DIEP Flap in Houston, TX

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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.

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.

Doppler wire
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.

Visible changes
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.

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*Individual results are not guaranteed and may vary from person to person. Images may contain models.