DIEP Flap Breast Reconstruction Ohio
The DIEP flap, or deep inferior epigastric artery perforator flap, is an ideal option for breast reconstruction because it can produce very natural results, using one’s own tissue, while minimizing side effects at the donor site. This operation utilizes tissue from the lower abdomen. It is limited to skin and fat and, by definition, does not include muscle tissue. As a result, it spares the six-pack or rectus muscles which may improve muscle function and reduce the likelihood of complications that are sometimes seen with more traditional operations that interrupt these muscles, such as the TRAM flap.
The DIEP flap is extremely versatile and can be performed in many settings:
- For reconstruction either immediately after mastectomy surgery or in the delayed setting, months or even years after the mastectomy has been done
- For reconstruction after single or double mastectomy
- Because it consists of skin and fat that is outside the field of radiation, the DIEP flap is particularly useful when reconstructing patients who have had radiation therapy after their mastectomy
- For reconstruction without implants, potentially reducing the need for additional future operations that are often necessary when reconstructions are done with implanted devices.
Most patients are suitable candidates for reconstruction using a DIEP flap. Previous abdominal surgeries, such as hysterectomy and C-section, are typically not an issue. However some operations, including abdominoplasty (tummy tuck) and hernia repair with mesh, can be limiting. Other factors such as smoking and excessive body weight may pose challenges, but are not considered absolute contraindications to surgery. For patients who do not have an adequate amount of tissue on the lower abdomen, other perforator-based flaps, such as the GAP, TUG, or PAP flap may still be an option.
Dr. Kocak is a wonderful and skilled Plastic Surgeon. He was warm and professional and his office staff was equally caring......
He's very knowledgeable, honest, kind, and sincere. He made me feel comfortable......
Highly recommend Dr. Kocak. The whole team from front office to Doctor are caring and very professional. They put me at ease on my first visit and were honest, incredibly knowledgeable and detailed with explaining the procedure......
He wants the best for his patients and make sure his patients are informed so that they can make the right decision for them. The staff, as well as Dr Tiwari, are very nice and always helpful......
He is a great surgeon. He answered all my questions. He was very easy to talk to. The procedure went well and my recovery was short and less painful than I thought. The staff is great and made me feel very comfortable! I highly recommend Kocak, he‚??s ......
Dr. Tiwari is an excellent board certified plastic surgeon......
I had a great experience with Dr. Tiwari. He is amazing at what he does, he made me feel beautiful again. His staff was super friendly and welcoming. I am so pleased with the quality of care, the staff and the results......
Dr. Kocak is an amazing doctor. He has the best bedside manner of any doctor I've ever been to. Dr. Kocak is truly an artist in what he does. I highly recommend him. His staff is very well-mannered and expert in what they do......
Dr. Kocak is wonderful! I recently had a breast reconstruction surgery with Dr. Ergun Kocak and it was one of the best decisions I have ever made. I am so contented with the result. He was reassuring every step of the way and explained everything to me and made......
Dr. Kocak & Dr. Tiwari performed my DIEP reconstruction when I had my prophylactic double mastectomy due to having a BRCA1 mutation. Their excellent surgical skills are equally matched by their compassion, accessibility, and dedication to their patients. Their confidence and guidance led me ......
Dr. Kocak and Dr. Tiwari are amazing surgeons. ¬†They are caring, thorough, easy to get in contact with for questions and all around great doctors. ¬†After many years of painful, deformed implant reconstruction I chose to have the DIEP flap reconstruction, Drs. Tiwari and Kocak did a great job......
Frequently asked questions about DIEP flap reconstruction:
Why should I consider DIEP flap reconstruction?
Breast reconstruction after mastectomy surgery can be accomplished by several different surgical methods. Deciding between these options can sometimes be very difficult. The DIEP flap utilizes natural tissue from a person’s own body to reconstruct their breasts. For some patients, the possibility of having their reconstruction without the need for implants is appealing. In other cases, factors such as a single-sided reconstruction or previous radiation therapy may make using natural tissue a more favorable option when compared to the use of tissue expanders or implants.
Where will the tissue for my reconstruction come from?
The tissue used for the DIEP flap is taken from the patient’s own lower abdomen, between their belly button and pubic region. The scar that is left at this tissue donor site extends from side-to-side and is generally well-hidden by pants underwear.
The DIEP flap removes only skin and fat from this area. This is in contrast to the TRAM flap operation, which also removes all or part of the six-pack muscles.
Another major difference between the two operations has to do with the layer of tissue that overlies the muscles of the abdomen, known as the fascia. This layer of tissue is very important for providing strength and tone to the abdominal wall. If this tissue is interrupted, bulges or even hernias can occur. The TRAM flap, by design, requires some of the fascia to be removed with the flap. If this is done on both sides of the abdomen (as is the case for a two-sided reconstruction), the risk for bulge and hernia increases dramatically and synthetic mesh is sometimes required to fix and support this area. In contrast, the DIEP flap spares not only the muscle tissue, but the fascia as well. Mesh is rarely, if ever, needed and hernias are very unlikely.
Is a DIEP flap the same as a Tummy Tuck?¬†
The DIEP flap surgery is often billed as the “tummy tuck breast reconstruction.” While these two operations are not the same, some similarities do exist. First, the location from which the tissue is being removed in a DIEP flap procedure is very similar, and sometimes identical to that which is removed during a Tummy Tuck (abdominoplasty). Second, in both operations, only skin and fat is being removed. Muscle is not removed, but this is where the main difference between the two operations also enters. In a traditional Tummy Tuck, the tissue that is above the muscles (fascia) is tightened to create an “internal girdle” and flatten the front of the abdomen. During a DIEP flap, this layer of tissue is opened and the small vessels which supply blood to the skin and fat that will be removed and used for the breast reconstruction are carefully freed from the muscle fibers. In other words, the fascia is cut open and re-closed during a DIEP flap, but only tightened in a Tummy Tuck.
Can DIEP flap breast reconstruction be done on a patient who smokes or uses nicotine?
Nicotine, when present in the blood stream, can cause the small blood vessels in the body to squeeze shut. This can potentially limit the amount of blood and oxygen that reaches the tissues at the surgery site. In turn, this can lead to poor wound healing and loss of the tissues that were used to reconstruct the breasts. For these reasons, it is generally favorable if a patient who is an active smoker can completely abstain from nicotine use for four weeks before and four weeks following their surgery.
For patients who are unable to quit smoking, the DIEP flap may still be a very reasonable option as long as the patient understands the additional risks that smoking and the use of nicotine products may cause.
What are the most common problems or complications that are seen with DIEP flap reconstruction surgery?
While DIEP flaps are generally well tolerated, but just like any other type of operation, complications are possible.
Minor delays in wound healing are one of the more common issues. Small areas along the incision lines can separate at the level of the skin. These wounds are treated conservatively by washing them daily with soap and water and keeping them covered with clean gauze dressings. Most of them go on to heal uneventfully and do not require additional surgery.
Infection is relatively infrequent. When it does occur, it can generally be treated with antibiotic pills. Additional surgery is rarely needed. This is in contrast to tissue expander and implant reconstruction cases where infection is more frequent and a much bigger issue. Infection in these cases can lead to multiple additional surgeries and even failure of the reconstruction with removal of the expanders or implants all together.
Even though the DIEP flap does not require the six-pack muscles to be removed from the abdominal wall, it does require the surgeon to carefully follow the small vessels that are used to transplant the tissue to the breast. Therefore, there is a small chance for abdominal bulging or hernias to occur.
While not common, one of the most concerning complications is partial or total flap loss. One possible way this can occur is if a blood clot clogs one of the small vessels that supply blood to the transplanted flap tissue. Because we are monitoring the flap for blood flow and circulation continuously after surgery, we are generally able to detect such a blood clot immediately. Prompt attention and attempts to repair the vessels are usually successful. Another possible way a flap can partially be lost is due to fat necrosis. Fat necrosis occurs when the fat tissue in the flap does not receive adequate blood flow. When this happens, some of the cells will cease to survive, creating firm areas in parts of the flap. This can be avoided by designing the DIEP flaps to have robust blood supply and including critical vessels as they are harvested from the lower abdomen.
How long does DIEP flap breast reconstruction surgery take?
With our dual-surgeon approach, one-sided reconstruction generally takes between 3.5 to 5 hours and two-sided DIEP flap reconstruction generally takes between 6.5 – 8 hours.
The length of surgery can vary significantly for several reasons. Surgeon experience (not just years in practice, but actual number and frequency of operations done) is likely an important factor as there is a definite learning curve with the DIEP flap operation. We also believe that having a consistent team with more than one specialty-trained microsurgeon may not only shorten these otherwise lengthy cases, but lead to improved outcomes.
How long do patients stay in the hospital after DIEP flap surgery?
Most patients stay in the hospital for three days. Of course, this can vary by patient, with some staying as few as two days and others requiring up to five before they are comfortable enough to be released home.
How long does it take to recover from DIEP flap breast reconstruction and when can I return to work?¬†
In general, we recommend six weeks for a full recovery. During those initial six weeks, we prefer patients to refrain from strenuous activity and heavy lifting of any type. Many people can return to desk or other low-impact jobs approximately four weeks after surgery. People who hold jobs which require more strenuous activity, such as long hours of standing, lifting, or repetitive movements of the core may require the full six weeks to recover before returning to work.
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