DIEP Flap Breast Reconstruction
Serving patients in Fairfield County, Westchester County, and New York City
For women undergoing breast cancer treatment, DIEP flap reconstruction offers the opportunity to restore a sense of wholeness and symmetry using the body's own tissue. The DIEP flap (Deep Inferior Epigastric Perforator) is widely considered the gold standard in flap breast reconstruction surgery. Unlike older techniques, the DIEP flap preserves the abdominal muscle, ensuring that your core strength remains intact while creating a soft, natural breast.
Choosing a plastic surgeon with an academic background in microsurgery is essential for a flap procedure of this complexity. Dr. Otake’s reconstructive and microsurgical expertise allows him to meticulously navigate the tiny blood vessels required to ensure a healthy blood supply for the new breast. At our practice in White Plains, we combine this elite technical mastery with a compassionate, patient-centered approach to help you move forward with confidence.
DIEP flap breast reconstruction is a sophisticated breast reconstruction option that utilizes the skin and fat from the lower abdomen to rebuild the breast. DIEP stands for the deep inferior epigastric perforator artery, which is the primary vessel that provides the blood supply to the abdominal tissue.
Unlike TRAM flap surgery, which often requires creating an incision in or removing the rectus muscle, the DIEP flap procedure is muscle-sparing. This means the surgeon removes only the skin, fat, and the specific blood vessels needed to keep the tissue alive. This means patients recover core strength sooner with a lower risk of abdominal wall weakness or hernias compared to other flap procedures. Patients may choose immediate reconstruction (at the time of the mastectomy) or delayed reconstruction, depending on their specific breast cancer journey.
On the day of your DIEP flap reconstruction surgery, you will be cared for by a specialized surgical team in a state-of-the-art hospital setting. The procedure is performed under general anesthesia and typically lasts 6 to 8 hours. During the DIEP flap reconstruction procedure, Dr. Otake makes an abdominal incision similar to a tummy tuck, carefully isolating the deep inferior epigastric artery and its associated fat and blood vessels.
Once the tissue flap is disconnected from the abdomen, the surgeon transfers it to the chest. Using a high-powered microscope, Dr. Otake performs a micro-anastomosis, connecting the abdominal blood vessels to vessels in the chest wall. This meticulous connection is what allows the entire flap to survive and become a permanent, living part of your new breast.
DIEP flap surgery creates a reconstructed breast that looks, feels, and behaves like a natural breast. Because it is made of your own tissue, it will stay warm to the touch and gain or lose weight just like the rest of your body.
Unlike the TRAM flap, which can lead to permanent core issues, the DIEP flap preserves the abdominal muscle. By keeping the rectus abdominis muscle intact, you maintain the ability to sit up, exercise, and perform daily activities without the chronic weakness associated with other breast reconstruction methods. Additionally, this method avoids the long-term maintenance or potential complications associated with breast implants.
Most women who require breast reconstruction and have a sufficient amount of extra tissue in the lower abdomen are good candidates for the DIEP flap procedure.
Dr. Otake will evaluate your cardiovascular health and medical history, including a history of certain abdominal surgeries. It is important to have realistic expectations and be prepared for a longer recovery than implant-based surgery, though the long-term rewards are often considered superior.
The recovery process for flap surgery is more intensive than for a breast implant. Patients typically stay in the hospital for 3 to 5 days, during which the surgical team monitors the blood supply to the new breast around the clock. You will have temporary drainage tubes in both the chest and the abdomen to prevent fluid buildup.
Once home, you will focus on a gradual return to activity. While you may experience some discomfort, it is usually manageable. Dr. Otake’s background in biochemistry allows him to provide specific protocols to optimize wound healing and minimize firm scar tissue. Most patients find they can return to non-physical work within 6 weeks and resume full exercise after 8 to 12 weeks.
For the first several months after surgery, your new breast mound will undergo a process of softening and settling into its natural position. As the swelling subsides, the reconstructed breast will achieve a natural, teardrop shape that mirrors your other breast.
These results are considered permanent. Unlike implants, which may need to be replaced, the DIEP flap is a living part of you, providing a natural result that restores your sense of self for a lifetime.
DIEP flap breast reconstruction is one of the most technically demanding surgical procedures in medicine. Dr. Leo Otake brings a unique surgeon-scientist perspective to this challenge.
As a Yale-educated MD and PhD with 17+ years of experience and Stanford-level microsurgical training, he possesses the technical mastery required to successfully perform the micro-anastomosis of tiny blood vessels. At Otake MD, we provide academic-caliber care in a patient-centered environment, ensuring your journey to recovery is handled with the highest standards of excellence.
In most cases, yes. While the TRAM flap also uses abdominal tissue, it involves removing or cutting the rectus muscle. The DIEP flap preserves this muscle, which significantly reduces the risk of abdominal wall weakness and hernias, making it a much more functional long-term breast reconstruction option.
If you have already had a tummy tuck, the abdominal blood vessels and tissue necessary for a DIEP flap may have been compromised. However, Dr. Otake can evaluate your abdominal wall and medical history to see if you might be a candidate for other flap procedures, such as a PAP or GAP flap, which use tissue from the thighs or buttocks.
A DIEP flap procedure is a long and complex surgery, typically taking 6 to 8 hours. This time is necessary for Dr. Otake to carefully isolate the deep inferior epigastric artery and perform the microsurgical connections to the chest wall.
Initially, the reconstructed breast will be numb. Over time, some sensation may return as the nerves grow into the new breast mound, but it will likely not feel exactly like your natural breast. Dr. Otake uses advanced techniques to maximize the potential for sensory recovery during the flap reconstruction.
As with any major surgical procedure, there are risks such as infection, bruising, or issues with wound healing. A specific risk of flap surgery is "flap loss," where the blood supply to the tissue flap is compromised. However, in the hands of a microsurgical expert like Dr. Otake, the success rate for these procedures is exceptionally high.
In cases of delayed reconstruction, tissue expanders may be used to gradually stretch the breast skin to make room for the new breast mound. If you are undergoing immediate reconstruction, Dr. Otake may be able to perform the flap procedure without the need for expanders.
