Natural Breast Reconstruction Without an Implant
A DIEP flap is a state of the art breast reconstruction procedure using the lower abdominal tissue to reconstruct the breast after a mastectomy. It is a completely natural way to reconstruct the breast using a patient's own fat instead of an implant. A DIEP flap involves microsurgery to connect small blood vessels in the chest to the flap to restore blood flow. Dr. Jandali's microsurgical team is one of only a few groups performing DIEP flap breast reconstruction for patients in Southern Connecticut.
Benefits of DIEP Flap over Implants for Breast Reconstruction
The benefits of a DIEP flap over an implant are multiple and include:
A DIEP flap is a patient's own tissue and therefore appears more natural and feels more natural than implants.
The DIEP flap is natural and therefore has a very low risk of infection, unlike an implant reconstruction. The national risk of tissue expander or implant infection with breast reconstruction is reported to be around 4-5% in multiple large studies. That means about 1 in 20-25 women who undergo breast reconstruction with implants will have an implant infection requiring hospital admission for IV antibiotics and possible implant removal.
A DIEP flap is a patient's own fat, so it will fluctuate in weight as a person gains or loses weight. This also gives a better match to the normal breast on the opposite side (for women who only undergo a mastectomy on one breast).
If radiation therapy is needed after the mastectomy, a DIEP flap is a much safer operation with better cosmetic outcome. If a tissue expander or implant needs radiation, there is a 30-40% complication risk, with possible skin breakdown, wound formation, implant infection, need for implant removal, implant hardening with capsular contracture, and pain from the hard implant. A DIEP flap does not have these risks after radiation since there is no foreign body and the reconstruction consists of only a patient's own fat.
Studies show that the cosmetic outcome after a TRAM or DIEP flap breast reconstruction improves with time and aging. On the other hand, as time passes, implant breast reconstructions sometimes don't hold up as well and tend to have greater asymmetry with the opposite breast.
Once a DIEP flap is used to reconstruct the breast, the fat is alive and in place forever. However, implants don't last forever and have to be changed every 10-15 years when they rupture - this requires additional surgery.
Benefits of DIEP Flap over TRAM Flap
The TRAM flap is a microsurgical procedure which also uses the lower abdominal tissue to reconstruct the breast. However, a TRAM flap does involve removing part of the rectus abdominis muscle with the blood supply to the flap. These are the "six pack" muscles on the abdomen. Because a piece of muscle and fascia is removed with the flap, mesh is often needed to repair the defect. In addition, there is a small risk of an abdominal hernia or bulge with the TRAM flap technique.
With a DIEP flap, absolutely no muscle is removed from the abdomen - just skin and fat. Therefore, no mesh needs to be used and there is a much lower chance of a hernia or bulge, compared to a TRAM flap.
Benefits of DIEP Flap over Latissimus Back Flap
The latissimus flap from the back was used much more commonly for breast reconstruction in the past. However, this was before free TRAM and DIEP flaps started being performed. The latissimus flap takes an entire muscle from the back, often along with some of the skin. This leaves a long scar across the middle of the back. It also causes weakness with certain motions, like pulling and rowing, and it can affect a patient's ability to play certain sports like tennis. Further, another downside to the latissimus flap is that it still has to be used with an implant for the reconstruction. So it has all the downsides of an implant reconstruction, in addition to removing a large muscle with a long scar. For these reasons, the latissimus flap is rarely used anymore for breast reconstruction and has mostly been replaced by the DIEP flap.
Contact Us for Natural Breast Reconstruction with a DIEP Flap
For more information on mastectomy reconstruction options, and to learn more about the DIEP flap, contact us at 203-374-0310. Call to set up a consult with Board Certified plastic surgeon Dr. Shareef Jandali.
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