Is DIEP Flap Surgery Right For You? And Other Questions About The Procedure, Answered
By Lisa Hannam / Art by Masha Chernova
Research supports it. Doctors sometimes endorse it. And that’s great and all, but we want more information about it. Like what is DIEP? What is the recovery like? And so much more.
First, the basic info: What does D-I-E-P stand for?
DIEP stands for Deep Inferior Epigastric Artery Perforator. Deep, Inferior and Epigastric refer to the location of the tissue that will be used to replace breast tissue – the upper abdomen. Perforator Artery is the blood vessel that is transported from the abdomen to the chest to ensure the tissue has a good blood supply and is meant to prevent post-surgery blood issues like clotting.
In simple terms, what is involved in the surgery?
With DIEP Flap Surgery, tissue, skin and blood vessels are taken from the abdomen to replace the tissue and skin removed from the breasts from a mastectomy. The blood vessels in the chest are cut and then connected with the blood vessels that are transferred. The surgeons will also reconstruct a new belly button. The actual surgery takes about eight to 10 hours.
How much will it cost?
Post-mastectomy breast reconstruction, including the DIEP flap surgery, are covered in Canada under all provincial health plans, like OHIP.
What’s the recovery like?
The recovery is between two and three months, starting with a four-to-five-day stay in the hospital for monitoring. Depending on the hospital, expect to stay in the ICU or Step Down Unit (one nurse to two patients) for the first 24 hours where a nurse will check on you every hour. As soon as the first day after surgery, you will likely be asked to get up and walk around the hospital floor. It might be hard to stand up straight for a while but it is important to start walking. You will not be able to lift anything heavy for at least two months but your doctor will advise on that.
There is a scar from hip bone to hip bone that curves upwards (like a smile), a scar where your new belly button is, and a scar on your reconstructed breast in a circle-like shape on the bottom half of your breasts.
How long has DIEP flap surgery been around?
You might think that you’re not interested in a history lesson, but the longer a surgery has been in practice means that there is more likelihood of good research about the outcomes and how well it works over the long term. And it could also mean the surgery techniques may have evolved for better results, too.
The first flap noted surgeries date back to the 1800s. (Impressive, right?) But the DIEP flap surgery, in particular, became popular in the medical community in the 1990s. Previously, doctors and plastic surgeons included abdominal muscle in breast reconstruction to maintain the blood supply to the transferred tissue. And that meant a longer time on the surgery table but quicker recovery, according to both initial and current research.
According to the peer-reviewed journal Plastic and Reconstructive Surgery, DIEP-flap surgery had decreased rates of issues in the abdomen, including hernias, as well as higher patient satisfaction. And the risk of blood clots is low – about one to three percent.
Who is eligible for DIEP flap surgery? Who’s not?
The good news is most women are. As long as the doctor gives a nod that a patient is healthy enough to deal with recovery and the lengthy surgery and has no concerns or health risks for the abdominal blood vessels, she can be a candidate.
Women undergoing a mastectomy surgery can have the DIEP flap surgery at the same time, but it can also be used on women years after mastectomy. However, women who have already had the DIEP flap surgery are not eligible. Also, women with not enough body fat (whether naturally or from previous surgeries like a colostomy) aren’t either. The size of the blood vessels could also determine if the surgery will work too. That’s determined with medical tests, such as an EKG. Also, smoking can reduce eligibility too.
If it’s so good, why don’t more women have DIEP flap surgery?
Unfortunately, many women don’t know it is a choice, even when they are presented with reconstruction options. There are reports that some women have to wait up to five years to receive the surgery depending on where they are located which can be a deterrent as well. And like with with most cancer care, women have to be their own health advocates.
Is DIEP my only option?
Not at all. There are other options, including implants, other methods with tissue from the body (including TRAM flap, SAGP, IGAP, TUG and others). And there is the choice to not pursue reconstruction, too.
For more stories on reconstruction, click here.