Breast reconstruction with DIEP flap
DIEP breast reconstruction: the benefits
This is the breast reconstruction technique with 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 abdomen obtained by abdominoplasty (tummy tuck).
DIEP breast reconstruction: what does it involve?
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.
Breast reconstruction with DIEP flap: procedure
The procedure is performed under general anesthesia. This requires a pre-anaesthetic 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 before the operation by our specialized radiologists at the Clinique de l'Alma.
Surgery lasts between 4 and 6 hours and requires hospitalization for 5 to 7 days, including 3 days in continuous care.
A return to work can be envisaged 2 weeks after the operation.
Diep breast reconstruction: contraindications
The first contraindication is that you do not have sufficient excess abdominal fat and skin to undergo a tummy tuck.
However, "hybrid" strategies can be proposed if you have a small tummy. The skin of the DIEP flap can repair the damage caused by radiotherapy, enabling volume to be added in a second phase by means of purified fat injections. A small stomach can also be harvested as a double DIEP, enabling it to be used in its entirety and reconstruct sufficient volume. However, a history of abdominoplasty with transposition of the umbilicus formally contraindicates this surgery. This is not the case for previous abdominal liposuction, provided the angioscan is favorable.
A history of recurrent phlebitis, severe overweight (Body Mass Index greater than 35) and age over 75 mean that DIEP flaps should be avoided.
Other contraindications are those for microsurgery, i.e. suturing 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, corresponding to abnormal whitening of the fingertips on exposure to cold, although this is not an absolute contraindication
- homozygous sickle cell anemia, a rare genetic disease that mainly affects people in West Africa.
Possible complications of DIEP flap reconstruction
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 DIEP flap breast reconstruction 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.
Results of breast reconstruction with a DIEP flap
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 large clinical study showed that patients operated on with a DIEP flap regained breast-related quality of life scores (Breast Q) identical to or higher than those obtained before mastectomy, which is not the case with implant reconstructions.
Price of breast reconstruction by diep: how much does this procedure cost?
Breast reconstruction using the DIEP technique is covered by social security.
Unfortunately, the social security rate paid to the plastic surgeon is less than €700 for a 4-6 hour surgery.
This amount does not cover the cost of surgical aids for this type of surgery, which we perform with 2 surgeons and two assistants. We charge additional fees ranging from €5,000 to €7,500, depending on the case. Hospitalization in a single room is also compulsory and costs €200 per day. These additional fees, as well as the cost of the single room, may be reimbursed by your supplementary health insurance.
DIEP flap breast reconstruction: before/after photos
Drs Yael Berdah and Marc-David Benjoar, plastic surgeons in Paris, have been performing Diep flap breast reconstruction for over 20 years, with more than 500 patients operated on. Discover the results of their operations from the before-and-after photos below:
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Cosmetic surgery in Paris
Docteur Yaël Berdah and Docteur Marc-David Benjoar
Plastic surgeons in Paris France