The abbreviation DIEP stands for „Deep Inferior Epigastric Artery Perforator Flap”. It is also known as abdominal skin-fat flap or lower abdominal flap. Perforator flaps refer to tissue units whose blood supply is running in such a way that it passes through (perforates) the underlying musculature. This gives the surgeon the possibility to extract the tissue sparingly without damaging the underlying musculature. The term DIEP refers to the tissue segment on the lower abdomen below the belly button. Here lies usually a skin and fat surplus from where tissue can be extracted and re-used to reconstruct one or at the same time two breasts. The area of the abdomen from which the tissue is removed is tightened as a result of the loss of skin excess. This is known as a tummy tuck creating an abdominal profile that is smoother and firmer. The scar line is placed within your “bikini” area, making it non visible even while wearing a two piece swimsuit or underwear. The abdominal skin qualifies in many ways for the creation of the new breast mound. The breast is a mass of glandular, fatty, and fibrous tissue with a specific consistency to which the DIEP flap closely resembles. A breast that has been reconstructed with fat and skin will look and feel more natural than an implant reconstructed breast and will last longer without the long-term implant-associated risks. The DIEP reconstructed breast is warm and also ages like a natural breast whereas silicone implants produce a harder and unnatural haptic. However there are cases where silicone implants are indicated( look under Breast implants). The DIEP flap is transferred from the lower abdomen and connected microsurgically, with the use of a surgical microscope, to the chest wall along the old breast ablation scar (amputated breast). This is accomplished by connecting the lower abdominal flap with its preserved artery (provider of oxygen-rich blood ) and vein (carrier of the oxygen-poor blood away from the tissue) to the circulation so it is well perfused. This way the tissue is pinkish, warm and repositioned to a part of the body that was through the breast removal lost. In order to optimize the feeling on the reconstructed breast, we often connect additionally skin nerves to the intercostals nerves , so that a substantial approach to the original sensibility can follow. This procedure offers the advantage that the entire skin-fat tissue feeling and sensibility is preserved und faster by the body integrated.
As with any surgical intervention, complications can also occur with the DIEP procedure. The most common complication is an after-bleeding. In the case of a blood effusion because of an after-bleeding, an operation to raise once more the flap and remove the effusion is needed. These post-operative bleedings can occur on the abdominal as well the chest wall and when early detected do not lead to any further complications concerning the surgical result or the overall condition of the patient. For this reason, we hold the freshly operated patient for one night in the intensive care unit for observation. Besides the after-bleeding, seromas ( fluid accumulation/secretion) can occur in the operated area. Usually this fluid self-absorbs or it can be sucked off through a needle puncture when the volume of the collected fluid so indicates. With a DIEP breast reconstruction the abdominal wall is not damaged so that no abdominal wall weaknesses or hernias occur as they could after a TRAM reconstruction.
A DIEP breast reconstruction requires a plastic surgeon, highly skilled in microsurgery. In the hands of an experienced microsurgeon, the rate of a complete flap loss is about 3 %. Smaller partial border tissue losses can occur more commonly , are however uncritical und can be under local anaesthesia later corrected. The benefits and advantages offered by the DIEP method are in a very good rapport with the risks of the surgery, so that today, in our Clinic for Plastic Surgery in Berlin, we perform mainly the DIEP procedure for tissue reconstruction or reconstruction of the breast. A total of about four to six hours of surgery are required in order to achieve a result that comes very close to resembling the original breast. The DIEP is particularly suitable for patients with a voluminous abdomen. In this case, the breast size can be chosen as desired, so it can harmonically und symmetrically match the opposite side. It is possible that the patient wishes to become a smaller reconstructed breast and plan a reduction and lifting of the other breast for a later time. The therapeutic strategy should be based each time on the patient‘ s wishes and with him formulated. If the abdominal wall of a very slim patient does not provide enough volume or the abdominal wall is scarred as a result of numerous previous operations , an alternative method of reconstruction with autologous tissue ( see SGAP or TMG) is possible.