Jandali Plastic Surgery is one of the only specialized practices offering DIEP flap breast reconstruction for patients in Fairfield County, Connecticut. Dr. Shareef Jandali performs DIEP flaps on patients from Fairfield County, Norwalk, Westport, Stamford, Wilton, Weston, Easton, Fairfield, Trumbull, Shelton, Bridgeport, Milford, Stratford, New Haven County, and New York.
The use of a woman’s abdominal tissue is the most common way to perform breast reconstruction when not using an implant. The first procedure, first started in the 1980s, was the pedicled TRAM flap, which stands for Transverse Rectus Abdominis Myocutaneous Flap. This procedure involved taking one of the entire muscles of the abdomen as the blood supply to the overlying fat and skin. This was then kept attached and twisted up to the breast through a tunnel made in the upper abdomen. The problem with this flap is that it doesn’t have the best blood supply and one of the entire “six pack” muscles of the abdomen has to be taken. Mesh always has to be used to repair the abdomen and there is a chance of developing a hernia. Because the entire muscle is taken, this can lead to decreased strength with core activities and exercises, like sit ups and bending at the waist.
Advances in microsurgery allowed an improved operation, the free TRAM flap, to be used for breast reconstruction. This operation involves taking a different better blood supply to the tissue of the abdomen and usually only part of the muscle. The tiny vessels are then sutured into small vessels in the breast area using microsurgery. This operation was shown to have improved outcomes and strength of the abdomen after healing. However, a portion of the muscle is still removed and sacrificed. Mesh often has to be used to reinforce the abdomen after a free TRAM flap, so that a hernia doesn’t develop.
The DIEP flap, which stands for Deep Inferior Epigastric Perforator Flap, is a further refinement and improvement upon the free TRAM flap. The DIEP flap does not remove any muscle at all from the abdomen, and only takes the vessels and the overlying skin and fat for the breast reconstruction. This procedure also involves microsurgery, with the tiny flap vessels being sutured into vessels in the breast area. A DIEP flap is the most advanced way to reconstruct the breast using the tissue from the abdomen. It has been shown to have the best outcomes with no loss of strength of the abdomen, since NO muscle is removed from the abdomen with a DIEP flap.
Both the free TRAM flap and the DIEP flap use the same tissue on the abdomen that is discarded with a tummy tuck, or abdominoplasty procedure. So, the end result after a free TRAM or DIEP flap is that the abdomen has the appearance of a tummy tuck.
When a free TRAM flap or DIEP flap is used for breast reconstruction, all of the excess skin and tissue from the umbilicus (belly button) down to the pubic area is removed. Part of this is used to reconstruct the breast or both breasts if a double mastectomy is performed. The abdomen has a long low scar like an extended c-section scar. There is also a small circular scar around the belly button, which is kept in the same exact place.
If you are interested in natural breast reconstruction without implants, you may be a candidate for a DIEP flap. Dr. Jandali's microsurgical team is one of only a few groups performing DIEP flap breast reconstruction for patients in Southern Connecticut. Contact our office by calling 203-374-0310 to set up a consultation.