What does breast reconstruction using a DIEP flap (deep inferior epigastric perforator flap) mean?
In this specialized procedure, the breast is reconstructed using lower abdominal skin and fat. The abdominal muscles are not part of the DIEP flap and are spared. These are very small blood vessels, 1–2 mm in diameter, which are necessary for the blood supply and nourishment of the flap. We visualize these perforator vessels in advance using ultrasound, allowing us to create a surgical sketch and plan the procedure beforehand. These small blood vessels are dissected microsurgically using loupe glasses and multiple magnification. These vessels give the DIEP flap its name.
After microsurgical dissection of the vessels, the DIEP flap can be detached from the lower abdomen and anastomosed to the artery and vein in the area of the chest wall. The vascular anastomosis is performed under a surgical microscope. The tissue can then be shaped and adjusted to form a breast. A skin island is always necessary to monitor blood flow, but it can be removed after a few weeks. The resulting defect in the lower abdomen is closed by tightening the upper abdominal skin, as in an abdominoplasty. The scar in the lower abdomen is barely visible later on. The navel is repositioned within the tightened skin and sutured in place.
If necessary, the nipple can be reconstructed after 3 months using skin from the opposite side’s nipple, from the upper eyelids—as in an upper eyelid lift—or through tattooing.
Hospital stay and anesthesia
An inpatient stay and general anesthesia are always required for this procedure.