The DIEP flap procedure: possible revisions post-surgery

Deep Inferior Epigastric Perforator (DIEP) surgery is a trusted way to create a natural replacement after breast removal. It involves using the patient’s skin and fat from the abdominal wall to shape the new breast or breasts, as it is a close match to the original tissue.

This relatively new microsurgical breast reconstruction brings results that last a lifetime. It is often favoured to avoid the risk of hernia or bulge that can be a side effect of alternatives such as TRAM flap surgery.

Though surgeons will always aim to perfect the reconstruction during the procedure, patients occasionally ask for some revisions later on. This article will focus on the potential revisions you may request after you have recovered from your initial DIEP flap reconstruction, and how this optional step can match your ultimate goals and expectations.

Click on one of the links below to jump to that section:

• Potential revisions after DIEP flap surgery
• Preoperative planning for DIEP flap revisions
• Frequently asked questions

Potential revisions after DIEP flap surgery

The primary purpose of a DIEP flap procedure after a mastectomy is to reconstruct a breast or breasts exactly how the patient envisions their chest to look. However, sometimes patients or surgeons suggest additional corrective surgery to address some optional nips and tucks to create more symmetrical, smooth and natural-looking breasts.

Conducting these revisions depends on how possible it was for the surgeon to ‘spare’ the existing skin and nipple in the initial DIEP flap procedure. Using the mound and skin created in the first reconstruction surgery, this optional step focuses on the aesthetics and feel of the new breast(s). The surgeon will refine the shape, contour the mound. If not done before, this can also be when nipples are either readjusted or reconstructed.

One of the goals of DIEP flap revision surgery will be to create an even look between either two new breasts, or one new breast and an existing one if the patient feels this is necessary after they have recovered from their initial surgery. Adjusting the opposite breast in terms of a lift or reduction often helps give best possible final symmetry.

In some cases these adjustment are done at the same time as DIEP in the first procedure. However, it is often more accurate to do later. It is also when any work is done to restore the donor site of the abdominal tissue can be performed. Sometimes small “dogears” or bulges exist at the end of the scars and can be adjusted.

What could it involve?

As mentioned above, a DIEP flap breast reconstruction revision will focus on adjustments and improvements. For instance, the underlying fat-taken from abdominal tissue can be gently contoured or lifted to create the breast size and shape you were aiming for. You or your surgeon may also recommend fat grafting, which adds more substance to the breast without using an artificial implant.

When considering revisions after recovery, you may also see the opportunity for your surgeon to tighten and adjust the skin flap that forms your new breast. They will make nips and tucks to improve its appearance. It could involve removing or smoothing your scar(s), or taking away skin which isn’t needed to create your reconstruction.

Additionally, nipple reconstruction may involve areola pigmentation to simulate the appearance of a natural-looking nipple. Don’t be alarmed when you first see your reconstructed nipples after surgery and they look different than expected. They need to settle and tend to reduce in size post-surgery.

Preoperative planning for DIEP flap revisions

Your surgeon will not suggest undergoing this next procedure until you have fully recovered from your initial surgery. The good news is that DIEP flap revisions are more straightforward and less invasive. Your surgeon can outline likely recovery time, but it should be less than the main DIEP flap reconstruction surgery.

As this is when ‘fine-tuning’ occurs, it is important to discuss your aspirations with your surgeon. How do you want your breasts to look and feel? Your surgeon may be able to show you images of previous patients, so you can select your preferred reconstructed breast silhouette. Be honest about your concerns and goals, as this can ensure you achieve a result that makes you more confident.

Frequently asked questions

Who is a good candidate for DIEP flap breast reconstruction surgery?

One of the most important things is that you have realistic expectations and an understanding of surgical risks. As both your initial breast reconstruction and some additional revisions involve fatty tissue from your abdomen, one of the criteria will be whether you have sufficient amounts of skin and fat that can be used effectively.

A good candidate for DIEP reconstruction would also be someone with aspirations for natural-looking results, rather than the flawlessness that breast implants achieve. Incidentally, you can explore the options of a DIEP flap procedure using natural tissue if you have previously had implants.

What do you wear after DIEP flap surgery?

This delicate procedure involves not only breast surgery but the extraction of skin and fat from the lower abdomen as well. This leaves you with two parts of your body which may be sore for a while. Loose-fitting clothes are advisable following DIEP flap surgery. Some patients find nipple guards, elastic bandages or sports bras help to reduce swelling following the main procedure and any revisions later on.

Keep in mind that you may have drainage tubes for a short time to manage any swelling after the surgery, so this too necessitates avoiding tight fighting clothes.

How long is recovery from DIEP flap surgery?

The hospital stay following this procedure is usually four or five days. You will be able to get up from bed and move around gently within a day or two and should return to a normal diet within 24 hours.

When you first return home, heavy and strenuous activities must be avoided. As DIEP is an invasive reconstructive surgery, you will need a recovery period of four to six weeks before you resume normal physical activities. It is recommended that you wait until your surgeon assesses your reconstruction, and gives you the all-clear. Some women find their full recovery slightly longer, but the end result is worth the wait!

When should I talk to a health professional?

You should always consult a health professional as soon as you have any concerns or worries about the surgery itself or your recovery. Our team are available and always happy to answer any questions you may have about the DIEP flap procedure and healing process.