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DIEP Flap Breast Reconstruction

Cassileth Plastic Surgery Supports Breast Cancer Awareness Month

When considering breast reconstruction options, it’s important to consider not only what is aesthetically best for you, but also what works best for you emotionally.

The DIEP flap breast reconstruction uses extra abdominal fat to create a new breast. Many patients chose this option because it has some nice advantages over other types of reconstruction:

  1. It uses your own fat – unlike implant reconstruction, there is nothing “unnatural” about it.
  2. As it uses your own abdominal fat, you get a tummy tuck along with your new breasts!
  3. It provides a very natural-feeling breast.

If you are considering a DIEP flap procedure, keep in mind:

  1. It works best for unilateral (one-sided) reconstruction because the match to the non-treated breast is excellent.
  2. The operating room time is five hours (as opposed to one hour for an implant-based reconstruction).
  3. It involves surgery on an additional part of your body (your tummy). Many patients are already worried, facing a significant change to one part of their body (the breast) -- and they don’t want to add a change to another area.
  4. The recovery time is longer than with implant-based reconstruction.

Diep Flap Breast Reconstruction Before & Afters

diep flap breast reconstruction before and afterAge: 39, from Los Angeles, California. This patient had two prior failed implant reconstruction surgeries with another surgeon. Dr. Cassileth performed a right breast DIEP flap to reconstruct her breast. diep flap breast reconstruction before and afterAge: 39, from Los Angeles, California. This patient had two prior failed implant reconstruction surgeries with another surgeon. Dr. Cassileth performed a right breast DIEP flap to reconstruct her breast. diep flap breast reconstruction before and afterAge: 39, from Los Angeles, California. This patient had two prior failed implant reconstruction surgeries with another surgeon. Dr. Cassileth performed a right breast DIEP flap to reconstruct her breast. diep breast reconstruction pictureAge: 65, from Huntington Beach, California. Patient had a left breast DIEP flap reconstruction performed at the same time as her mastectomy. diep breast reconstruction on left breastAge: 65, from Huntington Beach, California. Patient had a left breast DIEP flap reconstruction performed at the same time as her mastectomy. diep flap reconstruction on breastAge: 65, from Huntington Beach, California. Patient had a left breast DIEP flap reconstruction performed at the same time as her mastectomy. Patient diep flap reconstruction picturesAge: 55, from San Diego, California. This patient underwent bilateral mastectomies and bilateral DIEP flap breast reconstruction. At a secondary surgery her nipple/areola were reconstructed using a full-thickness skin graft. diep flap breast reconstruction before and afterAge: 55, from San Diego, California. This patient underwent bilateral mastectomies and bilateral DIEP flap breast reconstruction. At a secondary surgery her nipple/areola were reconstructed using a full-thickness skin graft. DIEP breast reconstruction patientAge: 55, from San Diego, California. This patient underwent bilateral mastectomies and bilateral DIEP flap breast reconstruction. At a secondary surgery her nipple/areola were reconstructed using a full-thickness skin graft.

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How is the Surgery Performed?

All of our DIEP flap procedures are performed with two surgeons, Dr. Cassileth and top DIEP flap specialist Dr. Sean Boutros; this minimizes time in the operating room and ensures that highest technique expertise for our patients. In a DIEP flap, we move fat from your abdomen to your breast area. It is important to understand that a big section of fat is moved all at once, not in little amounts like in liposuction or fat grafting. This leaves a long scar on your abdomen, which looks very much like a tummy tuck (abdominoplasty) scar. The fat is moved with its blood supply, and the blood vessels that feeds this fat is actually hooked up to existing blood vessels in the chest so that the fat will live a nice, healthy life in its new location. There really is nothing that can beat a DIEP flap in creating a natural breast that matches the other side. Your abdominal fat does a very good job of imitating your breast tissue.

Dissecting and reattaching the blood supply is the most technically difficult portion of the surgery. The blood vessels that supply the abdominal fat go right through the “rectus abdominus” muscle, a very important muscle that makes up part of abdominal muscles (your “abs”) and allows you to do a strong sit-up. The DIEP flap spares the muscle, leaving it unharmed. The term DIEP stands for “Deep inferior epigastric perforator flap.” The “perforators” are tiny vessels go through the abdominal muscles, and feed the fat.

How is it Different from a TRAM Flap?

Like the DIEP flap, the TRAM flap (transverse rectus abdominus myocutanteous flap) uses your own abdominal fat. But unlike the DIEP flap, the TRAM flap removes one of your two rectus muscles. We consider the TRAM flap to be a greatly inferior surgery: it eliminates one of the core muscles; has a longer recovery; and has higher risks of hernia because of the weakening of the abdominal wall. The DIEP flap has none of these disadvantages, and we consider it a far superior surgery.

What are the Risks Associated with DIEP Flaps?

A risk of all “Free flaps” – surgeries where fat is moved and then reconnected in a new location – is that the blood vessels supplying the fat can clot off. If that happens, the fat will not survive. The risk of this happening is highest right after the surgery, right after the vessel is connected. For that reason, we watch you very carefully after surgery. A specially trained nurse will continually monitor you to ensure that there aren’t any problems with the vessels. Every hour after surgery, the risk of problems decreases. After about 48 hours have passed without trouble, the connection is fully secure, the fat is no longer at risk, and you can feel confident that your reconstruction is successful and trouble-free.

To find out if you are a candidate for DIEP Flap Breast Reconstruction, call our office at 310.278.8200 to make an appointment for a consultation with Cassileth Plastic Surgery.

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