July 16, 2020
DIEP flap breast reconstruction uses the patient’s lower tummy tissue to reconstruct a breast after mastectomy. Unlike the TRAM, the DIEP does not sacrifice any of your abdominal muscles. Only skin and fat are used.
Many patients have enough lower abdominal tissue to reconstruct both breasts if desired. However, even thin patients who don’t have a lot of lower tummy tissue can be DIEP flap candidates – in these cases, all the lower abdominal tissue can be used to reconstruct one breast.
Some patients need both breasts reconstructed but need more tissue than bilateral DIEP flaps can provide. In these cases, tissue from another area of the body can be used for the opposite breast, or a combination of flaps can be used for each breast.
Other tissue reconstruction options include:
- Inner thigh (TUG/VUG flap)
- Outer thigh (LTP flap, ALT flap)
- Buttocks (GAP flap)
- Back (Latissimus flap)
- Fat grafting
Which patients can benefit from a stacked DIEP?
In some situations, the required amount of lower tummy tissue to reconstruct the breast cannot be transplanted to the chest as a single flap. For example, the patient may have a midline abdominal scar from previous surgery, or may be too thin. In these cases, all the lower abdominal tissue can be transplanted as 2 separate flaps which are then reconnected on the chest using microsurgery to create one breast. The flaps are stacked, or folded, one on top of the other to create the required breast shape and volume. This is known as a stacked DIEP flap procedure.
For some patients, particularly if they do not have a pre-existing midline abdominal scar, the two flaps can remain connected and transplanted as one large flap with two sources of blood flow. This is called a bilateral conjoined DIEP flap.
Dr. Garza explains these procedures here:
Author: Dr. Ramon Garza III and Courtney Floyd
Even thin patients who don’t have a lot of lower tummy tissue can be DIEP flap candidates – in these cases, all the lower abdominal tissue can be used to reconstruct one breast.
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