DIEP flap
Encyclopedia
A DIEP flap is a type of breast reconstruction
in which blood vessels called deep inferior epigastric perforators (DIEP), and the skin
and fat
connected to them are removed from the lower abdomen
and transferred to the chest to reconstruct a breast after mastectomy
without the sacrifice of any of the abdominal muscles.
The DIEP flap is similar to the muscle-sparing free TRAM flap but only requires the removal of skin and fat. Unlike with the TRAM procedure no muscle is sacrificed. The blood vessels, or perforators, required to keep the tissue alive lay just beneath or within the abdominal muscle. Therefore, a small incision is made in the abdominal muscle in order to access the vessels.
After the skin, tissues and perforators (collectively known as the "flap") have been dissected, the flap is transplanted and connected to the patient's chest using microsurgery. The plastic surgeon then shapes the flap to create the new breast. As no abdominal muscle is removed or transferred to the breast patients experience less pain post-operatively and a faster recovery compared to TRAM flap patients. Abdominal strength is also maintained long-term following the DIEP flap procedure.
Many women who undergo this form of reconstruction enjoy the added benefit of a flatter abdomen, with results that mimic a “tummy tuck” procedure. The risk of abdominal complications such as bulging and hernia is also very small, much smaller than with the TRAM flap method of breast reconstruction. As with all types of breast reconstruction however, 2 or 3 stages performed a few months apart are often required to complete the reconstruction process and to obtain the best cosmetic result.
Unfortunately, due to the complexity of the surgery few breast centers offer DIEP flap breast reconstruction despite the many advantages the procedure offers over the TRAM flap.
Breast reconstruction
Breast reconstruction is the rebuilding of a breast, usually in women. It involves using autologous tissue or prosthetic material to construct a natural-looking breast. Often this includes the reformation of a natural-looking areola and nipple...
in which blood vessels called deep inferior epigastric perforators (DIEP), and the skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...
and fat
Fat
Fats consist of a wide group of compounds that are generally soluble in organic solvents and generally insoluble in water. Chemically, fats are triglycerides, triesters of glycerol and any of several fatty acids. Fats may be either solid or liquid at room temperature, depending on their structure...
connected to them are removed from the lower abdomen
Abdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
and transferred to the chest to reconstruct a breast after mastectomy
Mastectomy
Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...
without the sacrifice of any of the abdominal muscles.
The DIEP flap is similar to the muscle-sparing free TRAM flap but only requires the removal of skin and fat. Unlike with the TRAM procedure no muscle is sacrificed. The blood vessels, or perforators, required to keep the tissue alive lay just beneath or within the abdominal muscle. Therefore, a small incision is made in the abdominal muscle in order to access the vessels.
After the skin, tissues and perforators (collectively known as the "flap") have been dissected, the flap is transplanted and connected to the patient's chest using microsurgery. The plastic surgeon then shapes the flap to create the new breast. As no abdominal muscle is removed or transferred to the breast patients experience less pain post-operatively and a faster recovery compared to TRAM flap patients. Abdominal strength is also maintained long-term following the DIEP flap procedure.
Many women who undergo this form of reconstruction enjoy the added benefit of a flatter abdomen, with results that mimic a “tummy tuck” procedure. The risk of abdominal complications such as bulging and hernia is also very small, much smaller than with the TRAM flap method of breast reconstruction. As with all types of breast reconstruction however, 2 or 3 stages performed a few months apart are often required to complete the reconstruction process and to obtain the best cosmetic result.
Unfortunately, due to the complexity of the surgery few breast centers offer DIEP flap breast reconstruction despite the many advantages the procedure offers over the TRAM flap.
External links
- DIEP flap entry in the public domain NCI Dictionary of Cancer Terms