Plastic Surgery

What is DIEP flap surgery?

DIEP (deep inferior epigastric perforators) flap surgery is a cutting-edge breast reconstruction procedure that uses a flap of complete tissue - blood vessels (perforators), skin and fat - from a woman’s lower abdomen as donor tissue. The flap is then transferred to the chest, where the surgeon, aided by a microscope, will attach the donor tissue blood vessels to the chest blood vessels and reconstruct the breast. This delicate procedure provides significant benefits, such as a slimmer appearance, a natural-looking breast, maintained core strength and a quick recovery.

DIEP flap breast reconstruction surgery is relatively new to the world of plastic surgery, and few health care facilities have the expertise necessary to perform the surgery safely. Yet due to its significant benefits, DIEP is quickly becoming known as the state-of-the-art choice for breast cancer patients. That’s why Brigham and Women’s Hospital (BWH), as one of the select few hospitals nationwide that offers DIEP flap surgery, is committed to educating patients about the procedure and offering its benefits to more and more women.

What are the advantages of DIEP flap surgery?

A DIEP flap procedure is similar to the traditional TRAM (transverse rectus abdominus muscle) flap procedure. The TRAM procedure is preferable in some cases, but for other patients, there are unique advantages to choosing the DIEP procedure.

Both procedures harvest abdominal tissue, thereby giving the patient the benefit of a slimmer appearance. However, there is a difference in how each procedure treats the rectus abdominus (“six pack”) muscle when removing the abdominal tissue. The DIEP procedure keeps the muscle in place on the abdomen so that it may continue to perform its intended functions. By maintaining the viability of the abdominal muscle, the DIEP procedure helps to preserve abdominal strength, lessen the likelihood of a hernia and shorten recovery time.

After the DIEP flap has been taken from the abdomen, the dissected blood vessels from the belly tissue are then connected to the patient's chest blood vessels. Studies have shown that this aspect of the DIEP procedure, which requires a long period of delicate microsurgery, can lead to a better blood supply for the transplanted tissue, and thus, less fat necrosis (tissue damage). In the TRAM procedure, the harvested flap’s blood vessels are not severed, thereby maintaining the tissue’s connection to the original (belly tissue) blood supply.  

Once the vessels have been attached, the surgeon works on shaping the breast. By only using the body’s own tissue, a very natural shape can be attained. Visit our patient before-and-after photos page to see the results of DIEP flap surgery at BWH.

Summary of benefits:

• minimizes loss of muscle function
• minimizes risk of abdominal hernia
• less post-operative pain
• quicker recovery
• flatter abdomen
• natural appearance

Are there any risks associated with DIEP flap surgery?

Fortunately, there are minimal risks affiliated with DIEP flap surgery, such as:

• Slight risk of flap failure – but only about 2-3% with experienced micro-surgeons (This is why patients should make sure that their DIEP flap surgeon is fellowship trained and performs these procedures regularly.)
• 1% chance of abdominal hernia

Is there anything to prevent me from being a DIEP flap patient?

Although most women qualify as DIEP flap patients, there are several factors that can disqualify you, such as:

• heavy smoking history or active smokers unwilling to quit
• significant cardiopulmonary disease
• history of blood clots
• previous surgery that has damaged deep inferior epigastric vessels
• allergy to anticoagulants, such as heparin or aspirin

• not healthy enough to undergo an 8- to 10-hour operation

The following factors do not disqualify a patient, but can adversely impact the surgery’s success:

• diabetes
• autoimmune disease
• low body fat
• prior chest wall radiation – Wait until 4 – 6 months after radiation treatment.
• prior procedures (scars) performed in donor area (stomach)
• smoking – You must abstain for four weeks before and four weeks after surgery.

Are you interested in DIEP flap surgery?

Dr. Stephanie A. Caterson, a board certified plastic surgeon who specializes in breast reconstruction microsurgery, heads the DIEP flap program at Brigham and Women’s Hospital. If you’re interested in setting up an appointment with Dr. Caterson’s team, please contact her office at 617.983.4537, BWH Teleservices at 1-800-BWH-9999, or fill out an online request form.