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Deep Inferior Epigastric Artery Perforator (DIEP) Flap

The DIEP flap is the technique where skin and tissue (no muscle) is taken from the abdomen in order to recreate the breast. This is the most common procedure performed at our Breast Center as women generally have excess skin and fat along the lower portion of their abdomen; plus, patients like the “tummy tuck” it gives. This flap may be preferable to the older TRAM procedure, where women are prohibited from lifting anything weighing more than 25 lbs., because of the risk of a hernia.

What is a staged DIEP flap?

A “staged” DIEP flap is one that is done in phases, over time. This is a good option for women who might need post-mastectomy radiation therapy. A tissue expander is placed at the time of mastectomy and a few months later, when treatment is complete, the flap reconstruction can begin.

Deep Inferior Epigastric Artery Perforator (DIEP) Flap procedure.
Deep Inferior Epigastric Artery Perforator (DIEP) Flap procedure.

What are the benefits of a DIEP flap?

When the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about problems with implants. This technique minimizes the much higher risk of hernia or bulge which occurs more commonly in TRAM flap operations. In bilateral (both sides) reconstruction, TRAM flap patients have severely compromised abdominal wall strength which forces them to “roll over” out of bed, or use accessory muscles to rise from a chair or from lying down. Bilateral DIEP flap reconstruction avoids these impairments but has equivalent scar patterns. You will also have the added benefit of an improved abdominal contour.

Breast Reconstruction Surgery - DIEP Flap

At Johns Hopkins, the DIEP Flap reconstruction is an important option offered to mastectomy patients. This animation shows and describes this advanced surgical procedure.

What will I look like post-surgery?

Your plastic surgeon will do everything possible to make your breasts look and feel as natural as possible. Often you will require a final surgery after your DIEP flap in order to make your breasts as symmetric and natural-looking as possible. Creative techniques, such as fat transfer or grafting, may be used to give your silhouette a more natural appearance. You should discuss all your concerns with your plastic and reconstructive surgeon, as well as your expectations for your post-surgery appearance and recovery. He or she can also show you photos of other patients’ results.

How long will it take to recover from DIEP flap surgery?

This type of operation will require you to stay in the hospital for three or four days. This is shorter than most centers’ hospitalizations for these procedures. You will be able to eat the next day after surgery, and you will be able to get out of bed and walk with assistance on the second day after surgery. While at home you will be able to do all activities of daily living. Heavy or strenuous activity should be avoided until follow-up with your surgeon. You will also have three to four surgical drains depending on whether one or two breasts are reconstructed. In most circumstances, these drains will remain in for one to two weeks. If they are highly productive they will stay in longer.

The recovery time for flap reconstruction is four to six weeks to resume most normal activities. You will be sore for about a week or two and then begin to improve every day.

Compare reconstructive options.