Tag Archives: DIEP

Do you do the DIEP flap for breast reconstruction?

We don’t do the DIEP flap at Lawrence Plastic Surgery for several reasons.  A recent article in our local paper discussed this procedure being performed at a nearby teaching hospital and pointed out they were the only ones performing this procedure within “several hundred miles”.  Although this procedure was first being performed almost 20 years ago, it has not gained widespread popularity.  Here’s why:

  • It requires a much longer operating time than other techniques, especially if both breasts are reconstructed immediately after mastectomy.  In the same recent article the patient mentioned her “14.5 hour surgery”.  This is significantly longer than a traditional TRAM flap operation or tissue expander/implant reconstruction.  Longer operations, as you can imagine, are harder on patients than shorter ones.
  • The post-operative stay is significantly longer after this surgery as compared with a tissue expander/implant reconstruction.  Most of our immediate reconstruction patients are discharged the day following surgery when we use a tissue expander reconstruction as opposed to several days after a DIEP flap.  The time to return to normal activities, including work and exercise, is much longer with a DIEP flap.
  • The advantages of a DIEP flap over a pedicle TRAM flap (which we perform) are still debated in the plastic surgery community.  As we only utilize a portion of the abdominal muscles in a pedicle TRAM, functional muscle loss is usually not significant in most patients.
  • Tissue expander/implant reconstruction is getting better all the time.  The use of skin/areola/nipple sparing techniques along with the use of acellular dermal matrix products (Alloderm, etc.) and better implants has given us much better results than even just a few years ago.
  • Many patients are simply not good candidates for a DIEP flap due to inadequate tissue, body habitus, or other medical problems.
  • The available abdominal tissue in a DIEP reconstruction determines the size of the reconstructed breasts.  With tissue expander/implant reconstruction, a patient has more options in determining the final size of her breasts.

While we admire those surgeons who are performing the DIEP flap, and many patients can attest to their good results, we still have misgivings about performing this procedure, as do many other plastic surgeons involved in breast reconstruction.  There are more than 10 times as many breast reconstruction operations performed with tissue expander/implant techniques than the DIEP flap.  We believe there is a good reason why the number of tissue expander/implant reconstructions continues to increase year after year while the number of DIEP flaps performed has remained relatively flat over the years despite initial enthusiasm about this procedure.