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This is considered the “Gold Standard” breast reconstruction and there is no doubt that the feel, shape, movement, warmth and ability to age with thepersons other living tissues make the DIEP flap the best aesthetic breast reconstructive choice but only in the right patient who understand the magnitude of the procedure and the small but serious risks associated with it including the more prolonged operative and recovery time.
The operation is carried out in three stages. Firstly, the patient is placed on her back and the mastectomy performed. Any axillary surgery (sentinel node biopsy or axillary clearance) is performed at this time. The second stage involves turning the patient on her side and "harvesting" the LD muscle.
The pedicle (artery and vein to the flap) is identified in the armpit to avoid any inadvertent damage, and the muscle with its overlying piece of skin is lifted from the back, tunnelled through the armpit and swung round the ribcage to lie under the breast.
The third stage is then to turn the patient onto her back and the skin of the flap is trimmed to match the hole left by the mastectomy, Finally the breast is compared to the unoperated side and the muscle is sutured to create the contour of the breast mound. If necessary, an implant is inserted. Drains are inserted in both the breast and the back wounds which are then closed, generally with dissolving sutures.
Infection (5%) - this ranges from a superficial wound infection, easily treated with antibiotics, to an infection of the implant if one is used. Implant infections are especially troublesome as, generally, the implant must be removed to fully treat the infection, and re-inserted at a later date.
Bleeding (5%) - Although any bleeding points are cauterised during the procedure, it is possible that you may develop a collection of blood under the skin. Very occasionally, this can become infected or need to be let out by returning to theatre and re-opening the wound.
Seroma - this is a very common complication. If fluid continues to be produced after the drains are removed, it will collect under the skin and may become uncomfortable, but it can be easily and painlessly removed by sliding a needle through the scar on your back taking the fluid off with a syringe.
Flap failure (below 1%) - this is a very rare complication. We work as a team with some of the best results in the world for this operation
Revision Surgery - After the muscle is moved from the back to the front, it changes size over the first 3 months. Further small procedures may be required to improve the final outcome of your reconstruction.
Recurrence - Having a reconstruction would not stop a recurrence of the cancer in the skin that is left, if it were to occur.