A mastectomy is surgery to remove the breast, usually as part of the treatment for breast cancer. Following a mastectomy, some women choose to have their breast surgically reconstructed. A reconstruction surgery can be performed at the same time as a mastectomy or afterward.
Breast reconstruction can be done using natural tissue taken from a different part of your body (autologous) or using implants. There are two major types of autologous breast reconstructive surgery. They are called DIEP flap and TRAM flap. Talk to your surgeon to determine the best option for you.
DIEP stands for “deep inferior epigastric artery perforator.” Find out how the procedure works, its benefits and risks, and what you can expect if you opt for a DIEP flap.
You may prefer to have a DIEP flap procedure done at the same time as your mastectomy. This is often possible, but you, and your surgeon, will need to decide if this is right for you. You may decide to wait before having your reconstructive surgery. And in some cases, a woman may have to wait for a tissue expander to make room for the new tissue.
If tissue expanders are required, the DIEP flap procedure takes place in stages. Your surgeon will place a tissue expander in your chest wall during the mastectomy. The expander stretches the breast skin, creating room for the reconstructive tissue. The rest of the procedure can be performed later.
Your general health is also a factor. Certain comorbidities can affect the timing of your procedure. A comorbidity is a condition that occurs independent of your cancer. Factors that are separate from your cancer, such as weight or if you are a smoker, can play a role in the timing of your surgery.
In the DIEP flap procedure, a surgeon uses tissue from your lower abdomen to create the breast tissue and mound. Abdominal tissue is similar to breast tissue, so abdominal tissue is well suited for a transplant. In the DIEP procedure, the tissue taken from the abdomen consists of skin and fat. Unlike a TRAM flap, the DIEP flap does not involve the use of a muscle layer – or in some cases, very little muscle.
In the DIEP flap procedure, the transferred tissue is attached to the existing breast blood supply via microsurgery.
Other breast reconstruction techniques that remove muscle tissue from your abdomen, such as the TRAM flap, increase your risk of abdominal bulges and hernia. Since DIEP flap surgery doesn’t involve muscle, you’ll avoid those risks and have a shorter recovery time.
Because your new breast is made from your own tissue, you will experience a more natural look. In addition, you won’t have to be concerned about risks that come with artificial implants.
DIEP flap surgery is a good choice for women who have enough abdominal fat tissue to create a breast. Removing tissue from your abdomen will be similar to getting a “tummy tuck.” After the procedure, you may be pleased with the new contour of your abdomen.
All surgery comes with the risk of infection, bleeding, and side effects of anesthesia. Risks of breast reconstruction include loss of sensation and death of tissue (necrosis). As a result of DIEP surgery, you’ll have scars around your breasts and belly button. The abdominal scar will likely fall below your bikini line, stretching from hipbone to hipbone.
A DIEP flap procedure is a major surgery that takes place under general anesthesia. Your surgeon will begin by making an incision across your lower abdomen. Then, skin, fat, and blood vessels will be loosened and removed.
The surgeon will transfer the flap to your chest to create a breast mound. If you are having only one breast done, the surgeon will try to match the size and shape of the reconstructed breast to your other breast as closely as possible. Using a microscope, your surgeon will then connect the flap’s blood supply to the tiny blood vessels behind the breastbone or under the arm.
Once the tissue is shaped into a new breast and connected to the blood supply, the incisions in the chest and abdomen must be closed with stitches. Depending on whether the procedure is performed in conjunction with mastectomy or as a separate procedure, this surgery can take as long as 8-12 hours to complete.
Usually, a few days in the hospital are required after this type of surgery. After surgery, you will have tubes in your chest to allow fluid to drain. The drains will be removed when the amount of fluid decreases to an acceptable level, usually within a week or two. You may be able to resume normal activities within 6-12 weeks. Although you will not have normal sensation in your new breast, results are generally good.
After you recover, if your breasts are asymmetrical, or if you want nipples or areolas, you will require additional procedures.
Your surgeon will want to let your new breast heal before reconstructing the nipple and areola. This surgery is not as complex as the DIEP flap. A nipple and areola can be custom-made with your body tissue. Or, you can have them tattooed if you prefer.
DIEP flap surgery can lead to a condition called contralateral breast ptosis. This is the medical term for a drooping breast. Over time, your original breast may droop in a way that the reconstructed breast doesn’t. This will create an asymmetrical shape to your breasts. If this occurs, you may like to get an adjustment at a later point.
Whether or not to have breast reconstruction after mastectomy is a very personal decision. Though reconstruction isn’t medically necessary, keeping your natural look can add to your self-esteem after a mastectomy.
If you choose reconstruction, there are several options, and each procedure comes with its own benefits and risks. A variety of factors, such as other treatments and your general health, can make some procedures unsuitable for you. Make sure to discuss the pros and cons of all surgical and non-surgical options with your medical team.