Deciding upon which type of reconstruction surgery to have after losing part of your breast (or all of it) to breast cancer is often very difficult, so I decided to devote all of my blog posts this week to a discussion of the various types of reconstruction surgery that are available, together with a little feedback from women who have undergone each type of surgery.
The DIEP Flap
DIEP stands for “deep inferior epigastric perforator” which means that your surgeon will utilize lower abdominal skin and fat for the breast mound and does not remove any of the rectus abdominis muscle such as occurs with the TRAM flap. Instead, blood supply is provided through the perforator vessels that are separated out from the rectus abdominus muscle, using a muscle incision alone. Your surgeon decides in the operating room how many perforators are needed to provide sufficient blood supply for the DIEP flap to survive.
Once the DIEP flap is raised, a microscope is utilized to transplant the tissue to a set of blood vessels on the chest wall. The tissue is used to create a breast shape without having to be tunneled under the skin (as in the pedicled TRAM flap). In order to avoid using any muscle, it does take longer to harvest a DIEP flap than a TRAM flap. However, this results in the advantage of minimizing injury to the abdominal wall muscle, resulting in less pain, and a lower risk of hernia formation as compared with TRAM flaps.
This type of surgery requires a higher skill level from your surgeon – this is microsurgery and much more difficult to perform. The success rate in transferring tissue in this manner is very high in the hands of surgeons who perform microsurgery regularly. It is recommended that you inquire as to your surgeon’s expertise with this type of surgery, as well as to ask about the hospital where it will be performed because they will also need the necessary experience monitoring these kinds of flaps.
The DIEP flap can be used for reconstructing one or both breasts. You will have a horizontal scar running from hip to hip on your lower abdomen.
You would not be a good candidate for this type of surgery if you do not have enough lower abdominal tissue to create the flaps; if you have had previous abdominal surgical procedures such as abdominoplasty (a C-section scar is usually okay); or if you cannot tolerate anesthesia for long periods.
Length of Surgery: for one breast, 5-7 hours; for both breasts, 7-12 hours (this may vary according to your surgical team).
Hospital Stay: 3-5 days
From A Practical Point of View…
After this surgery, it’s normal to have abdominal pain and tightness for several weeks, and that can last up to several months before you can return to a full range of activity. Even though no muscle is cut, the fascia covering the muscles is cut and that requires healing time, as do your incisions and nerves.
Some surgeons require that you stay in a “flexed” position for the first 3 weeks after surgery.
Some survivors say they have some abdominal discomfort of various kinds, many months or even years after surgery but that it is not debilitating, some described a muscle cramp kind of sensation, others just described tightness. What they all agreed on was that it was really important to increase your core muscle strength after this surgery – yoga and Pilates were extremely helpful.
All in all, most survivors were pretty happy with their DIEP flap surgeries.
DIEP surgery is a fairly lengthy procedure, with potential for other complications such as total flap loss. You’ll want to make sure that your surgeon is very experienced with microsurgery and enjoys a high rate of success.
I’ve found a helpful YouTube video from a UK surgeon, Adrian Richards, explaining the difference between DIEP flap and TRAM flap. And here’s another one which has a lovely story within it, showing the entire procedure – but be warned, if you’re the least bit squeamish, you’d probably better not watch it: UCLA DIEP Flap Breast Reconstruction.
If you choose to have reconstructive surgery, please read my article Tips For Surgery – Useful Items to Take With You. Another article that might be helpful: My Top Favorite Things to Promote Surgery Recovery.
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