Reconstructing a breast using parts of your own body: Learn about DIEP Flap Surgery

Fighting breast cancer is not an easy journey. During that journey, you may have to have all or part of your breast removed. After that, it's normal to wonder, 'Should I have breast reconstruction?' This is a very personal decision. So, for those of you who are thinking about making such a decision, today we're talking about the most advanced method available, the DIEP Flap surgery.

What is DIEP Flap surgery?

Simply put, this is a surgery where you use your own body parts to create a new breast to replace the one that was removed. DIEP stands for `Deep Inferior Epigastric Perforator`. This is the name of a blood vessel in your lower abdomen.

In this surgery, the surgeon takes skin, fatty tissue, and blood vessels from your lower abdomen and uses them to reconstruct the breast.

In the TRAM flap surgery, which is an older method, the tissue is taken along with the abdominal muscles. This takes longer to heal and the strength of the abdomen is reduced. However, this problem does not occur with the DIEP flap. Therefore, the healing time is shorter and the strength of the abdomen is preserved.

Who needs this surgery?

Breast reconstruction is a procedure that can be considered by anyone who wants to reconstruct a breast after breast cancer surgery, either a mastectomy or lumpectomy. This can be done at the same time as the cancer surgery, or at a later date.

Having breast reconstruction is a completely personal decision. Some people make this decision for reasons such as:

• Get a balanced, beautiful body.
• Be confident because the clothes fit perfectly.
• Increase your self-esteem.

Is this the only way to reconstruct breasts?

No. There are two main methods of breast reconstruction. If you are making this decision, you should carefully discuss the advantages, disadvantages, and risks of each method with your doctor.

Are there any cases where DIEP Flap surgery cannot be performed?

Yes, not everyone is suitable for this surgery. There are times when this surgery may not be suitable for you. Here are some of the situations:

• If you have already had a DIEP flap or TRAM flap surgery: This type of tissue can only be removed from the stomach once in a lifetime.
• If there is not enough fatty tissue in the abdomen: If you are very thin, or if you have previously had abdominal fat reduction surgery (`abdominoplasty` or `tummy tuck`), you may not have enough tissue.
• If there is a problem with the blood vessels in the stomach: Sometimes these blood vessels are very small, or they are in a difficult place to operate on. But now, with advanced technology, there are ways to operate on these cases as well.
• Previous abdominal surgery: Some major abdominal surgeries (such as a colostomy) can be a problem. However , a C-section or open hysterectomy is usually not a problem. This is a common problem for many people, so talk to your doctor about it.

How do you prepare before surgery?

Your doctor will give you specific instructions on what to do before surgery, but here are some general things to prepare for:

• Do light exercise: Doing light exercise for a few weeks before surgery can help strengthen your muscles and maintain good heart health.
• Avoid smoking completely: Stay away from anything that contains nicotine. This is very important for the wound healing process.
• Stop taking certain medications: Medications that affect blood clotting, such as aspirin and NSAIDs (nonsteroidal anti-inflammatory drugs), may need to be stopped for a while on the advice of your doctor.

How is the surgery done?

This surgery usually takes between 6 and 8 hours. This is a bit of a long, complicated surgery. Let's take a simple look at what happens.

1. Anesthesia

Before the surgery begins, you will be fully anesthetized, which means you will be completely asleep and will not feel any pain.

2. Incision

The doctor will make a long horizontal incision in your lower abdomen, between your hip bones. This incision is usually made in a way that can be hidden by your underwear.

3. Tissue removal

Next, a flap containing skin, fat, and blood vessels is carefully removed from that incision. Again, no muscle is removed here.

4. Tissue transfer

Now this piece of tissue is taken to the area of ​​the chest where the breast is to be made. This is where the most complex and important part of the surgery takes place. That is, the tiny blood vessels in that piece of tissue are very carefully transplanted to the blood vessels in the chest. A special technique called `Microvascular surgery` is used for this.

5. Breast shaping

Once the blood supply is properly connected, the doctor uses that tissue to create a new breast that matches the other breast and looks natural.

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 the chest and abdomen are closed with stitches. When the skin on the abdomen is pulled and sewn, it is done in a way that leaves your belly button in a natural position. As an added benefit, the skin on the abdomen will look slightly taut (similar to a `tummy tuck`) after the surgery.

What are the benefits and risks of this surgery?

Like anything, there are benefits and minor risks.

Benefits

• Natural look and feel: Because your own tissue is used, the new breast will look and feel much more natural than an implant.
• No damage to muscles: As mentioned earlier, since the abdominal muscles are not damaged, the abdominal strength remains the same.
• Permanent Results: The results are permanent. They won't burst, harden, move around like implants, or need to be replaced when you get bigger/weaker.
• Ability to regain sensation: In some cases, some level of sensation can be regained in the newly reconstructed breast.

Risks

These occur very rarely, but it's important to be aware of them.

• Hernia: Very rarely, a part of the intestine can protrude through a weak spot in the abdominal muscles.
• Lumps: Scar tissue may form inside the new breast and feel like hard lumps. These may go away on their own, or they can be removed with minor surgery.
• Tissue death (`Necrosis`): If the blood supply to the transplanted tissue is insufficient, part of that tissue may die. In that case, the dead part will have to be removed.

How long does it take to heal?

It can take 6 to 8 weeks to fully heal. You will be asked to wear a special compression garment around your chest and abdomen for the first few weeks. You should avoid heavy lifting, strenuous activities, and activities that involve lifting your arms overhead for the first few weeks.

You can expect these things:

• Numbness: You may feel numbness in your new breast and abdomen. This may take about a year to completely go away.
• Pain and soreness: The pain in the chest and abdomen will subside significantly after about two weeks.
• Swelling: Swelling around the breasts, armpits, and abdomen may persist for several weeks.
• Skin tightening: You may feel a tightening sensation in the skin of your stomach and breasts.

The success rate is as high as 96% - 99%. So there is nothing to worry about.

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