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DIEAP (Deep Inferior Epigastric Artery Perforator) Flap Breast Reconstruction
- The DIEAP flap procedure is the most advanced form of breast reconstruction surgery available today. It is the preferred reconstructive technique performed in our practice. The surgery uses the patient’s own abdominal tissue to reconstruct a natural, soft breast after mastectomy without sacrificing any abdominal muscle.
- The DIEAP (deep inferior epigastric perforator) flap was first described in 1991 by a Japanese microsurgeon. But, it wasn’t until 1994 when Robert Allen reported that he had applied this flap to breast reconstruction that it was demonstrated what a big advantage the DIEAP was over the TRAM flap. Dr. Allen was the first to recognize the benefits of this kind of reconstruction, and along with the Belgian surgeon Philipe Blondeel, he convinced a number of microsurgeons that the extra time, care and skill needed for this surgery was well worth the effort. Amazingly, even more than ten years later, few surgeons are performing this procedure and many do not recognize it’s merits.
- The DIEAP flap provides the necessary tissue for a breast reconstruction while sparing the loss of the rectus muscles and fascia.
- With the DIEAP, patients have less post-operative pain, less post-surgical abdominal wall weakness and a decreased chance of abdominal wall hernia formation. By preserving the abdominal muscles, potential complications and loss of strength can be reduced. Since this type of reconstruction is not offered by all plastic surgeons, many patients are under the impression that this is a very new procedure. However, DIEAP flaps have been done for many years now and have been confirmed to be an excellent option for breast reconstruction.
- The DIEAP 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.
- Sometimes all the lower abdominal tissue is needed to reconstruct one breast. Occasionally this cannot be performed as a single flap (eg due to a previous midline abdominal scar). This requires the tissue to be transplanted as 2 separate flaps which are then reconnected at the chest site using microsurgery. This technique is known as the stacked DIEAP flap procedure.
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.
- Unlike many practices, we use two microsurgeons on every DIEAP flap procedure. This not only ensure you benefit from the expertise of two specially trained surgeons, but also significantly decreases the length of the procedure and anesthesia time.
- If you are considering reconstructive breast surgery and would like to schedule a consultation with one of our breast reconstruction surgeons please contact our office today.