Recontruction with Tissue from the Tummy (DIEP-Flap)
This form of reconstruction usually has the most natural result, because skin and fat tissue from the abdomen are most similar to that of the breast. It therefore is our preferred procedure. Naturally, it requires enough abdominal fat tissue.
With the standard technique we use the abdominal fat tissue is transplanted freely, by an aid of an microscope. Skin and fat tissue together with the supplying vessels are taken from the Tummy, or anatomically: abdomen, and sutured again at the breast under the microscope. The major advantage of this method is that the muscle is left intact so that the abdominal wall remains complete and the risk of a weakness to the abdominal wall is insignificant. Initially the time expended on this operation is clearly higher but generally leads to a more visually pleasing result. The operation is called DIEP-flap (Deep Inferior Epigastric Perforator), or if another vessel is used: SIEA-flap
After 6 months the inner healing and scarring process are also finished and the tissue has reached its final form so that corrections such as lifting of the other breast to achieve symmetry, or the reconstruction of the nipple, can be carried out.
A positive side effect of DIEP-flaps is that in order to close the abdomen again, the abdominal wall has to be tightened, leading to a "tummy tuck".
The operation is carried out under general anaesthesia. The abdominal fat flap is transplanted to the breast together with its vessels and is connected to new vessels in the region of the ribcage or the armpits. The abdomen from which the tissue has been taken is closed again by means of an abdominoplasty ("tummy tuck"). For this the skin is lifted from the abdominal musculature and pulled down to the bottom. The navel is fitted in again.
In rare cases it may happen that the body does not accept the new tissue. The risk of this happening is below 2%. Here we can try to remove a possible existing thrombosis in the sutured vessels by re-operating. Further risks are problems in healing of the abdominal wall as well as loss of the new navel, which then can be remodelled fairly easily, though in a later operation. However, these complications are extremely rare. We have not witnessed a weakness of the abdominal wall or tearing (hernia) of the abdominal wall amongst our patients.
The follow-up treatment is initially more thorough. The bed is kept in beach chair position to relax the tummy. A corsage and support bra is recommended for 6-12 weeks to protect the tissue and to improve the look of the scars. Strenuous activities should be avoided for 6 weeks.
We recommend operations for correction after 6 months at the earliest, that is after the inner scars have healed off completely. Included in the correcting operations are adjusting liftingor reduction of the other breast and, of course, the remodelling of the nipple. However, all assimilating procedures should have been finished before this last operation.