What Is DIEP Flap Surgery?

DIEP flap surgery is a form of breast reconstruction that uses your own tissue to rebuild the breast after mastectomy. It’s known for being one of the more advanced reconstructive approaches because it relies on microsurgery to connect tiny blood vessels, allowing transplanted tissue to remain healthy and well-supplied with blood. Despite how technical it sounds, the concept behind the surgery is relatively straightforward, it uses your body’s own tissue rather than implants to create the new breast.

So, let’s look at what this procedure involves, how it’s performed, and what recovery and results generally look like.

What actually happens during DIEP flap surgery?

The term “DIEP” stands for “deep inferior epigastric perforator,” which refers to the blood vessels that supply the skin and fat in the lower abdomen. During the procedure, a surgeon removes a section of skin and fat from the abdomen, while carefully preserving the abdominal muscles, and transfers it to the chest to reconstruct the breast.

The removed tissue (known as a “flap”) includes the blood vessels that keep it viable. Once transferred, these vessels are connected to blood vessels in the chest using microsurgery. This connection is what allows the flap to survive and become part of the new breast. The abdominal area is then closed, similar to what happens during an abdominoplasty.

How is DIEP flap surgery different from other types of reconstruction?

Compared to older methods, such as the TRAM flap, which involves taking some of the abdominal muscle along with the tissue, DIEP flap surgery aims to preserve those muscles. By leaving the abdominal muscles intact, patients typically experience less weakness and a lower risk of abdominal complications in the long term.

Unlike reconstruction using implants, DIEP flap reconstruction uses your own tissue, which means there’s no foreign material involved. The transferred tissue will change with your body over time, including during weight fluctuations. This is quite different from implants, which tend to remain the same regardless of body changes.

How long does the surgery take?

DIEP flap surgery is an intricate operation that usually takes several hours to perform, anywhere from six to eight hours, depending on whether one or both breasts are being reconstructed. The length is largely due to the microsurgical component, where blood vessels must be connected with precision under a microscope.

Since this surgery requires meticulous technique, it’s performed under general anaesthesia. After the operation, you can expect to stay in hospital for several days, usually between four and five, to monitor how the flap is healing and ensure blood flow remains stable.

What is recovery like after DIEP flap surgery?

Once you’re home, recovery continues for several weeks. It’s important that you allow your body enough time to heal properly before returning to regular activities. Many patients find that they need around six to eight weeks off work, though this varies depending on the type of work they do and how their healing progresses.

Your abdominal area will likely feel tight and may take some time to relax, especially when standing upright. The reconstructed breast may initially feel firm or swollen, but this tends to ease as internal healing continues. Gentle walking is encouraged soon after you return home to promote circulation, but you’ll need to avoid heavy lifting or strenuous activity until cleared by your surgeon.

You’ll also have follow-up appointments so your surgeon can check that the flap is healing as expected and that there are no signs of complications.

What are the expected results from DIEP flap reconstruction?

The goal of DIEP flap surgery is to create a breast that looks and feels as natural as possible using your own tissue. The reconstructed breast typically has a soft consistency and moves more like natural tissue compared to an implant. The size and shape are tailored to match the opposite breast, though some patients choose to have procedures on the other breast to achieve closer symmetry.

Since the tissue used comes from your abdomen, many describe it as similar to having had an abdominoplasty in that area, though that’s not the main purpose of the operation. Over time, the reconstructed breast settles into a more natural position as swelling reduces and tissues heal.

What should patients consider before deciding on DIEP flap surgery?

It’s important that patients understand this is a complex surgery that requires time for both the operation and recovery. You’ll need to have sufficient abdominal tissue to use for the reconstruction, and your overall health plays a large role in determining if this procedure is suitable. Certain medical conditions or previous abdominal surgeries can affect whether DIEP flap surgery can be performed.

When considering any type of reconstruction, it’s always helpful to discuss all available options with your surgeon. They can guide you through the benefits and limitations of each, taking your health, anatomy, and personal goals into account.

Dr Grant Fraser-Kirk: Specialist Plastic Surgeon on the Sunshine Coast

If you’re researching surgeons for your breast surgery, Dr Grant Fraser-Kirk is a Fellow of the Royal Australian College of Surgeons and a qualified Plastic and Reconstructive Surgeon (RACS), with a specific interest in skin and breast reconstruction.

To book your consultation on the Sunshine Coast, please get in touch with our team.