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Everything You Wanted to Know about Laparoscopic DIEP

In reconstructive surgery, innovation and technique refinement are constant. Among the most significant advancements is the development of Laparoscopic Deep Inferior Epigastric Perforator (DIEP) flap surgery. This method represents a leap forward in reconstructive breast surgery, offering patients a less invasive option with numerous benefits.

In this blog, Sydney Specialist Plastic Surgeon Dr Bish Soliman discusses the details of Laparoscopic DIEP, its advantages, the procedure itself, and what you can expect during recovery.


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What Is Laparoscopic DIEP?

Laparoscopic Deep Inferior Epigastric Perforator (DIEP) flap surgery is an option for reconstructive breast surgery for patients undergoing mastectomy. This procedure is a testament to the advancements in medical science, particularly in the field of plastic and reconstructive surgery, where the emphasis on patient recovery, aesthetic outcomes, and minimally invasive techniques has never been stronger.

At its core, Laparoscopic DIEP flap surgery is a procedure that marries the principles of microsurgery with laparoscopic techniques. It involves the careful harvesting of skin and fat from the lower abdomen—akin to the tissue removed in a tummy tuck – abdominoplasty—but most important, it spares the abdominal muscles. This distinction is essential, as it not only preserves the structural integrity and function of the abdominal wall but also significantly reduces post-operative pain and expedites the recovery process.

The “deep inferior epigastric perforator” refers to the network of blood vessels that nourish the skin and fat of the lower abdomen. In the context of Laparoscopic DIEP flap surgery, these vessels are meticulously preserved and included with the harvested tissue. This ensures that when the tissue is transplanted to the chest area, it remains vibrant and healthy, capable of integrating seamlessly into its new location to form a natural-looking breast.

Unlike traditional DIEP flap surgery, which necessitates a larger muscle incision, the laparoscopic approach is characterised by its use of several small incisions to harvest the DIEP blood vessels. Through these incisions, Dr Soliman inserts specialised instruments and a camera, allowing him to operate with precision and causing minimal disruption to the surrounding tissues. This technique significantly reduces your recovery time and maintains your abdominal core strength.

The Evolution towards Laparoscopy

The journey towards the adoption of laparoscopic techniques in reconstructive surgery has been driven by a pursuit of better patient outcomes. Traditional DIEP flap surgeries, while revolutionary at their inception, presented challenges that spurred the search for improvements. These surgeries involved extensive internal incisions that could lead to longer recovery times, increased pain, and a higher risk of complications such as abdominal weakness and hernia formation.

When taking about the advantages of laparoscopic DIEP reconstruction surgery over the traditional DIEP method, it’s important to emphasise that while the external incision remains unchanged, the internal incisions are significantly smaller. This distinction is crucial for maintaining muscle strength and facilitating a faster recovery process.

The evolution towards laparoscopy represents a paradigm shift in surgical philosophy. By prioritising the preservation of muscle integrity and minimising tissue trauma, the laparoscopic approach addresses many of the shortcomings associated with traditional methods. This shift is not merely technical but also philosophical, reflecting a broader trend in medicine towards patient-centred care. It underscores a commitment to not only achieving the desired aesthetic and functional outcomes but also ensuring that the patient’s overall well-being and quality of life are enhanced.

Laparoscopic techniques have revolutionised various fields of surgery, and their application in DIEP flap procedures is a testament to their versatility and effectiveness. By utilising minimally invasive techniques, Dr Soliman can harvest the necessary tissue with precision, reducing the risk of damaging surrounding structures. This approach minimises the risk of complications such as abdominal weakness or hernia, which are more prevalent with traditional techniques (up to 20%) that may compromise the integrity of the abdominal wall.

Furthermore, the laparoscopic approach facilitates a quicker recovery. Patients typically experience less post-operative pain, thanks to the reduced trauma to the abdominal wall and the smaller incisions used. This not only enhances your comfort during the recovery period but also allows for a quicker return to daily activities and an overall shorter hospital stay.

Benefits of Laparoscopic DIEP

Laparoscopic DIEP flap surgery offers advantages that significantly enhance patient outcomes and satisfaction. These benefits not only underscore the technical advancements in surgical techniques but also highlight a patient-centric approach that prioritises minimal invasiveness, aesthetics, and overall well-being:

·       Quicker Recovery

The impact of surgery on a patient’s life extends beyond the operating room, with recovery time playing a crucial role in the overall surgical experience. Laparoscopic DIEP flap surgery is distinguished by its minimal impact on the abdominal wall, which translates to a faster recovery period. Patients typically find themselves able to return to their normal activities much sooner than they would after traditional surgery. This quicker recovery is not just about physical healing; it also means less time away from work, family, and social activities, thereby minimising the surgery’s disruption to the patient’s life.

·       Decreased Pain

Pain and discomfort are common concerns for patients undergoing surgery. The laparoscopic DIEP flap procedure addresses these concerns by preserving the integrity of the abdominal muscles. Since the muscles are not cut or significantly disturbed, patients experience considerably less post-operative pain and discomfort. This reduction in pain not only makes the recovery process more comfortable but also reduces the reliance on pain medication, which can have its own set of side effects.

·       Lower Risk of Complications

Every surgical procedure carries a risk of complications, but the laparoscopic DIEP flap surgery’s minimally invasive approach significantly reduces these risks. Traditional methods that involve more extensive dissection and manipulation of the abdominal wall can lead to complications such as hernias or muscle weakness. The laparoscopic technique, by preserving the abdominal muscles and using smaller incisions, greatly diminishes the likelihood of such complications. This not only contributes to a smoother recovery but also ensures long-term health and functionality of the abdominal wall.

How Is Laparoscopic DIEP Surgery Performed?

The Laparoscopic DIEP flap procedure requires a surgeon who is not only technically skilled in laparoscopic and microsurgical techniques but also possesses a deep understanding of aesthetics and patient care. The procedure unfolds in several meticulously planned steps:

Consultation and Planning

The process begins with a thorough consultation, where Dr Soliman evaluates your health, the condition of the donor site, and the desired outcome. This step is crucial for ensuring your suitability for the procedure and for setting realistic expectations. It also provides an opportunity for you to ask questions and express any concerns, ensuring you are fully informed and comfortable with the plan.

Harvesting the Flap

The next step involves the careful harvesting of the flap. A traditional skin incision is made to locate the blood vessels and then small incisions are made around the muscle to harvest the blood vessels. Dr Soliman uses laparoscopic tools to dissect and harvest the required blood vessels, while meticulously preserving the abdominal muscles. This phase demands precision and skill, as it sets the foundation for the success of the reconstruction.

Microsurgical Transfer

Once the flap is harvested, it is transferred to the chest area. Here, Dr Soliman employs microsurgery techniques to connect the flap’s blood vessels to those in the chest, ensuring the transplanted tissue receives adequate blood supply. This step is critical for the viability of the flap and requires a surgeon with expertise in microvascular surgery.

Shaping the Breast

The final step is the artistic shaping of the breast. Dr Soliman moulds the transferred tissue to create a breast that looks natural and symmetrical, taking into consideration the size and shape of the opposite breast if necessary.

Recovery and Aftercare

Recovery from Laparoscopic DIEP flap surgery is generally smoother and quicker than traditional reconstructive methods. You can expect:

  • Initial Hospital Stay: A short hospital stay is usually required to monitor the flap and ensure proper healing.
  • Pain Management: Pain and discomfort are managed with medication, and patients typically report less pain compared to traditional methods.
  • Recovery Time: Most patients can resume light activities within a few weeks, with a full return to normal activities after 6 to 8 weeks.
  • Follow-Up Care: Regular follow-up appointments are necessary to monitor the healing process and the success of the flap.

FAQs about Laparoscopic DIEP

How long does the Laparoscopic DIEP flap surgery take?

  • The length of time required for Laparoscopic DIEP flap surgery varies, influenced by factors such as the case’s complexity, whether the reconstruction involves one or both breasts, and the techniques employed by Dr Soliman. Typically, the procedure lasts between 4 to 7 hours—approximately 4 hours for a single breast and 6 hours for both breasts, with an additional 30 minutes added to the overall duration. For a more precise estimate tailored to your specific situation, it’s essential to consult with Dr Soliman.

What is the difference between a DIEP flap and a TRAM flap procedure?

  • Both DIEP (Deep Inferior Epigastric Perforator) flap and TRAM (Transverse Rectus Abdominis Muscle) flap procedures are used for breast reconstruction using tissue from the patient’s abdomen. The key difference lies in the preservation of muscle. The DIEP flap procedure preserves all the abdominal muscles, using only skin, fat, and blood vessels for the reconstruction. In contrast, the TRAM flap involves taking a portion of the abdominal muscle, which can lead to a longer recovery and a higher risk of abdominal weakness or hernia. The Laparoscopic DIEP flap is preferred for its muscle-sparing benefits.

Will I have sensation in the reconstructed breast after Laparoscopic DIEP flap surgery?

  • Recovery of sensation in the reconstructed breast varies among patients and depends on several factors, including the surgical technique and individual healing processes. While some patients report a return of sensation over time, it’s important to have realistic expectations. Sensation in the reconstructed breast may not be the same as in a natural breast, and the process can take months or even years. Ongoing advancements in microsurgical techniques continue to improve sensory outcomes for patients.

Can Laparoscopic DIEP flap surgery be performed after a failed implant reconstruction?

  • Yes, Laparoscopic DIEP flap surgery can be an option for patients who have experienced complications or are dissatisfied with the results of an implant-based breast reconstruction. This procedure can offer a natural-looking alternative using the patient’s own tissue. It’s important for patients to undergo a thorough evaluation by a surgeon experienced in both laparoscopic and microsurgical techniques to determine their suitability for this type of revision surgery.

How do I prepare for Laparoscopic DIEP flap surgery?

Preparation for Laparoscopic DIEP flap surgery involves several steps to ensure the best possible outcomes. You may be advised to:

  • Maintain a healthy lifestyle, including a balanced diet and regular exercise, to optimise overall health and healing.
  • Avoid smoking and limit alcohol consumption, as these can impair healing and increase the risk of complications.
  • Discuss all medications and supplements with Dr Soliman, as some may need to be adjusted or stopped before surgery.
  • Arrange for help at home during the initial recovery period, as mobility will be limited and rest is crucial.
  • Prepare your home for recovery, such as setting up a comfortable resting area and ensuring necessary items are within easy reach.

Further Reading about DIEP Breast Reconstruction with Sydney Consultant Plastic Surgeon Dr Bish Soliman

Medical References about DIEP Breast 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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