DIEP Flap
The DIEP flap is regarded today as the gold standard in autologous breast reconstruction. This is the evolution from the free TRAM flap over the muscle-sparing TRAM flap, with the aim to reduce donor site morbidity. With this Diep technique, skin and fat from the lower abdomen is removed, reattached to the chest and shaped to reform the breast. Small blood vessels from this tissue are connected to blood vessels in the chest, just under the rib, using microsurgery techniques.
What is the difference between TRAM, MS-TRAM and DIEP?
When a portion of the rectus muscle ('six-pack') is used, this is called a TRAM flap. Where possible though, when a DIEP flap is performed, the blood vessels are carefully dissected out from the muscle so that the muscle still remains in place. This helps to speed-up recovery and prevents possible weakness and bulging of the abdomen. In some instances, if the blood vessels can't be completely dissected out of the rectus muscle, a strip of muscle is removed with the blood vessels. This is called a MS-TRAM (Muscle Sparing TRAM) flap.
What is a perforator flap?
The preservation of the underlying muscles - when harvesting a tissue flap - is called a perforator flap. The DIEP flap is a perforator flap. Unlike the TRAM flap, the DIEP flap leads to a shorter and easier recovery, enabling the patient to maintain muscle strength.
Which other flaps are perforator flaps?
Next to the DIEP flap, SIEA, S-GAP, and I-GAP
Further Information
Anaesthetic
The operation is performed under general anaesthesia. The operation takes 5-8 hours.
Length of stay
4-5 nights following the operation.
RISKS/POSSIBLE COMPLICATIONS
Early (1-2 days):
Frequent
- Bruising
- Swelling
- Discomfort
Infrequent
- Bleeding (haematoma)
- Infection
- Failure of the flap (approx 1%)
- Partial failure of flap
- Re-operation (approx 1%)
- Wound breakdown
- Necrosis of the mastectomy skin flaps
Later (after one week):
Frequent
- Temporary reduced sensation of the abdominal wall
- Reduced or no sensation of reconstructed breast
Infrequent
- Scars - abdominal, umbilicus, breast unsightly, lumpy, stretch
- Bulging, weakness, hernia (<1%) of the abdomen
- Seroma
- Fat necrosis
General anaesthetic
- Deep vein thrombosis
- Chest infection
- Allergic reaction to drugs or tape
RECOVERY
Immediately after the operation
- You will feel bruised and sore and there will be some swelling
- Pain is usually moderate and controlled with standard painkillers
- There will be drains in the chest and the abdomen, which will be removed between 2-5 days later
- You will be sat out of bed the next day. Over the next few days you will increase the amount of walking that you do
After return home
- Socialising with friends 1-2 weeks
- Return to work at 4-6 weeks
- Driving at 4-6 weeks
- Swelling and bruising 6-8 weeks
- Return to the gym and strenuous activity after 3 months
- Final result at 4-6 months
DIEP Flap
The DIEP flap is regarded today as the gold standard in autologous breast reconstruction. This is the evolution from the free TRAM flap over the muscle-sparing TRAM flap, with the aim to reduce donor site morbidity. With this Diep technique, skin and fat from the lower abdomen is removed, reattached to the chest and shaped to reform the breast. Small blood vessels from this tissue are connected to blood vessels in the chest, just under the rib, using microsurgery techniques.
What is the difference between TRAM, MS-TRAM and DIEP?
When a portion of the rectus muscle ('six-pack') is used, this is called a TRAM flap. Where possible though, when a DIEP flap is performed, the blood vessels are carefully dissected out from the muscle so that the muscle still remains in place. This helps to speed-up recovery and prevents possible weakness and bulging of the abdomen. In some instances, if the blood vessels can't be completely dissected out of the rectus muscle, a strip of muscle is removed with the blood vessels. This is called a MS-TRAM (Muscle Sparing TRAM) flap.
What is a perforator flap?
The preservation of the underlying muscles - when harvesting a tissue flap - is called a perforator flap. The DIEP flap is a perforator flap. Unlike the TRAM flap, the DIEP flap leads to a shorter and easier recovery, enabling the patient to maintain muscle strength.
Which other flaps are perforator flaps?
Next to the DIEP flap, SIEA, S-GAP, and I-GAP
Further Information
Anaesthetic
The operation is performed under general anaesthesia. The operation takes 5-8 hours.
Length of stay
4-5 nights following the operation.
RISKS/POSSIBLE COMPLICATIONS
Early (1-2 days):
Frequent
- Bruising
- Swelling
- Discomfort
Infrequent
- Bleeding (haematoma)
- Infection
- Failure of the flap (approx 1%)
- Partial failure of flap
- Re-operation (approx 1%)
- Wound breakdown
- Necrosis of the mastectomy skin flaps
Later (after one week):
Frequent
- Temporary reduced sensation of the abdominal wall
- Reduced or no sensation of reconstructed breast
Infrequent
- Scars - abdominal, umbilicus, breast unsightly, lumpy, stretch
- Bulging, weakness, hernia (<1%) of the abdomen
- Seroma
- Fat necrosis
General anaesthetic
- Deep vein thrombosis
- Chest infection
- Allergic reaction to drugs or tape
RECOVERY
Immediately after the operation
- You will feel bruised and sore and there will be some swelling
- Pain is usually moderate and controlled with standard painkillers
- There will be drains in the chest and the abdomen, which will be removed between 2-5 days later
- You will be sat out of bed the next day. Over the next few days you will increase the amount of walking that you do
After return home
- Socialising with friends 1-2 weeks
- Return to work at 4-6 weeks
- Driving at 4-6 weeks
- Swelling and bruising 6-8 weeks
- Return to the gym and strenuous activity after 3 months
- Final result at 4-6 months
DIEP Flap
The DIEP flap is regarded today as the gold standard in autologous breast reconstruction. This is the evolution from the free TRAM flap over the muscle-sparing TRAM flap, with the aim to reduce donor site morbidity. With this Diep technique, skin and fat from the lower abdomen is removed, reattached to the chest and shaped to reform the breast. Small blood vessels from this tissue are connected to blood vessels in the chest, just under the rib, using microsurgery techniques.
What is the difference between TRAM, MS-TRAM and DIEP?
When a portion of the rectus muscle ('six-pack') is used, this is called a TRAM flap. Where possible though, when a DIEP flap is performed, the blood vessels are carefully dissected out from the muscle so that the muscle still remains in place. This helps to speed-up recovery and prevents possible weakness and bulging of the abdomen. In some instances, if the blood vessels can't be completely dissected out of the rectus muscle, a strip of muscle is removed with the blood vessels. This is called a MS-TRAM (Muscle Sparing TRAM) flap.
What is a perforator flap?
The preservation of the underlying muscles - when harvesting a tissue flap - is called a perforator flap. The DIEP flap is a perforator flap. Unlike the TRAM flap, the DIEP flap leads to a shorter and easier recovery, enabling the patient to maintain muscle strength.
Which other flaps are perforator flaps?
Next to the DIEP flap, SIEA, S-GAP, and I-GAP
Further Information
Anaesthetic
The operation is performed under general anaesthesia. The operation takes 5-8 hours.
Length of stay
4-5 nights following the operation.
RISKS/POSSIBLE COMPLICATIONS
Early (1-2 days):
Frequent
- Bruising
- Swelling
- Discomfort
Infrequent
- Bleeding (haematoma)
- Infection
- Failure of the flap (approx 1%)
- Partial failure of flap
- Re-operation (approx 1%)
- Wound breakdown
- Necrosis of the mastectomy skin flaps
Later (after one week):
Frequent
- Temporary reduced sensation of the abdominal wall
- Reduced or no sensation of reconstructed breast
Infrequent
- Scars - abdominal, umbilicus, breast unsightly, lumpy, stretch
- Bulging, weakness, hernia (<1%) of the abdomen
- Seroma
- Fat necrosis
General anaesthetic
- Deep vein thrombosis
- Chest infection
- Allergic reaction to drugs or tape
RECOVERY
Immediately after the operation
- You will feel bruised and sore and there will be some swelling
- Pain is usually moderate and controlled with standard painkillers
- There will be drains in the chest and the abdomen, which will be removed between 2-5 days later
- You will be sat out of bed the next day. Over the next few days you will increase the amount of walking that you do
After return home
- Socialising with friends 1-2 weeks
- Return to work at 4-6 weeks
- Driving at 4-6 weeks
- Swelling and bruising 6-8 weeks
- Return to the gym and strenuous activity after 3 months
- Final result at 4-6 months
DIEP Flap
The DIEP flap is regarded today as the gold standard in autologous breast reconstruction. This is the evolution from the free TRAM flap over the muscle-sparing TRAM flap, with the aim to reduce donor site morbidity. With this Diep technique, skin and fat from the lower abdomen is removed, reattached to the chest and shaped to reform the breast. Small blood vessels from this tissue are connected to blood vessels in the chest, just under the rib, using microsurgery techniques.
What is the difference between TRAM, MS-TRAM and DIEP?
When a portion of the rectus muscle ('six-pack') is used, this is called a TRAM flap. Where possible though, when a DIEP flap is performed, the blood vessels are carefully dissected out from the muscle so that the muscle still remains in place. This helps to speed-up recovery and prevents possible weakness and bulging of the abdomen. In some instances, if the blood vessels can't be completely dissected out of the rectus muscle, a strip of muscle is removed with the blood vessels. This is called a MS-TRAM (Muscle Sparing TRAM) flap.
What is a perforator flap?
The preservation of the underlying muscles - when harvesting a tissue flap - is called a perforator flap. The DIEP flap is a perforator flap. Unlike the TRAM flap, the DIEP flap leads to a shorter and easier recovery, enabling the patient to maintain muscle strength.
Which other flaps are perforator flaps?
Next to the DIEP flap, SIEA, S-GAP, and I-GAP
Further Information
Anaesthetic
The operation is performed under general anaesthesia. The operation takes 5-8 hours.
Length of stay
4-5 nights following the operation.
RISKS/POSSIBLE COMPLICATIONS
Early (1-2 days):
Frequent
- Bruising
- Swelling
- Discomfort
Infrequent
- Bleeding (haematoma)
- Infection
- Failure of the flap (approx 1%)
- Partial failure of flap
- Re-operation (approx 1%)
- Wound breakdown
- Necrosis of the mastectomy skin flaps
Later (after one week):
Frequent
- Temporary reduced sensation of the abdominal wall
- Reduced or no sensation of reconstructed breast
Infrequent
- Scars - abdominal, umbilicus, breast unsightly, lumpy, stretch
- Bulging, weakness, hernia (<1%) of the abdomen
- Seroma
- Fat necrosis
General anaesthetic
- Deep vein thrombosis
- Chest infection
- Allergic reaction to drugs or tape
RECOVERY
Immediately after the operation
- You will feel bruised and sore and there will be some swelling
- Pain is usually moderate and controlled with standard painkillers
- There will be drains in the chest and the abdomen, which will be removed between 2-5 days later
- You will be sat out of bed the next day. Over the next few days you will increase the amount of walking that you do
After return home
- Socialising with friends 1-2 weeks
- Return to work at 4-6 weeks
- Driving at 4-6 weeks
- Swelling and bruising 6-8 weeks
- Return to the gym and strenuous activity after 3 months
- Final result at 4-6 months
