At Breast and Body Center of Austin, our perforator breast flap reconstructions represent some of the most state-of-the-art techniques in breast reconstruction today. Our board-certified Plastic and Reconstructive Surgeon Dr. Ned Snyder IV can replace the skin and soft tissue removed at mastectomy with soft, warm, living tissue. This is accomplished by borrowing skin and fatty tissue from another part of the body. One such flap is a DIEP (deep inferior epigastric perforator) flap. 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. An 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 and matched to supplying vessels at the mastectomy site and reattached under a microscope.
Perforator flaps should only be performed by plastic surgeons who are specifically trained in microsurgery. There are very few surgeons who are capable of performing this type of reconstruction. Dr. Snyder at the Breast and Body Center of Austin is a pioneer in this technique; he has completed fellowships in microvascular surgery and has performed hundreds of perforator breast flap reconstructions. He knows that the psychological and emotional benefits associated with breast reconstruction are tremendous. Our doctor would like to offer you a private, compassionate consultation at one of their locations in Austin, TX. Please call and schedule your appointment today.
After your initial DIEP breast reconstruction surgery, you will typically not have a nipple. After healing from your original breast reconstruction, you will be a candidate for nipple reconstruction. Nipple reconstruction may be performed as an in-office procedure. You will be measured for symmetry and a small portion of skin from your new breasts is used to create a nipple. Some patients opt to undergo 3D nipple areola tattooing. These tattoos give the illusion of a nipple but have no actual projection. The tattooing is also offered as a procedure in our office and is typically covered by insurance. Your surgical scars fade substantially with time and proper care.
The usual length of a unilateral DIEP breast reconstruction ranges from 2 – 3 hours. Bilateral DIEP breast reconstruction ranges from 4 – 6 hours in length. Additional time is needed when combined with the mastectomy. Your family will be given periodic progress reports during your surgery. 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 and can usually be hidden under normal clothing. The length of the incision is from hip-to-hip along the lower abdomen. DIEP flap reconstruction is unique because it does not use any muscle. The rectus abdominus remains intact which allows patients full strength of the muscle.
Admission into the hospital for reconstruction is appropriate and necessary. Expect to be admitted into IMC (Intermediate Care Unit) or ICU (Intensive Care Unit) for a total of 3 – 5 days following the procedure. The reason for being admitted into IMC/ICU is because they are the only units 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. Small sensors on your breasts connected to a bedside console and are used to continuously ensure the flap has adequate blood flow.
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 and at least one additional drain is placed at each breast. Before you are discharged you will need to perform activities such as sitting up, walking, eating, and moving your bowels. After discharge, it is important to record the amount of drainage that is emptied from the bulb. 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. Please see our handout on "Taking Care of Your Drains" for further information on drain care.
Recovery periods vary for each patient. Typically, you are sore and tire easily for the first few weeks after surgery. After 2 weeks, you will notice an increase in energy levels each day. Generally, heavy lifting and strenuous activity should be avoided for at least 4 – 6 weeks after the procedure. You will need to consult your physician for clearance to begin exercising, traveling, etc.
Plan Your Procedure
- Recovery Time
- 4 – 6 Weeks
- Average Procedure Time
- 4 – 6 Hours
- Post-op Follow-up
- 7 Days
- Procedure Recovery Location
DIEP FLAP FAQs
What Kind of Tests are needed?
At the time of your pre-op appointment you will be sent with orders for a CAT or CTA scan of the abdomen. A CTA is an image that is used to view suitable blood vessels in preparation for the procedure. The images will help map out the blood supply to the abdominal wall and to decide which of the blood supply will be used. A radiology appointment will need to be made in advance to schedule the study.
My blood will 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 the abdominal muscles. The abdominal blood vessels used are connected to vessels at the mastectomy site. The small blood vessels are carefully reattached under a microscope.
Will I Lose My Belly Button?
You will actually keep your own belly button. Since abdominal skin will be excised from the low part of your abdomen, making it unnecessary to relocate the belly button.
How long is the procedure?
Usual length of a Unilateral DIEP breast reconstruction ranges from 2-3 hours in length. Bilateral DIEP breast reconstructions range from 4-6 hours in length. Additional time is needed when combined with the mastectomy. Your family will be given a report on the progress periodically.
What is the recovery period?
Recovery periods vary for each patient. Typically, you are sore and tire easily for the first few 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..