(A) By way of branches called perforators, the deep inferior epigastric artery (DIEA) and the deep inferior epigastric vein (DIEV) provide blood supply to the skin and fatty tissue of a DIEP flap. During the surgical preparation of the DIEP flap, these perforator blood vessels are meticulously separated from the abdominal muscle, leaving the muscle with enough remaining blood supply intact. (Inset) Cross-sectional view demonstrating perforator branches of the DIEA and DIEV that nourish the tissue of the DIEP flap. (B) To restore circulation to the tissue of the newly reconstructed breast after the DIEP flap is transferred to the chest, the blood vessels of the flap are connected to blood vessels at the recipient site using microsurgical techniques. The flap is then sculpted to restore the shape of the breast. (C) The horizontal abdominal scar that results following DIEP flap surgery is similar to that created by a “tummy tuck.” The scar that results on the breast will depend upon the technique used for mastectomy.
The blood vessels that are needed for a DIEP flap breast reconstruction are meticulously dissected without removing or destroying the muscles of the abdomen. Because muscle is preserved, postoperative pain and discomfort are minimized, and strength and function are preserved. After DIEP flap is transferred to the chest, the blood vessels that will nourish the DIEP flap are connected to blood vessels at the mastectomy site using delicate microsurgical techniques. When possible, sensory nerves may also be connected to facilitate recovery of sensation in a reconstructed breast. Finally, the skin and fat of the DIEP flap are shaped into a new breast.
Because the tissue removed from the lower abdomen during DIEP surgery is similar to that removed during a tummy-tuck, women who undergo this procedure generally benefit from an improvement in the contour of their abdomen. While typically not as low as the scar of a tummy-tuck tuck, the scar that results from DIEP flap can typically be concealed in most clothing and in a once-piece bathing suit.
Approximately three months after the initial stage of breast reconstruction surgery, refinement of breast shape and procedures to produce overall symmetry can be completed. These optional additional procedures are performed on an outpatient basis and are referred to as Stage II.
Contact us to schedule a consultation, or if you would like more information about the options for breast reconstruction after mastectomy. Our practice has offices in Greenwich, Connecticut and New York. We perform breast reconstruction surgery at several hospitals in Connecticut and New York.