What is a DIEP Flap Reconstruction?

A DIEP is a piece of tissue (flap) composed of fat and skin, taken from your lower tummy (abdomen), to create the feel and shape of a breast. The tissue and its blood vessels are carefully detached from your abdomen before being reconnected to a new blood supply in your chest. It is called DIEP because the blood vessels taken from the abdomen are called the deep inferior epigastric perforator blood vessels. It is a complex operation that takes about 5 - 7 hours. DIEP flaps give warm, soft and pliable reconstructed breasts that resemble natural breast tissue. The removal of tissue from your abdomen results in a flatter tummy, as if you have had a tummy tuck (abdominoplasty).
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After the skin, tissues and perforators (the flap) have been carefully dissected, the flap is connected to your chest using microsurgery. Mr Liew then shapes the flap to create the new breast. As no abdominal muscle is removed or transferred to the breast area you should experience less pain postoperatively and a faster recovery compared to other flap procedures. Abdominal strength is also maintained long-term after the DIEP flap procedure. The surgery involved is very complex, and few breast centres offer DIEP flap breast reconstruction. Mr Liew specialises in this procedure both in his public positions and privately.


How many operation will I require on my Breast Reconstruction Journey?

Nearly all breast reconstructions require two or more operations. Some time after your DIEP flap, there will often be the need for a second very small operation to refine and adjust the reconstruction, as well as undertake a nipple reconstruction and/or a tattoo procedure. Despite the need for more than one operation, the result should be life-long and the reconstruction should age with you naturally. It should also change with your body weight in a similar way to your breast. This is one of the major differences between flaps and implants, as implant-based reconstructions frequently need revision surgery as the years go by.
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What are the potential risks and complications of DIEP Flap Reconstrution? 

Risks and complications were discussed in detail at your first consultation. As a recap - any invasive surgical procedure has risks for medical and surgical complications. Medical complications include:

  • Chest or urine infection
  • Deep vein thrombosis or pulmonary embolus

Surgical complications with DIEP Flap Reconstruction include (see left): 

  • Infection
  • Haematoma or blood clot
  • Seroma or fluid buildup
  • Flap necrosis: total 1-2%, partial 5-10%
  • Fat necrosis, oil cysts
  • Return to theatre

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After the skin, tissues and perforators (the flap) have been carefully dissected, the flap is connected to your chest using microsurgery. Mr Harris then shapes the flap to create the new breast. As no abdominal muscle is removed or transferred to the breast area you should experience less pain postoperatively and a faster recovery compared to other flap procedures. Abdominal strength is also maintained long-term after the DIEP flap procedure. The surgery involved is very complex, and few breast centres offer DIEP flap breast reconstruction. Mr Liew specialises in this procedure both in his public positions and privately.


Why do I need a CT Angiogram before my operation?

To further define the blood supply of your abdomen, you will need to have a special CT Scan (CT Angiogram). This scan will determine the location and size of the blood vessels supplying the skin and fat of your abdomen, which will make your surgery a lot quicker and easier. You'll have been given a request form for this CT Angiogram at your initial consultation. Please go ahead and book this scan at your earliest convenience and bring a copy of your scan (CD Rom or USB Memory Stick) with you at your second consultation with me.
Locations and booking details for FMIG radiology can be found here
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What do I need to do before the operation?

  • Complete your CTA angiogram
  • Stop smoking (at least 3 weeks before)
  • Stop all medications containing aspirin, clopidogrel, warfarin
  • You'll be contacted for a nurse and/or medical team review
  • You'll be contacted by the anaesthetist
  • Sign consent (if you haven't already)

If you are unwell before the operation, please call Mr Liew’s office (03 8521 8888) as the date of surgery may need to be postponed.
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Please complete your CT angiogram, as detailed above. If you smoke you should stop at least three weeks before surgery to reduce the likelihood of postoperative complications. No medication containing aspirin, clopidogrel (or plavix) or warfarin should be taken for ten days before surgery. If this has not been discussed with you at your initial consultation, please bring this to the attention of Mr Liew and his team. A short time before your date of admission or when you arrive in hospital, you will be seen by a nurse and a member of the medical team who will discuss your general health and examine you to make sure that you are fit for surgery. They may also arrange for you to have some blood tests, a heart trace (ECG) and a chest X-ray. An anaesthetist will discuss the anaesthetic with you. You will be contacted by the Anaesthetist before your operation to discuss your general health. If required, they may make an appointment to see you before the day of surgery. You may be asked to sign a consent form (if you haven't already). Make sure that you are fully informed of and fully understand all the consequences of the surgery prior to signing this. Signing this form does not take any of your normal rights away, it merely states that Mr Liew has explained the operation to you and that you have had an opportunity to discuss the anaesthesia with an anaesthetist.


What should I bring to hospital?

Please bring with you:

  • Soft bra (no underwire) and supportive underwear
  • Dressing gown and slippers
  • Toiletries

Do not bring cosmetics or jewellery.

Patient Guides (including maps, visiting hours and parking) for the hospitals I operate at can be found at:


What happens after surgery and how will I feel?

After surgery, you'll wake in the recovery area before being transferred to the ward. You'll likely feel drowsy for some time; pain or nausea may also occur, and these are managed with medicaiton. Regular checks of your breasts and drains will occur for the first 24 hours and you'll gradually be more mobile over the next few days. 
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You will wake up in the theatre recovery area before being transferred to the ward. It is usual to feel drowsy and a little disorientated for some time after waking. If you have pain or feel sick, the nursing staff will give you the appropriate medication. You will have drains coming out of the breasts and abdomen, and you will also have a urinary catheter. You will have a device to control your own pain-killing medication (PCA or Patient Controlled Analgesia) for the first 24 hours. There will be pillows under your knees and you may have to walk slightly hunched over for the next few weeks to prevent straining the abdomen. For the first 24 hours, the nursing staff will check on your breast every hour to ensure you are progressing well. If there are any problems, they will contact me directly and you may have to return to theatre. The nurses will help you into your supportive bra and underpants the next day after surgery, and you will gradually become more mobile over the next 3-5 days.


How long will I stay in hospital and when can i go back to work or exercise?

 

  • Average length of stay is 3 to 5 days
  • Avoid any lifting for 3 weeks after surgery; limit of 5 kg from weeks 3-6
  • Drive after 2 or 3 weeks (dependent on pain control & insurance regulations)
  • Gentle exercise can commence at 4 weeks; usual activity from 6 weeks
  • Soft bra (no underwire) 24hrs a day for 3 months; supportive underwear for 6 weeks
  • Followup appointment in 10-14 days

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The average length of stay in hospital for my patients is 3-5 days. During your admission, you will be seen by a physiotherapist who will also give you an information sheet outlining exercises that you can do. Because of the surgery on your abdomen, you should avoid using your tummy muscles for 3 weeks and not lift anything heavier than 5 kilograms for 6 weeks to ensure your abdomen heals properly. You should be able to drive within 2-3 weeks of the operation if you are not taking any heavy pain-killers and can move freely without pain. It is a good idea to check with your own car insurance to ensure that they do not have specific rules regarding driving after a major operation. After 4 weeks you can commence gentle exercise and after 6 weeks you should be able to do all the things that you could pre-operatively. You will need to wear a soft bra (no underwire) 24 hours a day for 3 months and supportive underwear for 6 weeks. I'll visit you every day after your operation until your discharge from the hospital and we can clarify any questions you may have. Before you leave the hospital, you'll be given an appointment to be seen by myself and the team in approximately 10-14 days.


Where can I find additional information about DIEP Flap Breast Reconstruction?

A diagnosis of breast cancer and its subsequent treatment can be a very traumatic experience. The Cancer Council Australia has useful booklets on 'Breast Reconstruction' and 'Understanding Breast Cancer'. My team and I are available to discuss any questions or problems you may have. You may also find the following videos helpful. 
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For further information or any other enquiries, please contact:

03 8521 8888 or enquiries@theclinic.com.au

Mr Liew practices from:

St Vincent's Private Hospital (East Melbourne) - Hospital detailsdirections and parking