Microsurgical Breast Reconstruction Using DIEP Flap 

Microsurgical Breast Reconstruction Using a DIEP Flap

A DIEP flap (Deep Inferior Epigastric Perforator flap) is a microsurgical breast reconstruction technique that uses skin and fatty tissue from the lower abdomen to recreate a breast after mastectomy. Unlike older methods, the rectus abdominis muscles are completely preserved.

The transferred tissue is connected to blood vessels in the chest under an operating microscope, allowing it to survive as living tissue in its new location. The reconstructed breast ages, gains or loses weight, and changes naturally together with the rest of the body.

At the Art Clinic in Moscow, DIEP flap reconstruction is performed by surgeons trained in the microsurgical school founded by Professor A.I. Nerobeev.

Advantages of DIEP Flap Reconstruction

• Reconstruction with the patient’s own tissue, providing a natural appearance and consistency
• Complete preservation of the abdominal muscles and maintenance of abdominal wall strength
• No implant is required, eliminating the risks of capsular contracture, implant replacement, or implant visibility
• Particularly suitable for patients who have undergone radiotherapy, as healthy vascularized tissue tolerates radiation-related changes better than implants
• Additional benefit of donor-site contouring, resulting in a flatter abdominal profile similar to an abdominoplasty

Who Is a Candidate?

DIEP flap reconstruction may be considered for patients who:

• Have sufficient fatty tissue in the lower abdomen
• Have undergone radiotherapy to the chest wall
• Prefer reconstruction without implants
• Experienced complications or failure after previous implant-based reconstruction
• Require a larger volume of tissue for breast restoration

Surgical Procedure

The operation is performed under general anesthesia and usually lasts six to eight hours. Two surgical teams often work simultaneously.

One team harvests the flap from the abdomen while carefully preserving the rectus abdominis muscles and isolating the perforating blood vessels. The second team prepares the recipient vessels in the chest.

The flap is transferred to the chest, and the arteries and veins are connected microsurgically under an operating microscope.

The donor site is closed with a low horizontal scar similar to that used in cosmetic abdominoplasty.

Recovery

Hospitalization typically lasts seven to ten days.

The first 24–72 hours are critical, as the blood supply of the transferred tissue is monitored closely to detect any compromise as early as possible.

Heavy physical activity involving the abdomen or upper body should be avoided for six to eight weeks.

Most patients return to work within four to six weeks, depending on the nature of their occupation.

Swelling gradually subsides, and the final aesthetic result develops over six to twelve months.

Contraindications

• Insufficient abdominal tissue
• Previous extensive abdominal surgery resulting in damage to the blood vessels supplying the flap
• Severe systemic diseases increasing the risk of prolonged surgery
• Smoking, which significantly impairs blood circulation and wound healing

Patients are strongly advised to stop smoking at least four to six weeks before surgery.

Frequently Asked Questions

Does DIEP Reconstruction Affect the Abdomen?

Yes, usually in a positive way.

Because excess skin and fatty tissue are removed from the lower abdomen, the donor site is closed similarly to an abdominoplasty, often producing a flatter abdominal contour.

The abdominal muscles remain intact, which reduces the risk of weakness, bulging, or hernia formation compared with older flap techniques.

What Happens If the Blood Supply to the Flap Is Compromised?

During the first three postoperative days the flap is monitored regularly.

If signs of impaired circulation are detected, the patient is taken back to the operating room immediately for microsurgical revision. In experienced centers, many vascular complications can be corrected before irreversible damage occurs.

How Natural Is the Result?

DIEP flap reconstruction provides one of the most natural outcomes available in breast reconstruction.

The reconstructed breast consists of living tissue and changes over time in the same way as the patient’s own body. Weight gain or weight loss affects the reconstructed breast similarly to the abdominal donor site.

Can Older Patients Undergo DIEP Reconstruction?

Age itself is not a contraindication.

The decision depends primarily on overall health, cardiovascular status, and the patient’s ability to tolerate a lengthy surgical procedure.

Book a Consultation

Book a consultation to determine whether DIEP flap reconstruction is suitable for your individual situation. The surgeon will assess the abdominal donor site, review previous treatments, and discuss all available reconstructive options.