Deep Inferior Epigastric Perforator (DIEP) flap is a new and rare post mastectomy breast reconstruction technique that offers more natural breast with the effects of a tummy tuck. Jennifer Jablon, here with son Ryan, underwent a new reconstructive microsurgery after mastectomy. Photo Credit: UT Southwestern Medical CenterNovember 06, 2009, (Sawf News) - Deep Inferior Epigastric Perforator (DIEP) flap is a new and rare post mastectomy breast reconstruction technique that offers more natural breast with the effects of a tummy tuck.
In the microsurgical procedure blood vessels called deep inferior epigastric perforators (DIEP), and the skin and fat connected to them are removed from the lower abdomen and transferred to the chest to reconstruct a breast without the sacrifice of any of the abdominal muscles.
DIEP flap is similar to Transverse Rectus Abdominis Myocutaneous (TRAM) flap, but involves no transfer of muscles from the abdomen to the chest for breast reconstruction.
DIEP flap and TRAM flap allow breast to be reconstructed with one's own tissues instead of a foreign implant.
Identification of the target and donor sites. Photo Credit: US GOVIn TRAM flap a portion of the abdomen tissue group, including skin, fat, minor muscles and blood vessels, collectively known as the "flap," is taken from the patient's abdomen and transplanted onto the breast site.
Surgeons individually reattach blood vessels to the relocated tissue under a microscope in a technically challenging procedure. They then shape the flap to create the new breast.
Muscle is included in the flap because blood vessels, or perforators, required to keep the tissue alive lie just beneath or within the abdominal muscle. However, removal of muscle can weaken the abdomen.
Raising the flap and transposing it to the target site. Photo Credit: US GOVIn DIEP, a small incision is made in the abdominal muscle in order to access the vessels beneath.
Since her teens, Jennifer Jablon had watched family members deal with breast cancer during their 40s, 50s, and 60s. She wondered whether it would be her fate too.
In her mid-50s, Jennifer's mother was diagnosed with breast cancer and tested positive for the recently identified BRCA1 gene, indicating a genetic predisposition to breast cancer.
"I spent about six months in denial after my mom tested positive. When I finally tested myself, I tested positive for the gene," she recalled. During subsequent MRIs, doctors twice found benign cysts, prompting her to seek a prophylactic bilateral mastectomy – a precautionary procedure in which both breasts are removed to minimize the risk of malignancy.
The choice also set her thinking about breast reconstruction options.
The 36-year-old mother of a 7-year-old opted for the DIEP flap procedure by plastic surgeons at UT Southwestern Medical Center.
"The DIEP flap procedure can offer women seeking breast reconstruction after a mastectomy some of the advantages of a more natural breast with the effects of a tummy tuck. Although it is more complex surgery, it preserves muscles for quicker recovery and less postoperative pain," explained Dr. Michel Saint-Cyr, assistant professor of plastic surgery and one of the few surgeons in the nation trained to perform the procedure.
The result of the reconstruction. Photo Credit: US GOVThe procedure can be done immediately after a mastectomy, so patients can have breast tissue removed yet awaken with reconstructed breasts, Dr. Saint-Cyr said.
"The goal was to go to sleep with two and wake up with two," said Ms. Jablon, who underwent the procedure this past spring.
In addition, for many women, the reconstructed breast is firmer, has a more youthful appearance than prior to reconstructive surgery and ages similarly to a natural breast, said Dr. Saint-Cyr, who specializes in breast reconstruction surgery.
To determine whether DIEP flap or other reconstruction options are suitable, Dr. Saint-Cyr recommends that women consult with a board-certified plastic surgeon who has experience with all the available procedures.
"This is a critical life decision, so all options should be on the table. That may not necessarily happen if the physician doesn't have experience in all these procedures," said Dr. Saint-Cyr, who has written numerous papers on the DIEP flap and similar procedures for peer-reviewed journals.
"Due to the complexity of the microsurgery, only about 40 surgeons nationwide routinely perform these types of procedures, so travel may be required for some women to find a surgeon with the needed experience," Dr. Saint-Cyr said.
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