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Diep Flap - Beautopedia

Diep Flap

This guide provides information about the Diep Flap method of breast reconstruction including comparisons with the Tram flap technique, suitable candidates, stages of the procedure and likely results.

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What is Diep Flap?

Diep Flap is a method of reconstructing breasts after a mastectomy (removal) due to breast cancer. The acronym stands for deep inferior epigastric perforator. It’s a free flap method of breast reconstruction since the abdominal tissue is completely dethatched from the abdomen and reconnected to the chest wall. Other breast reconstruction methods include Tram flap, Latissimus dorsi flap, gluteal free flap and breast implants.

Diep Flap v Tram Flap

These two reconstruction procedures are very similar, the main difference being the blood vessels and muscle. With Diep flap surgery the plastic surgeon completely removes the skin, fat and blood vessels (collectively called the ‘flap’). The blood vessels are cut off from the body by making a tiny incision into the abdominal muscle, and then reattached at the chest.

Conversely, the Tram flap procedure removes muscle in addition to the skin, fat and blood vessels. Unlike Diep flap, the blood vessels are not cut off during this procedure. The surgeon moves the belly tissue (including muscles) up to the chest wall with the blood vessels still attached.

Since the Diep flap procedure requires removal and reattachment of blood vessels (microsurgery), the operating time is much longer (5 hours for one breast to 8 hours for both breasts) than with a Tram flap operation. However, because the muscles are left intact, the recovery is easier and shorter.

Good Candidates for a Diep Flap Breast Reconstruction

The Diep flap method of reconstruction is suitable for women who have sufficient abdominal tissue to reconstruct one or both breasts. If you are very thin the surgery may not be appropriate since there may not be enough abdominal fat available to create the breasts.  Also, if you smoke your blood vessels may be too narrow and inflexible for the operation. Enquire with your plastic surgeon if you have any concerns.

The operation does require an incision in your abdomen, at the bikini line which means you will have scarring in two places (the breasts and the tummy). Nevertheless, a Diep flap operation is still possible for women who already have scarring from prior abdominal surgery including scars from a hysterectomy, caesarean section, bowel resection, liposuction, appendectomy or tummy tuck.

Do Breasts Look Natural After a Diep Flap?

Whilst it’s difficult to reproduce your breasts precisely, plastic surgeons will attempt to make your new breasts’ appearance and texture as natural as possible. There will be visible scarring at the donor site (your bikini line) and on your reconstructed breasts. The scars can be hidden with everyday clothing. Since breast reconstruction is usually performed in 2 to 3 stages, each being a few months apart, you won’t see the final result until at least 5 months after your initial surgery.

After the final stage, you should have full breast(s) with reconstructed nipples and areolae. Your surgeon will try to form the breasts with symmetry in a shape suitable to your body contour. Whilst there will be visible scarring on the breast area, you should end up with symmetrical full bodied breasts which can fit into a bra.

Stages of a Diep Flap Reconstruction

There are generally three stages to a Diep Flap procedure. Stage 1 involves transplantation of the flap (abdominal skin, fat and blood vessels) to the chest area using microsurgery. The procedure takes around 4-8 hours and you will be required to stay in hospital for approximately 4 days for monitoring.

Stage 2 is typically performed 3 months after the first stage. This timeframe is not set. If you need longer to recover or for other reasons, then this part of the reconstructive process can be delayed. The second phase involves shaping of the breast flap for aesthetic purposes. This could involve a breast reduction, breast augmentation or breast lift in order to achieve asymmetry and harmony. The surgeon removes excess skin which was formerly placed for perioperative monitoring. Revision surgery may require liposuction and scar revision. This stage also includes reconstruction of the nipple (postponed for irradiated patients). It generally takes two hours and is performed on an outpatient basis.

Stage 3 involves completion of the areolar reconstruction. It’s usually done 2 months after stage two in an office setting and does not require hospitalization.

How to Find the Best Diep Flap Surgeon

Diep Flap reconstructive surgery is an invasive surgical procedure which requires specialty training and experience. Although any doctor can be a cosmetic surgeon and claim to practice in plastic surgery, invasive surgeries should only be done by a plastic surgeon that is board certified by the American Board of Plastic Surgery. To ensure the surgeon is also experienced in cosmetic surgery, find out if they are a member of the ASAPS (American Society for Aesthetic Plastic Surgery). If the plastic surgeon does not have hospital privileges for the procedure, make sure that the surgeon’s facility is accredited, state licensed or certified by Medicare.

Be sure to ask your surgeon which procedures they specialize in, where they trained and how many treatments they’ve performed. Obtain lots of before and after photos of patients they’ve treated using this technique.

Even if a doctor has the right credentials, this does not mean they will be good at performing Diep Flap surgery. Apart from researching their formal qualifications and training in Atlanta, try to find customer reviews to see the overall satisfaction rate of your potential specialist. Independent recommendations are invaluable for assessing the best surgeon who is most experienced in the treatment. Don’t be tempted to opt for the cheapest cost without considering the above factors. A cheap center may not offer the experience you desire. Also, you may wish to consider whether you feel more comfortable with a female or male surgeon.

How much does Diep Flap Surgery Cost? Price Information

Price Range: $$ affordable $$$ moderate $$$$ high-priced

Price Indicator: $$$$

Cost of Diep Flap: $8,000 to $12,000

Average Cost: $8,650

Fees Include: surgeon fees, anaesthetic, operating room fees, surgery garments

Cost Variables: The prices vary depending on whether you require a unilateral or bilateral diep flap reconstruction. The above costs are for a unilateral flap.

Health Insurance: The costs should be covered by your health insurance plan. Speak with your insurer to ensure you are covered.

Medicare/Medicaid: Diep flap is a reconstructive surgery which is covered by Medicare.

Hospital Fee: approximately $300 per day for a private bed, $210 per day for semi-private and $1,000 per day for a bed in the intensive care unit. The hospital fees should be covered by your health fund or Medicare.

Facility Fees: payable for aspects of surgery completed at your surgeon’s clinic (for example areolar reconstruction). This fee should also be included in the total quote.

Ask the clinic for the total cost, whether it includes follow up visits and how much you’ll be balance billed (if anything).

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