DIEP Flap  Breast Reconstruction Overview
The deep inferior epigastric artery perforator (DIEP) flap is a common technique where skin and tissue (no muscle) is taken from a person’s abdomen to recreate their breast. Lillie Shockney, administrative director of the Johns Hopkins Breast Center, further explains. For more information about the Johns Hopkins Breast Center, visit http://www.hopkinsmedicine.org/breast_center/ 0:01.1 The deep inferior epigastric artery perforator tissue 0:04.8 reconstruction, or DIEP FLAP, is the technique where skin and fat 0:09.1 tissue is taken from the abdomen in order to recreate the breast. 0:14.1 This is the most common tissue reconstruction procedure 0:17.1 performed at the Johns Hopkins Breast Center. 0:19.7 At Johns Hopkins we use a technique called vessel mapping, 0:24.1 which provides the surgeon a road map of the best vessels 0:27.7 to give better blood flow to the flaps, decreases the chance 0:31.6 of complications and reduces operating room time. 0:35.8 This is a pre-operative technique using 3D and 0:38.3 geography, which provides 0:41.0 an ultra high resolution map of the blood vessels. 0:44.7 At facilities that do not have this technology, 0:47.7 surgeons must look for the vessels once the patient's 0:50.6 abdomen is opened on the operating room table. 0:54.0 We feel it is beneficial to the patient to use vessel mapping. 0:58.3 An incision is made from hip to hip around the skin, fat and 1:01.8 blood vessels that would be used to reconstruct the breast. 1:05.1 The tissue is separated from the muscle and removed. 1:08.3 The skin is stretched down to close the abdomen. 1:11.4 The tissue from the abdomen is transplanted 1:13.7 into the breast pocket. 1:15.4 Blood vessels from the tissue are connected to blood vessels 1:18.3 in the chest to provide blood circulation for the new breast. 1:21.8 Small surgical drains are inserted for 1:23.8 your body's natural healing fluid. 1:26.0 This results in a scar on the newly reconstructed breast, 1:29.7 on the abdomen from hip to hip, and around the belly button. 1:33.8 The length of the surgery varies in different women. 1:36.9 However, generally the surgery lasts four to six hours 1:39.7 per breast. 1:40.9 Patients are usually in the hospital about three nights, and 1:44.3 can return to work approximately four to six weeks 1:47.5 depending on the type of work that they do. 1:49.2 While at home you will be able to do most activities of daily 1:53.0 living. 1:54.2 Heavy lifting, or strenuous activity, 1:56.2 should be avoided until six weeks following your surgery. 2:00.7 At Johns Hopkins, we strive to have shorter hospital stays for 2:04.0 these patients, 2:05.2 as we believe it benefits patients to recover at home. 2:08.8 In most circumstances, 2:10.0 the drains will remain in for one to two weeks. 2:13.1 But you'll begin to improve every day. 2:15.5 It is important to note that breast centers that do high 2:18.6 volume of these procedures, like John's Hopkins, tend to have 2:22.3 lower complication rates and shorter hospital stays for deep 2:26.0 flap reconstructions compared to lower volume centers. 2:30.4 Often you will require one or 2:32.1 more minor revision surgeries after your DIEP flap in order to 2:36.3 make your breasts as symmetric and natural looking as possible. 2:40.7 These revisions can include best lifts to match the breast shape 2:44.2 and location, fat grafting, nipple reconstruction and 2:48.9 an areola tattoo. 2:51.3 Your plastic surgeon will do everything possible to make your 2:54.1 breasts look and feel as natural as possible. 2:58.0 You should discuss all of your concerns with us, 3:00.7 as well as your expectations for 3:02.3 your post-op surgery appearance and recovery. 3:06.1 We can also show you photographs of other patient's results. 3:09.6 At Johns Hopkins, 3:10.8 your experienced breast reconstruction team will do 3:13.8 everything possible to make your breasts look and 3:16.6 feel as natural as possible. 3:18.4 And we'll be able to answer any of the questions or 3:20.7 concerns at any time throughout your treatment.