The DIEP flap, for Deep Inferior Epigastric Perforator flap, is an original technique that can be proposed to patients with a favourable stomach.
Excess skin and fat at this level is transferred to the chest to rebuild the breast without using a prosthesis.
The purpose of surgery is to restore the volume and contours of the breast by transferring excess skin and fat from the subumbilical abdominal area to the chest. The technique gives the reconstructed breast a natural shape and flexibility since it is made of the patient's own tissues. This reconstruction is definitive and progressive, it follows weight variations and the effects of gravity like the natural breast.
It is only one of the steps of complete breast reconstruction, which also includes, according to the patient's wishes, reconstruction of the areola and nipple and possibly an intervention on the contralateral breast to improve symmetry.
The procedure is performed either immediately during the mastectomy, called immediate reconstruction, or at a distance from the mastectomy and the additional treatments that were necessary, called secondary reconstruction.
The mastectomy scar is reused as an approach in reconstruction; while it can sometimes be improved, it is impossible to remove it.
The procedure is intended for non-smoking women without morbid overweight with a favourable abdomen, ideally the one that one would like to remove with abdominal plastic surgery.
Duration of hospital stay
7 days minimum.
Average length of stay
1 to 2 weeks.
A hospitalization of several days is usually necessary."
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This is a delicate procedure that can cause significant blood loss and requires the patient to be in good general condition.
A regular preoperative check-up is carried out in accordance with the prescriptions.
Angioscanning of the vessels of the abdomen must be performed before the procedure to allow for planning.
The anaesthetist will then be seen in consultation no later than 48 hours before the operation.
In all cases, the practitioner will check the breast imaging (mammography, ultrasound) of the other breast if the last control examination is not recent enough.
No medication containing aspirin should be taken within 10 days of the procedure.
The thromboembolic risks of this type of reconstruction are quite high and it is possible that the anaesthetist prescribes antithrombosis stockings (prevention of phlebitis) that you will have to wear even before the operation until you leave the institution. You are also asked to buy an abdominal support girdle that staples to the front to provide support from the first bandage. It will then be worn continuously for several weeks.
Type of anesthesia:
This is a classic general anaesthesia during which you will sleep completely.
A hospital stay of at least 7 days is usually required. The discharge will be conditioned by the success of the operation (absence of thrombosis) and the removal of the drainage.
The procedure consists of dissecting a flap, a horizontal spindle of skin and fat taken from the subumbilical abdominal region with an artery and vein but without the rectus muscle and its fascia, then transferring it to the thorax and keeping it alive by reconnecting the vessels with vessels in the armpit or thorax. This method uses microsurgery.
This flap is shaped at the level of the thorax in order to reconstruct a natural breast, without prosthetic input, the volume provided being such that it allows the surgeon to do without the use of any internal prosthesis. The reconstructed breast will have little sensitivity to touch.
Closing the donor site results in a lower scar across the entire width of the abdomen.
The improvement of the silhouette at the stomach level is often perceived as a convenience.
No synthetic reinforcement is put in place to strengthen the abdominal wall because not taking the rectus muscle and its fascia prevents the wall from becoming weak.
Symmetrization of the other breast and reconstruction of the nipple-areolar plate (areola+nipple) are most often performed later when the volume of the reconstructed breast is stabilized.
Breast reconstruction does not affect cancer surveillance.
The procedure can take four to six hours. At the end of the procedure, a belly shaping bandage is made. The reconstructed breast is uncovered to facilitate graft monitoring (colour, heat, pressure re-colouring).
Reconstruction with a flap of the rectus muscle of the abdomen (DIEP) immediately restores a volume and shape that allows the patient to dress normally with a neckline.
However, the final result is not immediately obtained.
At first, the breast may appear a little too stiff with a feeling of tightness in the stomach.
The appearance of the reconstructed breast will gradually change. It takes two to three months for your surgeon to appreciate the result and in particular the symmetry.
It is only at this stage that a possible retouching is envisaged.
In some patients, the psychological integration of this insensitive volume may be difficult and a period of ambivalence of at least six months is often observed. The medical and family environment plays an important role in this period when the patient needs to be reassured.
The purpose of this surgery is to bring a clear improvement without however being able to claim to perfection. If your wishes are realistic, you should be very satisfied with the result.
Breast reconstruction by DIEP flap is a fairly heavy surgical procedure, which implies the risks associated with any such procedure. However, the postoperative consequences are generally quite simple. However, complications can occur, some of a general nature, inherent in any surgical procedure, others more specific to DIEP breast reconstruction.
However, complications must be known and well understood. The following complications can be observed: skin necrosis, infection, hematoma, serous effusion, etc.
MEDICAIM organizes your entire stay for you: post-operative nursing care, biological follow-up, therapeutic, nutritional and psychological support.
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