Microvascular Free Flap (DIEP) Breast Reconstruction

Deep Inferior Epigastric Perforator (DIEP) flap reconstruction is the gold standard for autologous (using the patient's own tissue) breast reconstruction. This advanced technique, requiring specialized microvascular surgery skills, offers the most natural and durable results after a mastectomy.

What is a DIEP Flap?

The DIEP flap uses skin and fat tissue from the lower abdomen (the same area used for a tummy tuck) to reconstruct the breast mound.

Key Feature:The procedure carefully preserves the abdominal wall muscles. This is the main advantage over older techniques (like the TRAM flap), leading to:
- Faster recovery from the donor site.
- Significantly reduced risk of abdominal wall weakness or hernia.
The Microvascular Component: Once the tissue is harvested, its blood vessels (arteries and veins) are meticulously connected to vessels in the chest using specialized sutures and a high-powered microscope. This step ensures blood flow to the transplanted tissue.

Advantages of Autologous Reconstruction

Using the body's own tissue provides several compelling benefits compared to implant-based reconstruction:

Natural Look and Feel: The reconstructed breast tissue is soft, warm, and behaves like natural breast tissue, offering superior aesthetic results over time.
Permanent Solution: Once the flap heals, it is a permanent part of the body, eliminating the risks associated with implants (rupture, capsular contracture, need for future replacement surgery).
Adjustable Over Time: The reconstructed breast will gain or lose weight with the patient, maintaining a stable, proportional appearance.
Simultaneous Abdominoplasty: The procedure results in a flatter, tighter abdominal contour, similar to a cosmetic abdominoplasty (tummy tuck).

The Surgical Process

The DIEP flap procedure is complex and typically takes between 6 to 10 hours, often involving a two-surgeon team (one harvesting the flap, one preparing the chest recipient site).

Phase	Description	Key Consideration
1. Flap Harvest	Skin and fat are carefully separated from the abdominal muscle, isolating the tiny perforator blood vessels.	Precision is essential to preserve muscle and nerve function.
2. Recipient Site Preparation	Blood vessels in the chest (usually the Internal Mammary Artery and Vein) are identified and prepared for connection.	Ensuring adequate blood supply and outflow is critical for flap survival.
3. Microvascular Anastomosis	The flap's vessels are sewn to the chest vessels under a microscope.	This is the most technically demanding part of the procedure.
4. Breast Sculpting	The transferred tissue is shaped into a natural-looking breast mound.	Dr. Khout uses advanced oncoplastic principles to maximize symmetry and projection.

Recovery Considerations

Because two separate surgical sites are involved (the chest and the abdomen), recovery is extensive but typically predictable. Patients usually spend 4–7 days in the hospital for flap monitoring. Full return to normal activity is typically 6–8 weeks.