DIEP Flap Surgery with Nipple Sparing

When it comes to breast reconstruction, maintaining a normal look and feel to the breast is important in helping patients feel confident and accepting of their new bodies. With many types of breast reconstruction surgery, however, the breast is replaced with implants or with muscle and skin from other parts of the body. The result is either a breast that does not feel natural, and/or weakness in the part of the body where the muscle was taken to build the breasts. Avoiding these issues can often make a difference in how women recover, and, just as importantly, in how they feel about their bodies after their surgery. That is why many women choose a DIEP flap surgery with nipple sparing as their breast reconstruction surgery.

breast cancer and breast reconstruction

What is DIEP flap surgery with nipple sparing?

“DIEP” stands for the name of the blood vessels used in the surgery: Deep inferior epigastric perforators. They are blood vessels located in the abdomen. “Flap” refers to the use of your own skin, fat, blood vessels, and (in certain types of flap surgery) muscle to create the new breast. “Nipple sparing” refers to the fact that this surgery preserves the original nipple and areola. So, DIEP flap surgery with nipple sparing refers to a surgery during which the fat, skin, and certain blood vessels from your lower abdomen are used to reconstruct your breast (or breasts), all while preserving your original nipples.

Why should I consider this type of surgery?

Despite its somewhat intimidating name, DIEP flap surgery translates into a less complicated recovery for many women. The key is the fact that DIEP flap breast reconstruction does not use any muscle, unlike other types of flap surgery. Instead, it uses only abdominal skin, fatty tissue, and DIEP blood vessels to reconstruct the breast(s). This technique means that you will not suffer the herniation or weakness that many women experience in the areas where their muscle was taken for the breast reconstruction. You will also not experience any muscle bulge due to manipulation of any muscle during your surgery. Perhaps just as importantly, this surgery is much less invasive than other types of flap surgery. As a result, you are likely to feel less pain as you recover, require a shorter hospital stay, and be able to return to your normal activities more quickly. These benefits have convinced many women to choose DIEP surgery with nipple sparing over other types of flap surgery for their breast reconstruction.

What will my breast(s) look like after DIEP flap surgery?

DIEP surgery with nipple sparing can give you breasts that look and feel normal. While you will not have the same sensation as you did in your original breast, it will feel warm and natural to the touch. Plus, because your new breast will be made of your own skin, fat, and blood vessels, your breasts will change with you as you age, and you will never have to replace them as you would if you had implants. In addition, the nipple sparing portion of this surgery will leave you with a nipple and areola that may retain some sensation. Their preservation may mean more feeling in your breast than with other types of flap surgery, while also achieving a more natural look.

What are the downsides to this type of surgery?

DIEP flap breast reconstruction requires a high degree of skill in microsurgery (surgery using a microscope), because it requires the detaching and reattaching of tiny blood vessels. Because of the complexity of these procedures, you can usually expect a much longer surgery time (typically 6-8 hours total. However, Dr. Elisabeth Potter is known to perform such surgeries in shorter sessions). You will end up with a scar on your lower abdomen. And, if the surgery does not go well, you may be unable to pursue this type of flap surgery again. However, each of these drawbacks tends to be counteracted by the surgery’s many benefits. For example, your scar will lie across an abdomen that is tighter and firmer than before, thanks to the removal of tissue for the breast reconstruction. Potential complications include the clotting of an artery or vein that leads to the death of the tissue, herniation, or fat necrosis (when blood flow is cut off to the fat used in your DIEP flap surgery). However, these complications are either extremely rare (less than 2 percent), or easily corrected by a qualified breast cancer reconstruction surgeon.

Who makes a good candidate for this type of surgery?

DIEP flap breast reconstruction offers many advantages for the right candidates. Generally, the best candidates for this surgery are women who have sufficient abdominal tissue to complete the breast(s). However, procedures such as stacked DIEPs are available for thinner women who lack excess abdominal tissue. Candidates may also need to have finished their chemotherapy or radiation treatments a certain amount of time before the surgery, though you should always consult with your treatment team about the best breast reconstruction timing. If you want to know more about whether or not you might make a good candidate, let us know. You should always consult with a doctor before making decisions about medical procedures such as this one. We would be happy to discuss your individual situation and suitability for this potentially life changing procedure.

What is recovery from DIEP flap surgery like?

In general, you can expect a hospital stay of 3-5 days, and a total recovery time of 4-8 weeks. However, you will be able to walk and eat after the first day, and should experience a decrease in discomfort after the first week. Consult your doctor directly to learn details about your unique recovery plan. DIEP breast reconstruction is a groundbreaking and complex surgery. As a result, there are only a few surgeons who have the ability to complete it successfully. Even many surgeons skilled in breast reconstruction are unable to master DIEP breast reconstruction because of the complex microsurgery required. Dr. Potter, however, has successfully completed numerous DIEP flap surgeries and has the skill and experience to complete this surgery for you as well. If you think this type of surgery might help you to achieve the look and confidence you want after a mastectomy, let us know. We are both able and willing to help.