What is A DIEP Flap?
Breast cancer survivors who wish to not use breast implants to reconstruct their breasts have an opportunity to use their own body tissue to create new breasts. The skin, fat, nerves, and blood vessels are harvested from another area on the body, like an ample section of the abdomen. This is called a deep inferior epigastric perforator (DIEP) flap breast reconstruction, which comprises of a muscle and nerve-sparing tissue transfer. Our talented plastic and reconstructive surgeon, Dr. Aldona J. Spiegel, can provide you with a comprehensive assessment in a private consultation to see if you are a good candidate for this procedure after a mastectomy.
If your blood vessels are more in the fatty layer of your lower abdomen, then you may qualify for a superficial inferior epigastric artery (SIEA) flap, which is the same surgery on the abdomen, but the harvesting process is just not as deep as the DIEP requires. You want to have a healthy amount of skin to cover and blood vessels to nourish your newly reconstructed breasts. Either way, both of these breast reconstructions by Dr. Spiegel are available. At Aldona J. Spiegel, M.D., we will also propose your treatment plan with neurotization of the nerves in your chest to the transferred nerves in your flap to support nerve regeneration. Then, you will have the opportunity to have a progressive return of sensation in the reconstructed breast. In practice for more than 20 years, Dr. Spiegel is a seasoned surgeon who can help you decide which technique is more appropriate for your anatomy at her practice in Houston, TX.
DIEP Flap Reviews
"After being diagnosed with breast cancer only six weeks after giving birth, my life was turned upside down over night. I immediately started chemo therapy, and a few moths later I was researching reconstructive surgeons. Dr. Spiegel came highly recommended by my oncologist, and I'd later find out it was for very good reason. Not only was I welcomed very warmly by everyone in the office, Dr. Spiegel showed me such a great deal of compassion that it really helped to put my mind at ease for my upcoming surgery. It was very clear from the wealth of information on her website, her tutorial videos, and the personal attention from everyone in office - from her PA's, to the office manager to her billing specialist - that everyone there was working together, fighting together, for the absolute best experience and results for the patient. The whole process from start to finish took a holistic approach to treating the patient. I ended up getting the DIEP Flap reconstruction surgery, and I was very worried about the final results - not just the look of the breasts, but also the abdominal scar. Dr. Spiegel explained everything in great detail to me, assured me she was going to make it all look wonderful, and after just having finished the second surgery (the cosmetic phase), I am thrilled with how it all looks so far. I'm still healing, but I cannot believe how great it all already looks. Dr. Spiegel surpassed my expectations, which were already very high. She's given me back a body I'd thought I'd never have again. My breasts look like they did when I was 20, maybe even better. And while there's no getting around the fact that this type of surgery leaves a long abdominal scar, her work left a very clean, soft line. One that over time, I know will fade and blend nicely. She contoured my entire abdominal and thigh area, and used that tissue to reconstruct the breasts. It all looks incredible. She's truly an artist. I'd highly recommend her to anyone thinking about about getting this complex surgery done after a double mastectomy. Thank you Dr. Spiegel and all you amazing souls at her office. You all helped me tremendously through such a terrifying time in my life and shepherded me to the other side of it."- C.S. / Google / Jan 08, 2019
"Dr. Spiegel and her wonderful staff got me through the most difficult experience of my life. Going through mastectomy and DIEP flap reconstruction is traumatic. I chose her over other Houston area surgeons and felt that I could trust her. Everyone in her office supported me each step of the way. First, and foremost, this is a major surgery and you rely on medical excellence to avoid important risks. She is a perfectionist regarding medical safety. Next, her artistry is outstanding. She got the best result that could be possible. Finally, if you have radiation, it is a long journey of several years to get from the beginning to end of the process, involving a year of a temporary expander before the final reconstruction. It is important to have a team that you can have that trusting supportive relationship over time. I feel very lucky and grateful that I was in the hands of this wonderful group of highly skilled women."- L.S. / Google / Jul 08, 2019
"I cannot recommend Dr Spiegel and her team more highly. I attended her clinic when having trouble with uncomfortable implants after a previous mastectomy. Dr Spiegel suggested DIEP procedure and I was really not sure. Over the coming months both she and her team explained the procedure, the benefits and results and implications. I decided to go ahead and I could not be more happy with the results. I look like I would have done pre mastectomy. I have been amazed by the continued care and concern of the whole team from the finance folk to the clinic nurses and doctors and their absolute pleasure in seeing my delight. A fantastic experience and I can't thank them enough."- C.A. / Google / Aug 01, 2019
"Dr. Spiegel is my guardian angel and I owe her and her entire team and staff a debt of gratitude that I will ever be able to repay! I am one year out from my original Diep flap surgery with her and I feel great- like myself again! After undergoing a prophylactic mastectomy ( due to testing positive for the BRCA 2 gene and strong family cancer) and getting breast implants with another doctor, Dr. Spiegel saved my life by removing the implants and performing Deip surgery. The implants cased me so much pain and diminished my quality of life but now I have it back. I have no more pain and my breasts are soft again and created from my very own tissue. Thank you Dr. Spiegel!"- J.A. / Google / Jul 08, 2019
"I trusted Dr. Spiegel to perform breast reconstruction on both of my breasts following chemo and radiation. I have NEVER regretted that decision for one moment. She is an amazing physician with skills that are second to none. After researching my reconstruction options (type of procedure), it was crystal clear that Dr. Spiegel offered me what I was looking for...DIEP. Ladies, do yourself a favor and do your research before you decide to compromise your abdominal muscles!! One last important comment- Dr. Spiegel is a perfectionist. You will not be disappointed with the end result!"- A.W. / Google / Aug 08, 2013
Can I have a Diep Flap?
If you are looking for a more natural look and feel to your breasts after a mastectomy, then you want the option of transferring your own abdominal tissues in a DIEP flap reconstruction. Dr. Spiegel will want to have a consultative appointment with you, and this can be at any stage after your cancer diagnosis. She will discuss the pros and cons of each type of breast reconstruction for you to make the decision to proceed with a DIEP or SIEA flap breast reconstruction, which involves a lengthy surgery on several areas of your body. This translates into multiple incisions to make, close, and heal. Your recovery time will be longer than if you were to choose a breast-implant based reconstruction. Dr. Spiegel will also talk with you about the amount of scarring, risks of infection, and what she can do to limit both. There is also the possibility that the flap does not respond well to the transfer, which can lead to becoming a failed flap. Our team at Aldona J. Spiegel, M.D. will put your best interests first in and out of the operating room. Dr. Spiegel can perform a different type of breast reconstruction with implants to give your breasts a feminine shape and feel.
How Is The DIEP performed?
You will be admitted into the hospital for an inpatient breast reconstruction for your health and safety. Under a general anesthetic, Dr. Spiegel will begin the procedure by removing the tissues from your lower abdomen for a microsurgical tissue transfer. She will be using a microscope to split off the artery and veins from the abdominal rectus muscle to spare you a life with weakened abdominal muscles. These blood vessels are not disconnected from your body. Instead, they are reconnected to the vascular components in your chest. Delicately, Dr. Spiegel will shape the tissues to create each breast flap. Skin from your stomach area will be used to cover each breast. A nipple can also be reconstructed with part of the abdominal skin left over from the tissue transfer. Dr. Spiegel will close the incision from the removal of fat and tissue from your abdomen just as she would a tummy tuck. She will also make sure that what is left of this area appears contoured and leaner — without taking anything away from your abdominal muscular strength. We now include neurotization in the breasts to facilitate the possibility of reestablishing feeling in your breast skin after this reconstruction. All of your incisions will be closed with absorbable sutures as seamlessly as possible and sealed with surgical glue. Dr. Spiegel will keep aesthetics in mind when placing each incision to limit visible scarring. You will notice in two weeks that the glue will start to flake off and should come off when washing your skin in the shower.
Once the surgery, which could last 4 – 8 hours, is complete, you will then be taken into our recovery room with our post-op nursing staff. Monitoring you very closely, these nurses will manage your pain, check the blood flow to your new DIEP flap, and treat your incisions as needed. Since you were admitted into the hospital for this surgery, you can expect a hospital stay as directed by Dr. Spiegel.
Assessing Your DIEP Flap
Once you are discharged from the hospital, it will be your responsibility to monitor the health of your flaps. Your new DIEP flaps will and should look like your regular abdominal skin. If it is not the right color, with fever, or causing discomfort, please call our office for medical assistance right away.
Keeping track of how much fluid is being drained from your surgical sites is very important at this stage of your recovery. Drains will be placed in both of your surgery sites (breasts and abdomen). Dr. Spiegel will determine when the drains will be removed.
You will have an implant Doppler signaling how the blood is flowing to and from your reconstructed breast. Dr. Spiegel will remove the Doppler wire after your first post-op visit. We will dress the area so that you will be able to shower yourself and not compromise the technology.
The swelling of the surgical sites is a normal reaction after surgery. You may see signs of swelling for more than four weeks. If the swelling is excessive or causing you concern, please reach out to our office. Knots in your incisions are also part of the recovery process, and we can take care of them at a follow-up visit. Follow all of your incision care instructions provided by our team.
Call our office anytime you need to ask a question, have a concern, think your equipment is not working properly, or just to feel reassured what you are experiencing is normal. We are here to support you in this sensitive recovery period to see if the flap will be viable.
After the Flap Reconstruction
Your level of health during your recovery period is vital to the viability of your DIEP flap. Dr. Spiegel will have a set schedule of follow-up appointments with you in the weeks after your hospital discharge date. During these visits, we will be observing, assessing, and addressing any concerns that arise. We will also continue giving you guidance on how to care for yourself.
Wearing surgical garments
We ask that you purchase fitted, post-op compression garments for your chest and abdomen. This will cost about $55.00 for the girdle and $30.00 for the bra. These compression garments will do wonders to alleviate the amount of swelling and pain you may experience after the drains are taken out. You will find that the fitted bra and girdle are simple to put on and zippered to be easier to wear with an abdominal incision. We will give you a receipt for the garments so that you can put in a reimbursement claim with your insurance provider.
Taking time off for DIEP flap surgery and recovery
We recommend that you take at least four weeks off for your surgery. If you perform heavy lifting in your job, then you may need more time to be able to do your job. You will also need to pace yourself as you recover to not overextend yourself or hurt yourself in the process.
Your activity level
Take care of yourself in the most basic ways possible after this surgery. When you are ready to take a walk or climb a flight of stairs (about a month after surgery), work your way up to it. Your movement will be limited. Your arms should not be lifted above your shoulders for the first week. You will notice that you will not be able to walk upright all the way either as you will be healing in the chest and abdomen. We ask that you lift nothing over five pounds in the first 4 – 6 weeks. Then, you may be able to go to the gym for light exercise. It may be two months before you are able to return to your normal exercise schedule. Core work, like sit-ups and crunches, may take up to six months before you are able to do them post-surgery. Also, please keep in mind:
- You will not be allowed to drive a car until Dr. Spiegel has released you to do so
- We strongly suggest that you do not smoke or take in second-hand smoke for a minimum of six weeks after your surgeries
Sleeping in a recliner
Please sleep in a recliner for the 3 – 4 weeks after your surgeries. You will be healing in more than one place. Sleeping on your back in a reclined position will be easier on your body. Knees should also be elevated with two pillows. Once you transition back to the bed, please remain sleeping on your back until after the eight-week mark.
Mammograms and self-exams after breast reconstruction
Your mammograms and self-breast exams are still very important for you as requested by your oncologist or primary care physician.
Emotional Care + Breast Cancer
Dr. Spiegel and our team at Aldona J. Spiegel, M.D. want you to know that your mental health is important to us, too. We understand how difficult living with breast cancer, going to a number of doctor appointments, and making decisions about surgeries can wear you down. Not to mention, you may not feel well. We would like to offer you guidance and assistance in finding an emotional support group with women just like you. At our practice, we host our own support group called "The Pink Sisters." If you are interested in meeting with this resourceful and resilient group of women, we would be happy to put you in contact with them. You are not in this alone.
Know Your DIEP Flap options
Step-by-step, we will help you understand the procedures and surgical techniques our board-certified plastic surgeon can provide you when you are facing the removal of your breasts. You have many decisions to make, and we will offer you support during this time. When you are ready to start planning your surgery, please call our Houston, TX practice to make a consultative appointment. Referrals are wonderful but not needed in many cases. Call and set up your visit with Dr. Spiegel today.