| DIEP Flap Breast Reconstruction |
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One of the most exciting new advances in breast reconstruction following a mastectomy is the use of DIEP (Deep Inferior Epigastric Perforator) Flaps (or the SIEA which is a variation of the DIEP).
This procedure, which is a type of perforator flap, allows patients the advantages of using their own tissues, as with the traditional TRAM Flap, while reducing the risks of abdominal hernias and abdominal weakness. In addition, most patients find the procedure to result in far less discomfort postoperatively and a faster recuperation time.
Not every patient is a candidate for a DIEP / SIEA flap, and each patient should consider all the available options before making a decision about reconstruction. Dr. Chevray is proud to offer his patients all the currently available options for breast reconstruction, which allows him to work with each patient to meet their individual preferences and needs. |
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| DIEP Flap Description |
 A DIEP flap is a microsurgical technique that many feel represents an improvement over the TRAM flap. When a DIEP flap is harvested, the skin and underlying fatty tissues from the abdomen are removed, but the muscle and abdominal wall fascia are preserved and left in place.
In a DIEP flap, what the surgeon does instead is to microsurgically dissect out the major blood vessels (called perforator vessels). This illustration represents the blood vessels being dissected from the surrounding muscle which leaves the muscle intact. These vessels that run through the muscle are called perforator vessels.
DIEP Flap Advantages
Because this approach leaves the muscle wall and its overlying fascia intact, there is much less risk of abdominal wall weakness and hernia. In addition, patients clearly have less discomfort following DIEP surgery as compared to a free TRAM flap. Because of the reduced pain and fact that the muscle wall remains intact, patients are often able to get back to their normal daily routines more quickly than after a TRAM flap reconstruction. Patients undergoing a DIEP flap have essentially the same scar as those undergoing a TRAM flap, so their abdominal wall is nicely recontoured. |
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| DIEP Flap Contraindications |
As with any surgical procedure, there are disadvantages to a DIEP flap. Because it is a more complex procedure, the DIEP flap takes longer so the patient's anesthetic is also longer. If a patient has previously had abdominal surgery, or if the patient does not have enough extra skin and underlying fatty tissues in the abdomen, the patient may not be a candidate for this type of procedure. Also, because of the complexity of this procedure, there are only a handful of surgeons in the country who are experienced at performing a DIEP flap.
Determining whether a patient is a candidate for a DIEP is something the doctor must do on a case-by-case basis. However, because this is a lengthy surgery there are some conditions which may possibly prevent a patient from being a candidate for a DIEP. These contraindications are things like: |
- Significant cardiac or pulmonary diseases/conditions - may preclude a lengthy anesthetic
- Morbid obesity - affects wound healing after surgery and may preclude a lengthy anesthetic
- Age - as patients get older other health conditions are more likely to preclude a lengthy surgery or anesthetic
- Smoking - affects wound healing after surgery
- Previous abdominoplasty ("tummy tuck") - DIEP / SIEA cannot be done if there has been a previous abdominoplasty
- Liposuction - if a patient has previously had abdominal liposuction it may preclude having a DIEP / SIEA
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As a general rule, most patients who qualify for a TRAM flap will probably qualify for a DIEP flap, with some exceptions due to the increased length of surgery. Previous c-sections, hysterectomies, and appendectomies do not normally interfere with a patient qualifying for a DIEP flap. |
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We encourage you to visit the rest of our site to learn more about Dr. Pierre Chevray, plastic surgery procedures, breast reconstruction, cosmetic surgery, reconstructive microsurgery and more. Contact us today to schedule a one-on-one consultation with Dr. Chevray or to ask us questions about cosmetic or reconstructive plastic surgery at 713-441-0714. |
