I’m Dr. Tommaso Addona. I’m the president of the Long Island Plastic Surgical Group. A DIEP flap is a form of reconstruction that we can offer patients. It stands for D-I-E-P, deep inferior epigastric perforator flap. It’s a lengthy description that basically says we can borrow a patient’s tissue from their belly and transfer it to the breast to recreate the breast.
The tissue I refer to is actually from the belly button to the pubic region. It’s basically the skin, the fat, and that’s it. And that’s the crucial portion to a DIEP flap. That separates a DIEP flap from a TRAM flap. In the past, we would perform TRAM flaps and that would borrow muscle as well. The goal of a DIEP flap is to leave the muscle in place. So prior to a patient being worked up for a DIEP flap reconstruction, we often obtain CT scans to evaluate their belly. Not only to look at the skin and the fat, the muscle, but also to evaluate the blood supply, to see if they are in fact candidates and we can preserve that muscle in place while we bring the tissue up to the breast.
Patients that may qualify for a DIEP flap reconstruction vary. Most patients may have an area of burdensome or annoying extra tissue in the lower belly, usually from the belly button down to the pubic region. Those patients that have some excess tissue there, we can utilize that tissue to reconstruct the breast. Not every patient is a candidate for a DIEP flap. Some patients may desire to use their own tissue. However, we would have to search other locations besides their lower belly. Patients that have had prior abdominal surgery may still be candidates for breast reconstruction using DIEP flap in their belly tissue. It varies based on some of their imaging studies. So we would have to review the blood supply to make sure it’s safe to perform the surgery for them.
There is no age limit for performing DIEP flap reconstruction for patients. However, the patients must be in excellent health to tolerate the procedure, which is a prolonged procedure, anywhere from four to six hours of surgery. So a great question that’s often asked is whether a patient should gain weight prior to their DIEP flap. Now, I’ll be honest, I’ve offered patients the opportunity to Ben and Jerry’s every day within a couple of months of their surgery. That said, patients that are candidates for DIEP flaps need not gain extra weight. Patients who have had difficult times with other options for reconstruction, whether that be implants or using a different area of tissue, and if those reconstructions failed, and failed may vary based on what that means, may be candidates using their belly tissue.
Patients that have had previous abdominal plasty are no longer candidates for a DIEP flap reconstruction. The abdominal plasty itself removes the very tissue that we would prepare and utilize to reconstruct the breast. So the blood supply is no longer available to use for reconstruction.
We’ve had several patients ask, “If I’m a candidate for a DIEP flap, but I still would like to utilize implants as a supplement to the reconstruction. Is that an option in the future?” And the answer is yes. Patients that may be candidates to use their belly tissue and reconstruct the breast, but then after a period of time, say, “I still would like some more volume to get back to where I once was.” We can actually use implants to supplement the DIEP flap, also covered by insurance.
The recovery time for a DIEP flap varies significantly from patient to patient. However, if we look at a broad spectrum of patients, anywhere from two to six weeks of recovery. It varies based on how motivated the patients are. It varies based on some of the patient’s medical issues, but most patients can plan for about a month on average of recovery. What does that month of recovery entail? Most of our patients, I actually ask them to walk on postoperative day one after their procedure. So we start the recovery period immediately after the procedure. In terms of getting back into their daily routine, about one month is right for that. And that includes light gym activity and work.