BREAST RECONSTRUCTION WITH DIEP FLAP (Deep Inferior Epigastric Perforator)
Autologous breast reconstruction (using the patient's own tissue to be repositioned in the mastectomy) can obtain a more natural and stable aesthetic result over time than the breast reconstruction through the use of prostheses, but it has a technical difficulty of execution for the surgeon and a pre, intra and post-operative commitment to the major patient.
Furthermore, when the skin in the thoraco-mammary region is very thin, tense or the site of radiotherapy, or when part of the pectoralis major muscle has been sacrificed during the mastectomy, it is not possible to use a prosthesis and, to obtain a good reconstructive result, it is necessary resort to using a flap.
The DIEP flap (Deep Inferior Epigastric Perforator) is based on a vascular peduncle (artery and veins) that pierces the rectus abdominis and goes to supply the abdominal wall. During the reconstruction operation, this peduncle is isolated leaving the abdominal muscles intact. Sometimes it is necessary to remove a portion of the rectus abdominal muscle together with the peduncle and to repair the residual defect of the abdominal wall, it is sometimes necessary, although rarely, to use a reinforcement mesh, as for hernias. The set of tissues is anastomosed (the vessels are microsurgically connected) to the recipient vessels of the mastectomized area (in most cases to the internal mammary vessels or thoraco-dorsal vessels).
The suture of the skin at the level of the abdomen results in a long horizontal scar positioned in the suprapubic region. At the breast level, the flap is modeled in such a way as to make it as similar as possible, in volume and shape, to the healthy breast.
In the immediate post-operative period, a slightly flexed position is necessary in order not to damage the abdominal wound.
The type of anesthesia, the length of stay, the frequency of dressings, the time of stitch removal depend on the individual clinical case and the technique used.
As regards the surgery and possible complications, I had complete information regarding:
the intervention technique (dissection of the ellipsoidal skin island from the abdominal region, with its peduncle, and microsurgical reconnection in the thoraco-mammary region);
general anesthesia (narcosis);
the postoperative course (which may involve some discomfort, in the first days, due to pain, the inability to move the arms easily, the possibility of a temperature rise);