patients a new Option for Breast Reconstruction
Breast reconstruction is a type of surgery for women who have had one or both of their breasts removed (mastectomy). This surgery rebuilds the breast mound so that it is about the same size and shape as it was before the mastectomy. The nipple and the darker area around the nipple (areola) can also be added.
Most women who have had a mastectomy can have a breast reconstruction surgery. Although there are women who have had only the part of the breast removed around the cancer (lumpectomy) who may not need reconstruction.
Over the years there have been new choices in breast reconstruction. One of these choices is the DIEP flap procedure (deep inferior epigastric artery perforator).
What is a DIEP flap Procedure?
The deep inferior epigastric artery perforator (DIEP) flap is an evolution of the free TRAM flap. As with the free TRAM flap, tummy fat and skin are transferred to re-create the breast mound. Using fat to reconstruct the breast gives a natural feel to the new breast and, in most people there is sufficient tissue available to create a moderate to large volume breast. Removing this skin and fat from the abdomen results in a ‘tummy-tuck‘ as part of the procedure.
The deep inferior epigastric artery is the blood vessel which supplies blood to the Rectus Abdominis muscle. It also gives off side branches, which travel through or around the muscle to the overlying fat.
The DIEP flap uses these side branches or ‘perforators‘ as its blood supply with the result that the Rectus Abdominis muscle is entirely uncut during the operation. This reduces the risk of abdominal weakness compared to the free TRAM. Although the muscle is untouched during this reconstruction, the thick fibrous tissue overlying the muscle (fascia) is cut to ensure that the perforators have sufficient length and diameter to supply blood to the reconstructed breast tissue. After the abdominal fat and skin are transferred to the breast, this cut is closed with a very strong suture to minimize the risk of abdominal wall weakness.
Am I a Candidate for DIEP flap Breast Reconstruction Process?
Because perforators are used rather than the main deep inferior epigastric artery and vein, this operation is not suitable for all women. Perforators are generally smaller in diameter than the main vessel, and vary in size between different people.
If the perforators are too small, this type of reconstruction cannot proceed as the risk of flap failure due to inadequate blood supply is too great. In fact, it is often not possible to predict the size of these vessels until surgery is underway, so your surgeon may offer you a DIEP flap reconstruction with the proviso that the operation may be changed to a free TRAM flap reconstruction on the table.
Dr. Kari L. Colen, M.D. specializes in the Diep flap Breast Reconstruction Procedure
Dr. Kari believes that breast reconstruction is paramount in the treatment of a breast cancer patient. Breast cancer is a physical illness but a psychosocial one as well. Reconstruction treats the whole person physically, as well as mentally.
If you are considering DIEP flap breast reconstruction after mastectomy, we encourage you to contact Dr. Kari Colen for a consultation.