What is DIEP Breast Reconstruction?

Deep inferior epigastric artery perforator (DIEP) breast reconstruction is a type of reconstruction surgery for the breasts in which a skin flap of donor tissue from the patient is used to rebuild the breast. Using an autograft from the patient's own body reduces the risk of rejection, and can improve the chances of success for the procedure. This procedure requires a skilled plastic surgeon who is capable of performing microsurgery, and it tends to be available primarily in urban areas.

Breast reconstruction is performed after a woman has lost a breast to a mastectomy, a surgical procedure usually performed as part of breast cancer treatment. Reconstructions can be done immediately after mastectomy, or years after, depending on the patient, the situation, and the surgeon. The goal of reconstruction is to restore the appearance of a natural breast. Not all women opt for reconstruction, but those who do have a number of different procedures to choose from.

In a DIEP breast reconstruction, the doctor cuts a flap of skin and fat from the abdomen, dissecting into the abdominal muscles to grab several blood vessels, but not removing the muscles themselves. The flap is then sewn into place to replace the missing breast, with microsurgical techniques being used to reconnect the blood vessels. If the surgery is successful, the grafted tissue will take at the site of the breast. During the DIEP breast reconstruction, the surgeon also rebuilds a nipple and aureola, if necessary, or moves them if they were retained during the mastectomy; some surgeons perform tissue-conserving mastectomies when they know that a woman plans on breast reconstruction after mastectomy.

A related procedure, transverse rectus abdominus muscle (TRAM) flap surgery uses a graft from the same area as that used in DIEP breast reconstruction, but some of the muscle is taken as well. This procedure can be less prone to rejection, but it also weakens the abdominal wall. Some women may not be candidates for TRAM breast reconstruction, while others may opt for DIEP breast reconstruction in the interests of keeping their abdominal walls intact.

The DIEP breast reconstruction procedure also happens to bundle in a tummy tuck, with the stomach being tightened as a result of the tissue which needs to be removed. For some women, this may be viewed as a benefit of the procedure. Women who do not have enough tissue in this area can still be candidates for autografts from other regions of the body, including the upper back and buttocks.