Fox Chase Cancer Center offers mastectomy patients a new reconstruction surgery that uses lower abdominal tissues but no muscle to reconstruct one or both breasts.

In DIEP flap procedures, breast reconstruction is commonly performed at the same operation as the mastectomy. After the surgical oncologist performs a mastectomy the plastic surgeons transfer the DIEP flap tissues from the lower abdomen to the chest to reconstruct one or both breasts, and then use microsurgery to provide blood flow to the tissue.

The procedure is recommended for women who cannot have breast implants because they have previously been treated with radiation or women who have had a recurrence of localized breast cancer. Patients who are extremely thin, or who have scarring from other abdominal surgery may not be eligible for this procedure.

In addition, the technique creates natural looking and feeling breasts, and less scar tissue. It most often allows for fewer cosmetic issues than implants, which have the potential for movement deformity and implant ruptures.

The DIEP flap is becoming an increasingly popular procedure for women facing breast reconstruction after mastectomy, and it’s a technique in which Fox Chase physicians are specializing. As with any other surgical procedure, experience matters.

Who is a good candidate for the procedure?

• Women with sufficient extra tissue in their lower abdomen are the best candidates.
• Women who cannot have breast implants because they have previously been treated with radiation or had a recurrence of localized breast cancer.

Patients who are extremely thin or who have scarring from other abdominal surgery may not be eligible for this procedure.

Benefits

• Creates a natural looking and feeling breast because the surgery uses the patient’s own skin, tissue and fat.
• Generates less scar tissue and has fewer cosmetic issues than implants, which have the potential for movement deformity and implant ruptures.
• Avoids potential complications of silicone gel or saline breast implants such as leakage or the potential need for replacement surgery in the future.
• Although the initial hospital stay is 3-4 days and recovery takes about eight weeks total, the approach takes just one surgery. By comparison, silicone implants require two surgeries -- one to implant a pouch to expand the chest skin, which requires office visits each week, and a second to insert the final implant, with short hospital stays and recovery time after each stage of the process.
• Does not use abdominal muscle, unlike TRAM techniques that use a flap of skin, tissue, fat, and a small or large portion of the abdominal muscle (called a transverse rectus abdominus muscle or TRAM).
• Most patients recover more quickly than with TRAM procedures and they won’t have longer term problems such as losing abdominal muscle strength or developing hernias.

Side effects

• As with any breast reconstruction implant, sensation is likely to be initially altered. Over time, a good number of patients will regain more normal sensation.
• In rare cases where blood flow is inhibited or clots develop after the microsurgery, surgeons often can do a second procedure that salvages the tissue.

The surgery is now available from three Fox Chase plastic surgeons: Sameer A. Patel, MD, FACS, Shuja Shafqat, MD, and Neal S. Topham, MD, FACS.