Breast reconstruction with DIEP flap
The strong points
- This is the breast reconstruction technique that offers the best results
- The DIEP flap allows breast reconstruction without prosthesis and without any functional sequelae.
- The breast is reconstructed by transferring skin and fat from the belly obtained by a tummy tuck
The purpose of this procedure is to reconstruct the shape and volume of a breast in a single operation and without foreign material (autologous reconstruction). It can be performed at the same time as the removal of the breast (immediate breast reconstruction) or in a second phase (secondary breast reconstruction). The skin and fat of the abdomen are removed WITHOUT the abdominal muscle, keeping an artery and a small vein that passes through the abdominal wall. The whole is then transferred to the chest and arterial and venous sutures are made under a microscope to allow oxygenation of the tissue. This is a true auto-transplantation that restores the patient's body integrity in a completely natural way.
The procedure is performed under general anesthesia. This requires a pre-anesthetic consultation at least 48 hours before the procedure. A CT scan studying the anatomy of the arteries and veins of the abdomen must be performed 1 month before the diep reconstruction procedure.
It lasts from 5 to 6 hours and requires a hospitalization of 5 to 7 days including 3 in continuous care.
A return to work can be envisaged 2 weeks after the operation.
The first contraindication is that you do not have enough excess abdominal skin and fat to perform a tummy tuck.
However, "hybrid" strategies can be proposed to you if you have a small volume belly. The skin of the DIEP flap will be able to repair the damage caused by radiotherapy, which will allow, in a second phase, to add volume by means of purified fat injection sessions. On the other hand, a history of classical abdominoplasty formally contraindicates this surgery. This is not the case for a previous abdominal liposuction, subject to a CT scan of the vessels of the abdomen.
A history of recurrent phlebitis, significant overweight (Body Mass Index greater than 35) and an age greater than 75 years lead us to avoid DIEP flaps.
Other contraindications are those of microsurgery, i.e. suturing of vessels less than 2 mm in diameter.
The following are examples:
- a significant active smoking habit of more than 15 cigarettes per day. A total withdrawal is absolutely necessary at least 2 weeks before and after the operation. A consultation with a tobacco specialist and the use of nicotine substitutes will allow you to solve this problem.
- Raynaud's syndrome, which is an abnormal whitening of the fingertips when exposed to cold.
- homozygous sickle cell anemia, a rare genetic disease that mainly affects people in West Africa.
There are 2 main risks:
the risk of failure of the technique by occlusion of the vessels (microsurgical thrombosis). This can occur within 5 days after the procedure and requires the removal of the reconstructed breast.
This complication occurs in less than 2% of cases.
the risk of intra- or post-operative transfusion. Since the surgery is long, a transfusion may be necessary in less than 5% of cases.
Before the procedure:
In case of secondary breast reconstruction, a recent clinical check-up with your oncologist is necessary to detect a possible recurrence.
If you are taking Tamoxifen, it must be stopped 15 days before surgery because of the increased risk of postoperative phlebitis associated with this medication.
Once the surgery is scheduled, an abdominal angioscan is prescribed to visualize the path and location of the vessels that vascularize the DIEP flap.
Finally, you will need to order an abdominal compression girdle and anti-thrombosis compression stockings from your pharmacy.
The results of the operation
The result of a breast reconstruction by DIEP technique is stable over time. As it is a transfer of your own tissue, the reconstructed breast will follow your weight variations. In addition, it is subject to discrete ptosis or drooping like the remaining breast. Thus, in more than 50% of cases, symmetrization of the remaining breast is not necessary with the DIEP technique, which means that no additional scars are added to the breast not affected by the disease. The result is therefore completely different from a reconstruction by prosthesis or large dorsal prosthesis, where the implant once integrated remains fixed with an identical volume. In addition, there is no need for annual monitoring of the integrity of the implant or to change it in case of rupture. Clinical studies have shown that patients undergoing DIEP flap reconstruction undergo surgery an average of 2.5 times compared to 5 times in breast reconstruction with implants.
A breast reconstruction using the DIEP technique is covered at 100% by social security.
Unfortunately, the social security rate granted to the surgeon is less than 700 € for a surgery of six to eight hours.
This amount does not cover the cost of the operating aids related to this surgery that we perform with 2 surgeons and 2 assistants. We also employ a specialized nurse who spends the first two nights in your room to monitor the initial post-operative period. We charge additional fees ranging from 5,000 to 7,000€ depending on the case. Hospitalization in a single room is also mandatory and costs from 99 € to 180 € per day depending on the establishment chosen. These additional fees as well as the price of the single room may be reimbursed by your complementary health insurance.
Contact the association of patients reconstructed by the DIEP technique
Have a question? Please contact us!
Docteur Yaël Berdah and Docteur Marc-David Benjoar
Plastic surgeons in Paris France