Breast reconstruction surgery

DIEP Flaps

DIEP Flaps refers to a way of reconstructing the breast after surgery such as a mastectomy. The acronym stands for Deep Inferior Epigastric Perforator Flaps and it is the name given to the process of moving a piece of skin and fat from the abdomen and using it to rebuild the breast once the original breast tissue has been removed. No muscle transfers are used in a DIEP Flap operation.

For women requiring breast reconstruction, this approach is favoured by many as it can look and feel much more natural – a new breast is simply created from spare living tissue from your own body.

A DIEP is a piece of tissue (flap) composed of fat and skin, taken from your lower tummy (abdomen), to create the feel and shape of a breast. The tissue and its blood vessels are carefully detached from your abdomen before being reconnected to a new blood supply in your chest. It is a complex operation that takes about five to seven hours.

DIEP flaps give a warm, soft and pliable reconstructed breasts that resemble natural breast tissue, so they are considered as the gold standard for breast reconstructive procedures. In addition, the removal of tissue from your abdomen results in a flatter tummy, as if you have had a tummy tuck (abdominoplasty).

After the skin, tissues and perforators (the flap) have been carefully dissected, the flap is connected to your chest using microsurgery. Mr Ramsey then shapes the flap to create the new breast. As no abdominal muscle is removed or transferred to the breast area you should experience less pain post-operatively and a faster recovery compared to other flap procedures. Abdominal strength is also maintained long-term after the DIEP flap procedure.

Because the surgery involved is very complex, few breast centres offer DIEP flap breast reconstruction. Mr Ramsey specialises in this procedure both in the NHS (at the Royal Marsden Hospital) and privately, and he has performed more than 500 DIEP flap cases in the last few years.

All breast reconstructions are a process of care that usually require two or more operations. When using the DIEP flap, whilst as much of the reconstruction is done at the time of the main flap transfer operation, there is often a need for a second smaller operation to refine and adjust the reconstruction, as well as undertake a nipple reconstruction. Despite the need for more than one operation, the result should be life-long and the reconstruction should age with you naturally. It should also change with your body weight in a similar way to your breast. This is one of the major differences between flaps and implants, as implant-based reconstructions frequently need revision surgery in the future.

What my patients say about me

Having had the upset of being diagnosed with breast cancer and having opted to have a skin and nipple sparing double mastectomy, I was very keen to ensure that the cosmetic result that would be achieved when replacing the expander implants for permanent ones was as good as humanly possible.

I am a very fussy individual and after much research, I narrowed down my search to three top plastic surgeons. Two in the UK and one in the US. Mr Ramsey was the last of the surgeons I saw. His approach was very different to the others: he did not seem to think that I had ‘to make do’ with the result I had because I was a cancer patient who had had a double mastectomy.

I had two consultations, and he was incredibly thorough, patient and kind. He explained everything in great detail and never made me feel that I was asking too many questions (I always do!).

He was careful to manage my expectations. Frankly, there was no need. The result is near perfection, and this is not a qualified statement. Even if I had elected to have breast surgery for aesthetic rather than medical reasons, I would be completely delighted with the result. Mr Ramsey is a genius!

Mrs A BrakeBreast Reconstruction After Double Mastectomy