Diep breast reconstruction. Is it really like a tummy tuck?

With the advent of microsurgical perforator flaps, this form of reconstruction has revolutionized plastic surgery. Along with them, the application in breast reconstruction has been tremendous. By the replacement of the skin and soft tissue that is removed during the mastectomy with viable, well-vascularized, excess skin and soft tissue from the lower abdomen, a beautiful breast reconstruction may be achieved that is completely your own tissue. This Deep Inferior Epigastric Perforator (DIEP) flap has gained much notoriety for breast reconstruction today.The tissue is taken from the lower abdomen, much like that removed during a tummy tuck. Utilizing the excess tissue from this area and hiding the incision low on the abdomen, well-hidden within the panty line, the donor site is an excellent option for borrowing tissue for a breast reconstruction. This skin, fat, and soft tissue, along with its blood supply is taken and moved into the breast area. These small blood vessels are then reattached via assistance of a microscope to vessels in the breast area. This tissue is then shaped and molded to reconstruct an aesthetically pleasing breast reconstruction.With this new advent of perforator flap techniques, it is the most innovative and state-of-the-art technique used today in breast reconstruction, let alone plastic surgery as a whole. Unlike the traditional way of reconstructing a breast utilizing this tissue (aka TRAM flap), the DIEP spares the muscle of the abdominal wall, by carefully dissecting the blood vessel from within the abdominal musculature and leaving the muscle in place. This muscle-sparing, perforator flap type of reconstruction is beneficial for these reasons. There is less donor site morbidity from the abdomen, since the muscle is left intact. Along with that, there is less postoperative pain. The function of the muscle remains, so abdominal wall integrity remains intact and there is less chance of hernias or bulges, since the muscle remains. These problems are much increased with the conventional TRAM flap, but unlike it, the aforementioned benefits are obtained with the DIEP microsurgical free tissue transfer breast reconstruction.Unlike conventional TRAM flap reconstructions, use of our refined perforator flap techniques allow for collection of this tissue without sacrifice of underlying abdominal muscles. This tissue is then surgically transformed into a new breast mound. The abdomen is the most common donor site, since excess fat and skin are usually found in this area. In addition to reconstructing the breast the contour of the abdomen is often improved much like a tummy tuck. This well-vascularized flap reconstruction also is also completely your own tissue, and often resembles, moves, looks, and feels more like a natural breast than reconstructions using implants. Other perforator flaps used for breast reconstruction include the SIEA (Superficial Inferior Epigastric Artery), SGAP (Superficial Gluteal Artery Perforator), IGAP (Inferior Gluteal Artery Perforator), and TAP (Thoracodorsal Artery Perforator) flaps, among others.If you're interested in an advanced reconstructive procedure as such, very few surgeons have been trained to perform these and even fewer offer these procedures due to its complexity and skill involved. It may be difficult to find an experienced surgeon to perform this type of surgery with many patients, unfortunately, having to travel away to obtain such reconstruction.  Although lower abdominal tissue is utilized, I caution each patient that the risks and benefits are different than a standard cosmetic tummy tuck.  Your surgeon will educate you on all of the risks.   Best wishes!

Hi ramona58,
Tummy tuck and DIEP are the same in a few ways:1. They both remove the lower abdominal tissue, usually from the belly button to the pubic hairline. In tummy tuck, this tissue is discarded, and in DIEP, it is repurposed to reconstruct the breasts. 2. In my tummy tucks and DIEP, I will plicate the upper abdomen (from the xiphoid where your ribs come together to the belly button).
Tummy tuck and DIEP are different in several ways.1. DIEP scar is higher, because the majority of the perforating blood vessels come out in within a few centimeters of the belly button.2. DIEP by definition makes incision or incisions in the abdominal wall fascia. In tummy tuck, the fascia is tightened ("plication") but not incised. 3. Tummy tuck would typically liposuction the flanks to improve contour. I do not do this during the initial DIEP procedure.
Most women will have a flatter contour after DIEP--because the upper abdominal excess is stretched downward. Yes, there is a possibility of revision after DIEP to improve the contour--sometimes these revisions (like flank liposuction to obtain fat for fat grafting) would be insurance covered, and sometimes they would be out of pocket.
Hope this helps.
Best,Christopher Pannucci MD MSBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

Thank you for the great question.   DIEP is a highly advanced microsurgical breast reconstruction with the primary goal of reconstructing a breast.   Tummy tuck is a surgical procedure to enhance the body contour and strengthen the core and the tummy.  These procedures are not the same. In a tummy tuck,  the scar on the tummy is placed in an aesthetic location where as the abdominal scar during a DIEP is placed in an area where the best flap can be harvested.  Therefore the DIEP scar lies higher on the abdomen in an aesthetically un-pleasing location making the abdomen more boxy.   Even though during the DIEP no muscle is harvested some of the abdominal muscle is still damaged unlike a tummy tuck where no muscle is violated.  So a DIEP is not a tummy tuck. It is basically a procedure that uses the abdominal fatty tissue to reconstruct a breast.  I hope this helps. 

Thank you for the excellent question.The appearance of the abdomen after DIEP looks like a tummy tuck, but with a few differences. The abdominal wall is not plicated and there may be standing cone deformities (dog-ears) at the lateral edges of the incision. The dog-ears can be revised in office or another stage of surgery. Otherwise, the tissue above your umbilicus is undermined like a tummy tuck and this tissue is advanced inferiorly towards the lower incision. Liposuction is typically not done at the the time of a DIEP, but can be done at a later stage. Sometimes, if a fat graft is needed after your DIEP surgery, liposuction of the abdomen can be performed, and then covered by your insurance.Regards,Manish Champaneria, MD

Although a DIEP flap and a tummy tuck both remove the lower abdominal skin and fat, there are differences. During a tummy tuck, the fat above the umbilicus is often thinned during the procedure. Liposuction is not usually performed at the time of a DIEP because the focus is on completing the breast reconstruction. The upper abdominal wall does appear thinner after a DIEP flap because the tissue is stretched during closure. Also, similarly to a tummy tuck, I will routinely close the rectus diastasis of the upper abdomen during a DIEP flap which also flattens the upper abdomen. There is often a revision procedure 2-3 months after a DIEP flap which may include a nipple reconstruction, adjustments to the flap or fat grafting. Liposuction is performed to collect the fat to be grafted into the breasts. If the upper abdomen is still thicker than desired after your DIEP flap, then it can become the site of liposuction for the fat grafting and result in a thinner contour to the upper abdomen. Fat grafting is considered a reconstructive procedure and therefore the liposuction performed to collect the fat would be covered by insurance. I hope this helps. Feel free to contact me with any additional questions.
During a tummy tuck, we are focused on keeping the abdominal scar low. During a DIEP flap, the blood vessels that enter and nourish the flap must be included. If those vessels are located higher on the abdomen then the incisions for the flap must be adjusted which results in a slightly higher scar. During a tum

In my practice, I treat the DIEP flap donor site similarly to a tummy tuck. I make the incision low, so it is hidden by a bikini. This is more difficult to perform, since larger vessels are closer to the belly button, but in most cases it is possible to have an aesthetically pleasant incision location. The top of the abdomen is treated the same way as in a tummy tuck where the skin is advanced down (like pulling down an apron) so the abdominal contour is smooth. 

The incision is designed the dame way.  Plication is performed at the level in the lower abdomen routinely in the closure process.  The user abdomen is addressed as needed.   Additional procedures like liposuction are performed and the second step when symmetry procedures like lifts or reduction of the breast reconstruction or normal breast are being performed depending o whether my patient is having a unilateral  or bilateral reconstruction.

The tissue (skin and fat) that is usually discarded during a tummy tuck will instead be used to reconstruct the breasts.  I usually will repair the muscles as I do in a tummy tuck.  Liposuction can happen during the second stage as that fat can help create more symmetry to the flaps or add volume.