The abdomen is the most commonly used donor site for autologous breast reconstruction. The abdominal tissue used in a flap has a better chance of matching the appearance of the other breast, and removing tissue from the lower abdomen can give a “tummy tuck” effect that will improve the body contour. It creates a warm and soft breast that will last a lifetime. It can be used in immediate, immediate-delayed or delayed reconstructions. Ideal candidates are women who are mildly or slightly overweight with some extra tissue in their abdomen and are having only one breast removed.
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When considering DIEP flap breast reconstruction, a big concern for many patients is the post-operative pain. Many patients believe reconstruction with implants is the least painful option since the procedure is less invasive and has a shorter operative time than DIEP flap. However, studies have shown this is not the case.
Surgery duration: unilateral: 3-4 hours, bilateral: 5-6 hours
Average hospital stay: 5-7 days
Total recovery time: 4-6 weeks
When would I be able to move about, walk and drive?
Patients should expect to be walking multiple times the day after surgery and can gradually increase walking time and distance as they feel comfortable. By day 5, most patients can head home. Driving shorter distances can typically be resumed after 3-4 weeks.
When can I return to work?
Patients with low impact desk jobs can return to work after 4-8 weeks.
When would I be able to exercise again?
Lighter aerobic exercises like a stationary bicycle can be started after 4 weeks. To prevent injury to the abdomen strenuous lifting or core exercises (yoga, pilates, weight training) are not recommended for 12 weeks.
Where will the scars be on my body?
Scars will be located around the breast, the umbilicus, as well as an additional horizontal scar on the lower part of the abdomen (same as for abdominoplasty). The location of the abdominal incision varies between patients based on the location of the vessels needed for the reconstruction. In general, the scar is slightly higher than the site of an actual ‘tummy tuck’ scar. In some cases, the scar can be lowered as a secondary procedure at the time of revision.
Compression garments and bra?
You will need to wear a compression garment for your abdomen for 4-5 weeks. In the first week, we recommended the patient wears a sports bra. To prevent venous thrombosis and pulmonary embolism we recommend that you wear compression stockings for 3 weeks after the procedure.
Will I need any additional procedures?
Reconstruction is typically finished several months after flap transfer with nipple reconstruction and areola tattooing. In order to achieve the best result sometimes, additional procedures, such as liposuction, fat transfer, scar correction procedures, symmetrisation procedures on the other breast, etc. are needed. The significant advantage of autologous reconstruction is the ability to reshape the breast at a later stage to achieve the best final result, using a variety of different techniques.
Which are most common technique-related complications?
- Flap necrosis: in rare instances, blood supply through flap vessels is compromised due to vessel thrombosis. The tissue does not receive enough blood and can, if not surgically treated in time, results in the death of the tissue. The risk is the highest in the first days after the surgery while the patient is still being monitored in a hospital setting.
- Donor site problems such as a hernia or muscle weakness can occur. A hernia, or bulging of an internal organ through a weak part of the muscle can develop following harvest of an abdominal flap, where some of the muscle is damaged to rebuild your breast.
A surgeon takes the skin, fat and sometimes a part of the underlying rectus abdominis muscle, along with blood vessels (vascular pedicle) and transfers it to the breast area, which is called a flap. At the breast area, new blood supply for the flap is created. This is achieved by connecting local vessels with flap vessels using a surgical technique called microsurgery. Afterward, a flap is shaped and sewn into place to obtain a symmetric result. After the skin and fat are removed, your abdomen is closed. Surgical drains are inserted into the breast area and the donor area. Because tissue is moved from the belly to the chest, your belly will be flatter and tighter, similar as if you had an abdominoplasty or "tummy tuck." The procedure leaves a long horizontal scar extending from one hipbone to another, in most cases hidden below your bikini line.
Either one or both breasts can be reconstructed at the same time.
There are several types of free abdominal flaps used, depending on which blood vessels from the abdomen are used and whether any muscle is transferred along.
TRAM flap: a rectus abdominis muscle is taken along with skin, fat and blood vessels
MS-TRAM flap: only a piece of rectus abdominis muscle is ataken along with skin, fat and blood vessels
DIEP flap: a flap based on the vessels perforating the muscle, so muscle and abdominal wall integrity are sparred. The DIEP flap breast reconstruction is today's most advanced form of breast reconstruction. The procedure uses the patient's lower abdominal skin and fat to reconstruct a breast after mastectomy but unlike the TRAM flap procedure, preserves all the abdominal muscles.
SIEA flap: a flap based on more superficial blood vessels to entirely avoid dissecting the muscle. It is very rarely an option since superficial vessels are usually not strong enough to perfuse all of the transferred tissue.