Why do patients choose DIEP flap reconstruction over implants?

1) Desire for a natural looking and feeling breast after mastectomy

Many women prefer the natural look and feel of the DIEP flap over implants. The lower tummy tissue used for DIEP flap breast reconstruction feels very much like natural breast tissue.  This makes it a great option for reconstruction. After a mastectomy removes the breast tissue, only skin and a thin layer of fat remains to insulate and camouflage an implant. Implant patients often express dissatisfaction with the firmness of their breast(s) and frequently complain that the reconstructed breast feels cold to the touch. In contrast, the DIEP flap recreates a warm, soft, natural feeling breast after mastectomy and, through sensory nerve reconstruction, can even allow for restoration of some of the feeling lost because of the mastectomy.

“I chose DIEP flap because it is my own tissue and looks just like my own, which it is! If I had to do it over, I would make the same decision in a heartbeat.” – Diana

“I chose DIEP Flap because I did not want implants or anything foreign in my body. I wanted natural looking, warm feeling breasts” – Carla

“I did not want implants or muscle flaps. I wanted to have both breasts done (one was prophylactic) and wanted to look and feel as normal as possible. Using my own tissue had to be the choice. As 7 years have passed I have not regretted this decision for a minute!” – Linda

“My initial plan was to have implants. After listening to Dr Pisano explain the mastectomy and how all the tissue would be removed, I was concerned what implants would really look like without the tissue on top. I also had reservations about the expander part of it and really the whole idea of being able to use my own tissue eliminated the frustration or disappointment of losing my breast. Yes, at the end of the day I had a double mastectomy and the breasts I had were removed, but my new breasts were created with my own tissue rather than a foreign object. It certainly was a perk to have a tummy tuck, but really the concept of using my own body tissue was promising.” – Catherine

“I chose the DIEP flap procedure after careful research and consideration. I knew that I wanted to use my own tissue, if possible, and I knew that I wanted to look relatively normal once everything was done. The DIEP flap was the best option for me.” – Tina

2) Unhappy with prior implant reconstruction

Implant breast reconstruction is the most commonly performed method of reconstruction today. Unfortunately, for some women it may not be the best option. Some women simply don’t like their implant reconstruction(s) for a variety of reasons, including those mentioned above. Other women experience complications related to implant reconstruction and need to have them removed or replaced. We see this often at PRMA. In most of these cases, women choose to remove their implants and undergo DIEP flap reconstruction.

“I was diagnosed with breast cancer in 2009 and completed treatment, double mastectomy with immediate reconstruction with expanders and implants by 2010. I later chose DIEP flap because I was never happy with the implants. I did not like the way they looked or felt. I also had upper back/shoulder pain from the pulling of the muscles. I asked my oncologist almost every time I went for a check-up, “Is this as good as it gets?” I stumbled onto PRMA on Facebook! I have never been happier! I know they will never look or feel the way my “God given” breasts looked and felt…but they are darn close!” – Kim

“I had a shrunken, deformed left breast due to previous breast cancer. Partial mastectomy and radiation, plus a small implant, led to a deeply indented scar and hardening and displacement of the implant. I just wanted the rest of the breast removed and replaced with my own tissue– another implant wouldn’t have been ideal in my situation with the irradiated skin. The benefit of getting a tummy tuck at the same time was a deciding factor too! As it turned out, they found more cancer in the removed breast which had spread to 2 lymph nodes so I was extremely lucky I had decided to seek a cosmetic solution to my ugly deformed breast- I had no idea the cancer had returned! Anyway, the results are great and keep getting better with time. Dr Arishita did a wonderful job of matching up my breasts (he had to lift the other one) and I would have to say I feel pretty fortunate to have such nice-looking breasts and a flat tummy at my age!” – Bonnie

3) There is no need for further surgery down the road

Implants will typically need to be replaced, or will require some additional revision surgery, over time. The DIEP flap offers a natural and permanent alternative to implants.

“I didn’t want to deal with implant exchange surgeries decades down the road, as I read varying reports on how long implants would last until they had to be replaced. DIEP is for life.” – Misty

“I actually went into my consultation thinking I wanted the easiest surgery possible and that would be implants. I had just been through months of chemo and I was tired. But I’m so thankful Dr Ochoa went over all my options. Once it was all laid out on the table, I felt most comfortable with DIEP. Even though the surgery would be more extensive, it would be worth it to use my own tissue and not have to worry about replacing implants down the line. Thank goodness I did because I ended up needing radiation (unexpected) after surgery and if I had implants it would have really done a number on them. I love my breasts – they are warm, they move with me and I have more feeling than I ever expected. I’m just so thankful for the wonderful doctors and nurses at PRMA who take time to explain all of the options.” – Susan

“The replacement of implants every 10 or so years and the possibility of a rupture or leak with implants didn’t sit well with me. Personally, using part of my own body to reconstruct another part seemed a better fit for me. 
Yes, surgery was longer as well as recovery, however, the fact that it’s my body (kind of recycling my body) made my decision.” – Elisdelia

4) Fear of implant failure

About 1 in 3 implant reconstructions fail after radiation. There is also a risk of implant rejection (the body rejecting the placement of a foreign body). The DIEP flap uses your own tissue. No foreign objects are used.

“The failure rate of implants on radiated tissue was the biggest reason I wanted a tissue transfer procedure, specifically the DIEP flap. I didn’t want to be dealing with ongoing issues that one often deals with when you’ve had prior radiation.” – Misty

“I was given all the options, both implant and autologous, for breast reconstruction by my breast surgeon after my second breast cancer diagnosis. I’ll admit I glanced over the implant options but when I found out I could use my own tissue, there was NO turning back for me. I knew my body would easily accept my own tissue. I wanted nothing foreign in my body. The fact I was going to get a tummy tuck, too, after having two large boys, admittedly made it more appealing. I think what sealed the deal is when my breast surgeon called it the “Gold Standard” in breast reconstruction. Having DIEP flap breast reconstruction was one of the toughest yet truly BEST decisions I ever made. I love my soft, warm, natural breasts! My outlook on life has never been better after two breast cancer diagnosis. Thank you Dr Chrysopoulo!” – Terri

5) Results similar to a “tummy tuck” 

Women also enjoy the added benefit of a flatter abdomen with results that mimic a “tummy tuck”. Because the DIEP flap, unlike the TRAM flap, saves all the patient’s abdominal muscles, the risk of abdominal complications such as bulging and hernia is also extremely small, much smaller than with the TRAM flap.

“I chose DIEP because I wanted to change the negative impact of cancer into a positive. I took my 43-year-old muffin top, and made it into great breasts!” – Margaret

“I chose the DIEP because I did NOT want implants if at all possible. The DIEP gave me the reconstruction option & a tummy tuck that I needed to continue my new me! It made my recovery so much simpler. I knew there would be a lot more surgeries & hassles involved with implants & they are not my tissue so the rejection factor was there. I have never regretted my decision & I am happy to have my “belly boobs”.” – Sharon

“I have breast cancer. That’s bad. But, I have a lot of loose skin from losing 100 lbs. With DIEP flap, I got a mini-tummy tuck, a breast lift, and my breast cancer eradicated. SOLD!”

Author: Dr. Minas Chrysopoulo and Courtney Floyd