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Addressing Common Concerns and Myths about DIEP Flap Reconstruction

Breast reconstruction is an option for women who have battled breast cancer or faced genetic predispositions to the disease. Among the options available, DIEP flap reconstruction stands out as a solution for those seeking a more natural restoration process. However, despite its growing popularity and success rates, misconceptions and concerns cloud the understanding and acceptance of this procedure.

In this blog, Sydney Specialist Plastic Surgeon Dr Bish Soliman aims to discuss DIEP flap reconstruction, addressing common concerns and debunking myths, to provide clarity and comfort to those considering this surgery.

 

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What Is DIEP Flap Reconstruction

DIEP flap reconstruction is a form of autologous tissue breast reconstruction. The acronym “DIEP” stands for Deep Inferior Epigastric Perforator, which refers to the specific blood vessels that supply blood to the skin and fat below the belly button. Unlike other reconstruction methods that may use implants or other tissues, the DIEP flap procedure involves transplanting the patient’s own skin and fat from the lower abdomen to the chest to create a new breast mound after mastectomy. What sets DIEP flap apart is its preservation of muscle; the abdominal muscles are left intact, reducing recovery time and maintaining abdominal strength.

Step-by-Step Overview of the Procedure

The DIEP flap reconstruction process is meticulous and requires a skilled surgical team. It begins with the careful removal of skin and fat from the lower abdomen, ensuring the deep inferior epigastric perforator arteries and veins are preserved. This tissue, now called the “flap,” is then transplanted to the chest. Microsurgery techniques are employed to connect the blood vessels of the flap to those in the chest, ensuring the transplanted tissue receives adequate blood supply. The abdominal incision is then closed, often providing the added benefit of a flatter abdomen, much like a tummy tuck.

Benefits of Choosing DIEP Flap Reconstruction

Opting for DIEP flap reconstruction comes with benefits, making it an attractive choice for many. The use of your own tissue results in a breast that feels and looks more natural compared to synthetic implants. Since the abdominal muscles are preserved, patients typically experience a quicker recovery and maintain their core strength, which is important for overall health and well-being. Additionally, the procedure offers the cosmetic advantage of abdominal contouring, which is akin to the results of a tummy tuck – abdominoplasty.

Despite these advantages, the decision to undergo DIEP flap reconstruction is personal and should be made after thorough consultation with Dr Bish Soliman.

Common Concerns about DIEP Flap Reconstruction

When considering DIEP flap reconstruction, patients often have a myriad of concerns ranging from the recovery process to the impact on their daily lives. Here, we discuss some of the most common worries and provide insights to help alleviate apprehensions:

Pain and Recovery

Recovery from DIEP flap reconstruction is a significant concern for many. It’s a complex surgery that requires patience and time for healing. Initially, you can expect some discomfort, swelling, and bruising both at the donor site (abdomen) and the reconstruction site (breast). Pain management is a critical component of the recovery process, with Dr Soliman prescribing medication to help control discomfort in the early stages.

The first few days post-surgery are usually spent in the hospital, where medical staff can monitor healing and manage pain. You will be encouraged to walk with assistance to promote blood circulation and reduce the risk of blood clots. The total recovery time varies but generally, most patients can resume light activities within 4 to 6 weeks. Full recovery and a return to all normal activities, including exercise, may take up to 3 months as the body heals and adjusts to the changes.

Effective pain management strategies include medication, gentle exercises as recommended by the healthcare team, and wearing compression garments to support the healing areas. It’s also important for you to follow Dr Soliman’s advice on care for the surgical sites and engage in regular follow-up appointments to ensure a smooth recovery.

Scars after DIEP Breast Reconstruction

Scarring is an inevitable part of surgery, and DIEP flap reconstruction is no exception. The procedure leaves a horizontal scar across the lower abdomen, where the tissue was harvested, and scars on the breasts depending on the extent of reconstruction required. The appearance of scars can vary based on individual healing processes, but Dr Soliman strives to place incisions in less visible areas.

Minimising scarring involves several post-operative measures. Keeping the incision sites clean and protected, avoiding direct sun exposure, and following Dr Soliman’s guidelines on when to start using scar treatment creams or silicone sheets can be beneficial. Over time, scars usually fade and become less noticeable. It’s also helpful to maintain a healthy lifestyle, as proper nutrition and hydration can support the body’s healing process.

Surgery Time and Hospital Stay

The duration of DIEP flap reconstruction surgery can be a concern, as it is a lengthy procedure. Typically, the surgery lasts anywhere from 4 to 8 hours, depending on the complexity of the case and whether one or both breasts are being reconstructed. The time-consuming nature of the surgery is due to the meticulous work required in microsurgery to connect blood vessels.

Patients usually stay in the hospital for 5 to 7 days following their surgery. This allows the medical team to closely monitor your recovery, manage pain, and ensure that the blood flow to the transplanted tissue is stable. The hospital stay is also a crucial time for you to begin mobilising under supervision, which is vital for preventing complications.

Impact on Abdominal Strength

A common concern about DIEP flap reconstruction is its impact on abdominal strength. Unlike older techniques that involve taking muscle from the donor site, the DIEP flap preserves all the abdominal muscles. This approach significantly reduces the risk of weakened abdominal strength post-surgery. However, some patients may experience changes in sensation or tightness in the abdomen as they recover.

Post-operative rehabilitation plays a role in regaining strength and functionality. Physical therapy is often recommended to help you strengthen your core muscles gently and safely. Exercises tailored to individual needs and capabilities are gradually introduced, focusing on building strength without straining the healing tissues. You are encouraged to communicate openly with Dr Soliman and his team about the recovery and any concerns regarding physical activity.

Myths about DIEP Flap Reconstruction

DIEP flap reconstruction, while increasingly popular, is surrounded by myths and misconceptions that can deter individuals from considering it as a viable option for breast reconstruction. It’s important to separate fact from fiction. Here, we address some of the most persistent myths and provide evidence-based information to debunk them:

Myth 1: DIEP Flap is Only for Certain Ages or Body Types.

The Reality:

One common misconception is that DIEP flap reconstruction is suitable only for a specific age group or body type. In reality, the procedure can be a viable option for a wide range of patients. The primary consideration is not age or body type but rather the availability of sufficient abdominal tissue to create a new breast and the overall health of the patient. Candidates for DIEP flap reconstruction include those who prefer using their own tissue over implants and have enough abdominal fat to harvest, regardless of their age or body size. Each patient is assessed individually, taking into account their medical history, body composition, and personal preferences.

Myth 2: The Risk of Complications is High.

The Reality:

Any surgical procedure carries risks, but the notion that DIEP flap reconstruction has a high complication rate is misleading. While it’s true that the surgery is complex and requires a skilled microsurgeon, the complication rates are comparable to or even lower than other reconstruction options when performed by experienced professionals. Complications can include issues with wound healing, flap failure (< 1%), or abdominal weakness, but these are relatively rare. Advances in surgical techniques and post-operative care have significantly reduced these risks. You should discuss potential complications with Dr Bish Soliman to gain a realistic understanding of the risks versus the benefits.

Myth 3: Recovery is Extremely Long and Difficult.

The Reality:

The belief that recovery from DIEP flap reconstruction is exceptionally long and challenging is another myth that needs addressing. While the recovery process is indeed longer than some other procedures, such as implant reconstruction, it’s important to consider the quality of the outcome. Most patients can return to their normal daily activities within 3 months, and the full benefits of the surgery, including a natural-looking breast and improved abdominal contour, often outweigh the initial recovery period. Additionally, because the abdominal muscles are preserved, patients typically experience less pain and a quicker return to full activity levels compared to older flap procedures that involve muscle removal.

Myth 4: It Will Completely Eliminate the Risk of Breast Cancer.

The Reality:

A dangerous myth is the belief that DIEP flap reconstruction, or any form of breast reconstruction, can eliminate the risk of breast cancer recurrence. It’s essential to understand that breast reconstruction is designed to rebuild the breast’s shape and appearance after mastectomy or lumpectomy and does not influence the risk of cancer returning or developing anew. Patients should continue regular screenings and follow their healthcare provider’s recommendations for monitoring their health. The choice of reconstruction method should be based on personal preferences, medical history, and lifestyle, not on misconceptions about cancer risk.

Additional Concerns

Beyond these myths, there are other concerns and misconceptions that patients may encounter. It’s essential to have open, honest conversations with Dr Soliman to gain accurate information. Here are a few additional points to consider:

  • Sensitivity and Sensation: Some believe that DIEP flap reconstruction results in a complete loss of sensation in the reconstructed breast. While it’s true that sensation can be diminished initially gradual improvement in sensation over time can occur.
  • Aesthetic Outcomes: Another myth is that reconstructed breasts will look unnatural. The use of the patient’s own tissue in DIEP flap reconstruction allows for results that many find to be more natural in appearance and feel compared to implants, with the added benefit of matching the body’s ageing process more closely.
  • Insurance Coverage: There’s also a misconception that DIEP flap reconstruction is not covered by insurance. In many countries, including Australia, breast reconstruction after mastectomy, including DIEP flap, is covered by insurance. Read more about Medicare for DIEP Breast Reconstruction here.

FAQs about DIEP Flap Reconstruction

How long does it take for the final results of DIEP flap reconstruction to be visible?

  • The initial healing phase post-DIEP flap reconstruction can take several weeks, during which swelling and bruising decrease. However, it may take up to a year for the final shape and appearance of the reconstructed breast(s) to fully settle and for scars to mature and fade as much as possible. This timeline can vary based on individual healing processes, the body’s response to surgery, and any additional treatments that may be required, such as radiation therapy.

Can DIEP flap reconstruction be done at the same time as a mastectomy?

  • Yes, DIEP flap reconstruction can be performed immediately following a mastectomy in what is known as immediate reconstruction. This approach has the advantage of reducing the number of surgeries and anaesthesia exposures. It can also offer benefits by avoiding the experience of a flat chest after mastectomy. However, whether immediate reconstruction is suitable depends on various factors, including the patient’s overall health, cancer treatment plan, and personal preference. Some patients may opt for delayed reconstruction to allow time for recovery from the mastectomy or completion of additional cancer treatments.

Is it possible to have DIEP flap reconstruction after having had implant-based reconstruction?

  • Yes, patients who have previously undergone implant-based breast reconstruction and are experiencing complications or are dissatisfied with their results can consider converting to DIEP flap reconstruction. This process involves removing the implants and using the patient’s own tissue for the reconstruction. It’s a complex procedure that requires careful planning and discussion with a surgeon experienced in both explantation and DIEP flap techniques.

Will I need additional surgeries after DIEP flap reconstruction?

  • Some patients may require or opt for additional surgeries to refine the shape of the reconstructed breast, adjust symmetry, or perform nipple reconstruction. These revision surgeries are typically less extensive than the initial reconstruction and are often planned after the primary reconstruction has fully healed. The need for further surgeries depends on individual goals, the healing process, and the initial outcomes of the reconstruction.

How does DIEP flap reconstruction impact future mammograms or cancer screenings?

  • DIEP flap reconstruction does not interfere with the ability to perform mammograms or other forms of breast cancer screenings. However, it’s important to inform the radiologist about your reconstruction, as the presence of transplanted tissue may alter the appearance of mammogram images. Regular screenings remain an essential part of post-reconstruction care, and your healthcare team will guide you on the appropriate schedule and type of screenings based on your personal history and risk factors.

 Further Reading about DIEP Flap Reconstruction with Sydney Specialist Plastic Surgeon Dr Bish Soliman

Medical References about DIEP Flap Reconstruction

About Dr Bish Soliman

Dr Bish Soliman - Sydney Plastic and Reconstructive Surgeon, about us 01 2x
Specialist Plastic, Reconstructive and Cosmetic Surgeon
FRACS (Plas), MS (Plas), MBBS (Hons 1), BCom

AHPRA Registered Medical Practitioner MED 0001679053 Specialist Registration in Plastic Surgery

Dr Bish Soliman is a Sydney-based Specialist Plastic and Reconstructive Surgeon who performs aesthetic surgery of the face, breast, and body as well as skin cancer surgery.

He currently holds two consultant microsurgery positions in major Sydney hospitals performing complex microsurgical reconstruction including DIEP breast reconstruction.

After graduating from The King’s School, Dr Bish completed a Bachelor of Commerce degree at the University of Sydney. After working briefly at a major Sydney finance firm, he decided to pursue his passion and long-term goal of a career in medicine. He graduated from the University of Notre Dame at the top of his class, receiving First class honours and the prestigious Bower and Sherrard medal. He then went on to complete his junior medical training at Westmead Hospital during which time he was awarded Junior Medical Officer (JMO) of the Year, as well as a finalist for NSW Doctor of the Year.

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