Deep Inferior Epigastric Perforator Flap (DIEP Flap)
The DIEP flap is an acronym for Deep Inferior Epigastric Perforator flap. It is a variant of the TRAM flap which was extremely popular in the late 1990’s and early 2000’s. In a search to minimize the donor site morbidity research identified the patterns of the blood supply to the lower abdomen and showed it was possible to remove the same amount of skin and fat from the lower abdomen without damaging the muscles of the anterior abdominal wall. Although the surgery is more complicated and more time consuming, the chances of hernia formation or abdominal wall weakness are minimized by this technique.
Prof Ashton is one of the world’s leading experts on DIEP flaps and has published over 100 articles on the use of DIEP flaps in Breast Reconstruction. Please see the section on Publications for more details.
The surgery takes somewhere between five and six hours for a one sided reconstruction and seven and eight hours for a bilateral reconstruction. Patients are normally admitted to hospital for approximately one week to ten days after surgery.
The operation is divided into a number of steps which are relatively straightforward, however, it does require specialized surgical and nursing care and requires the use of anaesthetists to monitor your progress intra-operatively quite carefully.
Prof Ashton utilises computer assisted angiography preoperatively to help map the exact location of the blood vessels supplying your overall abdominal wall. These angiograms are usually conducted within the Royal Melbourne Hospital and allow your surgery to be performed more safely with less operative time than the more traditional techniques.
The advantages and disadvantages of the surgery will be discussed at length with you during your preoperative consultation with Assoc.Prof Ashton.
Breast Reconstruction with Tissue Expander
There has been a change in the utilisation of tissue expansion and its role within breast reconstruction. More often tissue expansion is used as an intermediate or holding procedure to maintain the skin envelope of your breast out to its natural dimensions whilst you undergo radiotherapy or chemotherapy. Because it is a relatively straightforward and simple procedure, it often can be added on to the end of a mastectomy with minimal increase in operative time or surgical risk. Once the tissue expander is inserted it then allows the reconstructive surgeon an opportunity to perform a definitive reconstruction either with an anatomically shaped implant or an autologous tissue reconstruction at a later stage in a more elective and considered setting.
In general, breast reconstruction with tissue expansion is a two stage process, involving the placement of a tear drop shaped expander and then the replacement of a definitive implant at a second operation. This second operation is relatively straight forward and can be under taken as quickly as six weeks after the placement of the tissue expander or as late as twelve-eighteen months after your mastectomy. Alternatively, the tissue expander can be replaced with your own tissue – such as a TRAM or DIEP flap. Prof Ashton will discuss these options with you in detail during your consultation.
Nipple Reconstruction / Nipple Tattooing
In the treatment of breast cancer and your mastectomy, your breast surgeon may need to remove your nipple and areola. It is possible to make a new nipple and areola for your breast. This is a two stage process involving the mobilization of local tissue in your breast to create a new nipple and then tattooing the skin to make a new areola. In the past many techniques have been described to make a new nipple. Usually this involved the harvesting of tissue from other areas of the body such as the groin or even the genitals. We do not use these techniques any more and find that we can make a very aesthetic nipple using local tissue from your breast.
Nipple reconstruction and nipple tattooing is claimable through Medicare and your private health insurance. Alternatively it can be performed under local anaesthetic here in the rooms.
Following the surgery we would recommend that you keep the area clean and dry and would therefore suggest that you don’t engage in swimming, heavy physical activity after surgery and that you take great care during showering or bathing not to get the dressings wet.
If you would like to make an appointment with Prof Mark Ashton to discuss Breast Reconstruction please give our rooms a call.
More Information about reconstructive surgery following a mastectomy or lumpectomy.
When is the best time to have a reconstruction?
It depends on each woman’s circumstances. If timelines for the surgery to remove the cancer are short (e.g. two weeks) a temporary tissue expander can be inserted at the time of the mastectomy. That allows the woman time to consider all the options and to decide on the best course of action. A tissue expander can stay in place for two to five years. However, this may not be suitable for women with a high-grade tumour or a high risk of recurrence, as it can limit the ability to feel any new lumps and make fine needle biopsy difficult in the future. A reconstruction is still possible, but may need to be delayed a year or two. Women diagnosed with DCIS, or those with a strong family history who choose to have a preventive mastectomy, are more likely to have had time to consider the options available, and may be able to undergo a reconstruction at the same time as the mastectomy.
Women undergoing a large lumpectomy may also be able to have a reconstruction at the same time as the lumpectomy, although this may be delayed if a woman is undergoing radiation treatment.
How does a reconstruction affect follow-up treatment or cancer detection?
A reconstruction should not affect follow-up treatment or cancer detection, as long as the breast surgeon has identified that there is not a high risk of recurrence. Mammograms would not usually be needed on the side that has had the mastectomy. MRI would be recommended for future screening of the new breast.