Fighting breast cancer is a real challenge. During that journey, you may have to undergo a mastectomy or lumpectomy. After that, the thought of "What will I look like now?" may haunt you. But don't worry. Today, medical science has advanced a lot. There are various ways to give you a natural look again. Today, we are going to talk about one such special method.
What is DIEP Flap surgery? Let's understand it simply.
Okay, this name may sound a bit complicated. But let's keep it simple. DIEP Flap Surgery is a type of breast reconstruction surgery.
Imagine taking a small part of your own body and using it to rebuild your breast. That's what happens here. Here, the surgeon takes a piece of skin, fat, and blood vessels from your lower abdomen and uses them to create a new breast where your breast used to be.
The blood vessel used here is called the `DIEP (deep inferior epigastric perforator artery)`. You don't need to think too much about the name. The important thing is that this is part of your own body.
Why is this so special?
One of the biggest and most important advantages of this surgery is that the doctor removes only this area of skin and fat without damaging or removing any of the muscles in your stomach .
In the older `TRAM (transverse rectus abdominal muscle) flap` surgery, this tissue was taken along with a portion of the stomach muscle. Then the stomach muscle becomes weak, and the recovery time is longer. But with the DIEP flap surgery, that problem does not arise. Therefore, you can recover quickly and keep the strength of the stomach. Just like a ``tummy tuck``, the stomach becomes flat, which is an added advantage!
Who is this surgery suitable for and why would someone choose it?
Anyone who wants to reconstruct a breast after breast cancer surgery can consider this. This surgery can be done at the same time as the cancer surgery (immediate reconstruction), or it can be done after all cancer treatments have been completed, some time later (delayed reconstruction).
Breast reconstruction is a completely personal decision. No one is forcing you to do it. Some people make this decision for reasons like:
- Achieve a balanced appearance: Having a breast removed can feel like your body is out of balance. This surgery can help restore that appearance.
- Dress properly: This is a good solution to avoid discomfort when dressing.
- Increase self-confidence: This is a great way to overcome anxiety about your appearance and rebuild your self-confidence.
Remember, it's your body, your decision. You have every right to choose what suits you best.
Can't everyone have this surgery?
Actually, DIEP flap surgery is not suitable for everyone. There are some cases where it may not be possible. Let's take a look at what those cases are.
| When surgery is not appropriate | Simply explained |
|---|---|
| If you have had this type of surgery before | If you have had a DIEP or TRAM flap surgery before having your other breast reconstructed, you cannot have tissue taken from your stomach again because that part can only be used once. |
| If there is not enough fat in the lower abdomen | If you are very thin, or have previously had a tummy tuck (abdominoplasty or liposuction), you may not have enough fat and skin in your stomach to create a breast. |
| If there is a problem with the blood vessels in the stomach | Sometimes the blood vessels needed for this surgery may be too small or their location may be different. However, with the new technology available today, there are ways to perform the surgery in these cases as well. |
| Other previous abdominal surgeries | If you have had major surgery, such as a colostomy, this may not be possible. However, it is usually not an obstacle to having this surgery, even if you have had a C-section or an open hysterectomy. |
Your doctor can make the best decision about this. He or she will examine you and tell you exactly whether this surgery is right for you or not.
What should you do before surgery?
Since this is a major surgery, you need to prepare well in advance. Your doctor will give you all the necessary instructions. They will usually tell you to do the following:
- Health tests: You will need to have several tests, such as blood tests, to see if your body is fit for surgery.
- Exercise: Light exercise for a few weeks before surgery can help strengthen muscles and maintain good heart health.
- Avoid smoking: If you are a smoker, you should stop completely before surgery. Do not use anything that contains nicotine. Smoking can constrict blood vessels and interfere with healing after surgery.
- Stop some medications: Your doctor will likely ask you to stop taking blood-thinning medications, such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), before your surgery. Be sure to tell your doctor about any other medications you are taking.
What happens during the surgery?
This surgery usually takes between 6 and 8 hours. This is a somewhat complicated surgery. Let's see what happens step by step.
1. Anesthesia: First, you will be completely anesthetized. This means that you will not feel anything during the operation, you will be completely asleep.
2. Incision: Next, the surgeon will make a long, horizontal incision in your lower abdomen, between your hip bones. This incision is usually made so that it is hidden by your underwear.
3. Tissue removal: A flap containing skin, fat, and blood vessels is carefully removed from the incision without damaging the muscles.
4. Tissue transfer: Then, an incision is made in the same area where your breast was removed, and the tissue from your abdomen is transferred there. This is the most important and complicated part. Under a microscope, very delicately, the blood vessels in that tissue are connected to the blood vessels in your chest. This is called `microvascular surgery`.
5. Breast shaping: Once the blood supply is properly connected, the doctor uses that tissue section to create a natural breast shape.
6. Drain placement: After surgery, small tubes (drains) are placed in the incisions in the abdomen and chest to drain any fluid that collects in the wounds. These are removed in a few weeks.
7. Closure: Finally, the incisions in your chest and abdomen are closed with stitches. As the skin on your abdomen is pulled and sewn together, your belly button is also repositioned in a natural-looking position.
What can you expect after surgery?
After surgery, you will need to stay in the hospital for about two to five days. After you go home, it will take about 6 to 8 weeks to recover. During this time, you may experience things like:
- Pain and discomfort: You may experience some pain and stiffness in the chest and abdomen for the first two weeks. Your doctor will prescribe painkillers for this.
- Swelling: The surgical area may be swollen. This swelling will gradually subside.
- Numbness: You will feel a tingling sensation in your newly created breasts and abdomen. It may take up to a year for this sensation to return.
- Restrictions: Doctors will advise you not to do strenuous activities like lifting weights or lifting your arms overhead for about a month and a half.
You will be asked to wear a special garment (compression garment). The hospital will also give you detailed instructions on how to care for your wounds and drains at home.
What are the benefits and risks of this surgery?
Like any surgery, DIEP flap surgery has both benefits and risks. It is important to be aware of both before making a decision.
| Benefits | Risks |
|---|---|
| Natural look and feel: Because it's your own tissue, the new breast looks and feels very natural. | Tissue death (Necrosis): If the connected blood vessels do not drain properly, the tissue may die. In this case, the area may need to be surgically removed. This is very rare. |
| No muscle damage: Since your abdominal muscles are not damaged, your strength remains the same. You can also recover quickly. | Hernia: A weakness in the abdominal wall that allows part of the intestine to protrude. This is also uncommon. |
| Permanent Results: This is a permanent solution. Unlike implants, it won't break, slip, or shift with weight gain or loss. | Lumps: Sometimes scar tissue can build up inside the breast and feel like lumps. These often go away on their own. |
| Ability to feel: In some cases, nerves from tissue taken from the abdomen can be connected to nerves in the chest, restoring some sensation in the breast. | General surgical risks: The risks of any surgery, such as bleeding and infection, are also present here. |
What time should I call the doctor?
If you have any of these symptoms while at home after surgery, call your doctor immediately:
- Fever
- Severe pain
- Difficulty breathing (dyspnea)
- Excessive bleeding from wounds
- Pus-like, foul-smelling fluid draining from wounds (signs of infection)
Take-Home Message
- DIEP flap surgery is a method of reconstructing a breast using your own skin and fat from your lower abdomen after breast cancer surgery.
- There is no damage to your abdominal muscles, which is one of the biggest advantages of this surgery.
- The result is very natural and permanent.
- This is not a one-size-fits-all surgery. Your doctor is the best person to know if this is right for you.
- It takes about 6-8 weeks to fully recover after surgery. It is very important to follow the doctor's instructions exactly during this time.
- Breast reconstruction is a personal decision. Talk openly with your doctor about it and choose what's best for you.
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