DIEP Flap Abdominal Scar Placement
By: Courtney Floyd
Where will the abdominal scar be after DIEP flap breast reconstruction?
DIEP flap breast reconstruction uses the patient’s lower abdominal skin and fat (no muscle) to reconstruct a natural, warm, soft breast after a mastectomy.
The lower abdominal tissue is removed as a football shaped incision between the belly button and the upper pubic hairline. One of the most common questions patients ask is where the final location of the abdominal scar will be.
In ideal situations, the DIEP flap abdominal scar is very similar to a traditional tummy tuck scar. After the DIEP flap tissue is removed, the remaining upper abdominal tissue is stretched downwards to close the gap created by removing the flap(s). Typically, the scar spans from hip to hip, and ideally can be hidden when wearing underwear or most bikinis.
There are a few anatomical factors that ultimately determine the scar’s location:
1.Amount of abdominal tissue
Generally speaking, patients who have more tummy tissue have a lower setting scar. Thinner patients may have a slightly higher scar depending on how they carry their weight.
2. Location of abdominal tissue
Final scar location is also heavily dependent on where the abdominal tissue is primarily located. Patients who carry their abdominal tissue low will generally have lower scars.
3. Location of the perforator
Sometimes the best perforator (the blood vessel used to transplant and connect the tummy tissue to the chest wall) for the DIEP flap is located higher up in the abdomen. This can lead to a higher scar location due to where the initial incision is made.
4. High lying umbilicus (or belly button)
The umbilicus position influences where the upper incision for the DIEP flap is made. Patients with a high-riding belly button can have a higher scar. However, patients who have more elastic upper abdominal tissue (eg due to multiple pregnancies) may end up with a lower scar if the upper tissue can be stretched enough.
5. Number of pregnancies
The more times a patient has been pregnant, the more stretchy the abdominal skin is. Again, this will allow the surgeon to pull the upper abdominal skin further down when closing the abdominal incision and ultimately create a lower scar.
In every case, our surgeons make every effort to keep the scar as low as possible. Cosmesis at both the breast and abdomen are important to us. During the 2nd stage of the breast reconstruction process (also known as the “revision” stage), scars can be improved and often lowered further with scar revision.