Breast Reconstruction
What is DIEP Flap Breast Reconstruction?

The DIEP flap is the most advanced form of breast reconstruction available today. It is also the preferred technique at PRMA. DIEP flap surgery uses the patient's lower abdominal skin and fat, while preserving the abdominal muscles.  The tissue is used to restore a natural, warm, soft breast after mastectomy. Restoring feeling is also possible with TruSense®, a nerve reconstruction technique pioneered at PRMA to repair nerves cut by the mastectomy. Unlike the TRAM flap, the DIEP preserves all the abdominal muscles. Only skin and fat are removed, similar to a "tummy tuck". Saving the abdominal muscles means patients have less pain. Patients also enjoy a faster recovery, maintain more core strength long-term, and have a lower risk of abdominal complications (eg abdominal bulging or hernia).

Who performs DIEP flap surgery?

PRMA is the only center in San Antonio, Texas and one of only a handful of centers worldwide to provide breast reconstruction on such a large scale. Our surgeons treat patients from across Texas and the US, as well as routinely welcoming international patients.  We are proud to have a tremendous global reputation for breast reconstruction excellence.

There are many reconstructive breast surgeons in the United States. However, very few perform DIEP flap surgery routinely due to the level of technical expertise required. To date, our surgeons have performed thousands of microsurgical breast procedures. We are proud to perform about 1,000 DIEP flap surgeries every year. Our success rate is over 99%.

How It's Done
How is DIEP flap surgery performed?

The skin and fat below the belly button feels similar to breast tissue. It is a good option to replace the breast tissue removed by the mastectomy. 

The blood vessels (“perforators”) keeping this skin and fat alive travel just beneath or within the abdominal muscle. A small incision is made in the abdominal muscle to access them. The tissue is disconnected from the body and transplanted to the chest using microsurgery. The surgeons shapes the tissue to create a new breast.

Some patients anatomy will not allow for full muscle preservation with a standard approach. Usually this is because the tissue needs more than 1 blood vessel to ensure the best blood supply. In some cases, there is intervening muscle between these blood vessels that many surgeons would just cut. Not at PRMA! In these situations, our surgeons perform a modification of the DIEP. This is known as an APEX flap. This technique allows for complete preservation of the patient’s muscle.

Women also enjoy the added benefit of a flatter abdomen with results like a “tummy tuck.”  The risk of abdominal complications like bulging and hernia is also very small, especially when compared with the TRAM flap procedure which routinely sacrifices abdominal muscle.

What Can You Expect
Additional Expertise PRMA Provides

Most patients are also candidates for sensory nerve reconstruction using TruSense®. Nerves providing sensation to the breast are often cut during a mastectomy. This may cause numbness to the chest and/or reconstructed breast. Sensory nerve reconstruction repairs the nerves that supply feeling to the breast. TruSense® improves the return of feeling to the reconstructed breast. PRMA is one of only a few centers in the world to offer this additional procedure to restore breast feeling.

Patients who have arm lymphedema from previous breast cancer surgery may also be candidates for Vascularized Lymph Node Transfer. This is performed in combination with DIEP flap reconstruction. The procedure involves removing healthy lymph nodes from the groin. The healthy lymph nodes are then transplanted to the underarm. This can significantly improve lymphedema symptoms.

Patients who are unhappy with their implant reconstruction results may also be candidates for DIEP flap surgery. Implants can be removed via Explant Surgery. Our surgeons can then reconstruct a natural breast with the patient’s own tissue. This is something we perform routinely at PRMA. Many patients report being more satisfied with their results after replacing their implants with their own tissue.

The Recovery
What Does DIEP Flap Recovery Look Like?

Knowing what to expect during recovery is very important and helps with planning. The healing journey is different for everyone but here is an outline of what patients can expect after surgery:

Week One:

Most patients stay 2 nights in the hospital after surgery. Thanks to our ERAS protocol, patients feel well enough to be up walking the morning after surgery. Patients will also take a shower in the hospital. The rest of the first week is spent getting settled back home or in a local hotel for patients who travel. Patients will slowly increase walking time and distance. For those traveling from out of state, a follow up appointment in the office is scheduled.  This allows travel back home a week or so after surgery.

Week Two:

For local patients, a follow up appointment is scheduled within two weeks after surgery. If drain output is low enough they are removed.   During the second week patients will begin easing into their post-operative range of motion arm exercises. By the end of the second week patients can switch from the surgical bra and abdominal binder to a wireless bra and panty girdle. (Be sure to get clearance from your doctor or nurse first.) Most patients also feel comfortable enough to drive. Driving is allowed as long as they are not taking narcotics.

Week Three:

During the third week after surgery, patients typically feel more like themselves.  Most at home medications can be resumed if not restarted already. Please clear all medications with your physician first. Any remaining surgical drains are removed.  Patients with low-impact/work-from-home jobs can return to work at this time if they desire.

Week Four:

During the fourth week a follow up appointment is scheduled with the surgeon. Planning stage 2 of the reconstruction (the revision stage) starts now. Patients should continue to increase cardio endurance as they feel able.

Week Five:

After the first month, many patient may experience new pains in the breast and abdomen as activity is increased. This is normal and will get better over time.

Week Six:

By week six most patients are released from all restrictions.  Most patients are able to return to work as well. Remember, not everyone heals at the same rate. It is important to listen to your body as you resume all activities.

healing after diep flap reconstruction
PRMA Plastic Surgery, San Antonio, Texas, Stone Oak | breast reconstruction, microsurgery, restoring feeing after mastectomy, aesthetic plastic surgery, TruSense®, High Definition DIEP
Important to Know
DIEP Flap Key Information

  • The DIEP is the most advanced form of breast reconstruction available today
  • It uses the patient’s own abdominal skin and fat to restore a natural, warm, soft breast after mastectomy
  • Unlike the TRAM, the DIEP preserves all the abdominal muscles
  • Most patients are also candidates for sensory nerve reconstruction to restore as much feeling as possible (mastectomies usually leave patients numb)
  • Women also enjoy the added benefit of a flatter abdomen like a “tummy tuck”
  • The risk of abdominal complications (such as bulging and hernia) is very small
  • Vascularized lymph node transfer can be performed at the same time to treat arm lymphedema
  • A team of two microsurgeons performs every procedure to shorten anesthesia time (2 experts are always better than 1)
  • PRMA performs about 1,000 DIEP flap surgeries each year
  • Our success rate is over 99%

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