How long does DIEP flap surgery take?

Deep inferior epigastric artery perforator (DIEP) flap surgery is a surgical technique used in breast reconstruction, usually carried out after a patient has had a mastectomy but can be done at the same time as the mastectomy to save having two surgeries. Essentially, it is a procedure where a surgeon reconstructs the breast(s) using skin and fatty tissue from the lower abdomen. This creates a more natural look than breast implants and has longer-lasting results.

The DIEP flap reconstruction surgical technique is used in preference to the transverse rectus abdominis myocutaneous (TRAM) flap technique which was developed some decades previously. TRAM flap surgery uses muscle as well as skin and fatty tissue to rebuild the breast, which can lead to a loss of strength in the abdomen. TRAM flap breast reconstruction surgery carries a higher risk of post-operative hernias developing.

This article will explain the timeframe of a typical DIEP flap experience, including the recommended steps to prepare for the procedure to make recovering from the surgery much easier. It will detail what the procedure itself entails and how long this takes, as well as what patients can expect immediately after the procedure. For tips on recovering from DIEP flap surgery, see our guides.

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Preparing for DIEP flap surgery

Unlike most guides to DIEP flap surgery, we want to answer the question of how long the procedure will take with some reasonable expectations about what you should do in the months and weeks before the surgery.

Pre-surgery diet

Maintaining a healthy diet during the pre-operative period is highly recommended. A well-balanced diet with sufficient protein, healthy fat, vitamins and minerals will aid recovery and healing after surgery. Processed foods that are high in saturated fats, sugars or salt should be avoided. These foods can be low in nutrients and pro-inflammatory which can have an adverse effect on the recovery process.

Pre-surgery exercise routine

Cardiovascular fitness improves the ability of the body to cope with DIEP flap surgery and anaesthesia. It also helps keep blood pressure at healthy levels and speeds up the healing process. Regular aerobic exercise such as walking, cycling and jogging will strengthen the body’s cardiopulmonary system in preparation for surgery.

Pre-surgery lifestyle choices

To minimise the risks of surgical complications, smokers are advised to give up smoking and those suffering from obesity are advised to reduce their body weight before surgery. Similarly, diabetics are strongly advised to ensure they have control of their blood sugar levels in the run-up to surgery.

Preparing mentally for surgery

Preparing yourself mentally is an important part of the process and should not be underestimated. Thoroughly understanding the procedure and knowing what to expect can reduce the mental and emotional stress of the operation. Candidates for the DIEP flap procedure should do as much research as possible both reading up on the process and watching the informative videos which are available. Family and friends also have an important role to play in helping the recovery process by providing love, companionship and emotional support.

Packing for hospital

Finally, when packing for hospital, ensure you have all the basics with you and those little extras to make life more comfortable. The same clothes worn on arrival at the hospital can be used for the journey home but ensure shoes are slip-on, and that tops, trousers, and skirts are loose-fitting and front buttoning. Other recommended items include:

Toothbrush and toothpaste
Clips, bands and other aids to keep hair out of the way
Dry shampoo
Lip balm, hand lotion and eye-drops
Mobile phone
Long charging lead
Books and magazines
Spare underwear
Safety pins to attach drain bulbs to clothes
Comfortable sports bra

The DIEP flap procedure

When first developed, DIEP flap reconstruction surgery would take a plastic surgeon eight to 10 hours to complete but advances in technique and technology have reduced the time of most operations to three-five hours. Stephen McCulley has spent 20 years mastering this operative technique. In many cases, he and his team of specialists can reduce the operation time to between three and four hours for a single breast procedure. If both breasts are being reconstructed at the same time, the operation will usually take five-nine hours. This speeds up patient recovery and reduces the time spent in hospital.

The first step in the procedure is a cut from hip to hip across the stomach. The skin below, together with the fatty tissue and blood vessels underneath the skin, is removed. Often only half of the lower abdomen is used but all of the lower tummy tissue is removed. A larger area of abdominal tissue is sometimes removed if both breasts are being reconstructed. This tissue is transferred to breast area and connected using microsurgery. Next, the recovered skin and fatty tissue are shaped and moulded into a reconstructed breast with a realistic shape and appearance.

Not all surgeons have the skills to be able to perform this reconstructive surgery which also requires expertise in microsurgery. Microsurgery is used to reconnect the blood vessels of the excised tissue to a blood supply in the chest or under the armpit.

Most women have some spare skin and fatty tissue in the area of the lower abdomen. Once this has been removed to create the new breast(s), the skin of the stomach is stretched and stitched together. The effect of this is akin to having a tummy tuck as the surgeon will seek to create a smooth stomach and abdomen.

Immediately after the DIEP procedure

The hospital stay is normally five days with patients restricted to their beds for two days of that time. After three-four days, most patients will be able to walk, though with some discomfort. Discomfort while walking should only last for 10-14 days after the operation.

Prior to discharge patients will be fitted with three or four drains to reduce swelling and these will remain in place for between one and two weeks.

Patients should have a sleeping plan and a feeding plan in place for their post-surgery discharge which accounts for their reduced mobility and their restricted sleeping positions.

Frequently asked questions

How long after a mastectomy can you have a DIEP flap reconstruction?

Immediate breast reconstruction can be carried out after or the same time as a mastectomy. However, in some cases, surgeons recommend the completion of chemotherapy or radiation therapy before reconstruction. This can mean reconstruction taking place six to 12 months or even some years after the initial surgery.

What determines if you are a candidate for DIEP flap?

Most women have spare skin and fatty tissue in the abdomen area which makes them candidates for the DIEP flap procedure. In cases where the patient has no spare skin or fatty tissue in that area, or where previous abdominal operative procedures have interfered with the blood supply to the abdomen, other breast reconstruction options such those from buttock (IGAP flap) or from the thigh (TUG or PAP) flaps maybe available.

How long does it take to recover from DIEP flap surgery?

Generally, DIEP flap surgery requires a three-four day hospital stay with patients able to resume most normal everyday life in six-eight weeks. Full tissue healing and scar fading can take up to a year.

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