Breast reconstruction (DIEP flap)

Dr Law has undergone extensive training in breast reconstruction in Australia and internationally. She completed specialised fellowships in Canada and Belgium, focusing on advanced techniques of breast reconstruction using flaps and implants.

Breast cancer in Australia

Breast cancer is one of the most common cancers diagnosed in Australian women - 1 in 7 women in Australia will be diagnosed with breast cancer in their lifetime. Whether you've experienced it yourself or supported a friend or loved one through it, you will know that - like any cancer diagnosis - it can bring significant physical, emotional, and social challenges.

Talking about breast reconstruction options early in your treatment journey is encouraged. While it’s normal to feel overwhelmed by the amount of information, understanding your options can give you a greater sense of control and help you focus on recovery and life beyond cancer.

In many cases, reconstruction can be done at the same time as a lumpectomy or mastectomy, helping to restore the breast’s shape and volume. These procedures are designed to support your confidence, well-being and quality of life, both during treatment and in the years to come.

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What breast reconstruction options are available?

There are two main types of breast reconstruction: implant-based reconstruction using implants, and natural tissue reconstruction using your own body tissue (autologous reconstruction). Both options are widely used and offer reliable results. Each has its own benefits and considerations, and Dr Law will help you decide which approach is best suited to your individual needs and goals.

Breast reconstruction with implants

Breast implants are commonly used to restore breast volume after a mastectomy. They have been safely used for decades in both reconstructive and cosmetic breast surgery.

Advantages of breast implant reconstruction:

  • Volume restoration: Implants are helpful for patients who do not have enough body tissue to use for natural tissue reconstruction (such as flap procedures).

  • Shorter surgery and recovery: The implant procedure may take less time than tissue-based reconstruction and may involve a faster recovery.

  • Size flexibility: Implants come in various sizes, so it may be possible to choose a volume that may enhance or match your natural breast size or your personal preference.

Disadvantages and considerations of implant reconstruction:

  • Implant lifespan: Implants are not lifetime devices. On average, they may need to be replaced every 10 to 15 years, though this can vary depending on individual factors.

  • Radiotherapy risks: If radiotherapy is planned before or after surgery, implants carry a higher risk of complications such as implant extrusion (where the implant pushes through the skin), capsular contracture (hardening of scar tissue around the implant), and poor cosmetic outcomes. For this reason, implants may not be recommended if radiotherapy is expected.

  • Complication risks: Minor problems like wound infections or fluid collections (seromas) can sometimes lead to more serious issues, including implant loss.

  • Cosmetic outcomes: Patients with larger natural breasts or wider chests may find that implant reconstruction does not achieve the best cosmetic result.

Breast reconstruction with autologous tissue

Autologous reconstruction means using your own body’s tissue - usually skin and fat from another area like the abdomen - to rebuild your breast.

Advantages of autologous breast reconstruction:

  • Natural look and feel: Because your own tissue is used, the reconstructed breast often feels softer and looks more natural than an implant.

  • Long-term solution: The tissue ages naturally with your body and unlike implants, it typically doesn’t need to be replaced.

  • Better for larger breasts: It may provide a better cosmetic outcome for patients with larger breasts or wider chests.

  • Avoids implant-related complications: Since no foreign materials are used, there is no risk of implant rupture, capsular contracture, or extrusion.

  • Improves tummy contour: If tissue is taken from the abdomen (like in a DIEP flap), the surgery can also improve abdominal contour, similar to a tummy tuck.

Disadvantages and considerations of autologous reconstruction:

  • Longer surgery and hospital stay: The surgery often takes longer and involves a longer hospital stay compared to implant reconstruction.

  • Donor site scar and problems: Since tissue is taken from another part of your body to create the flap, you will have an additional scar there.

  • Volume limitations: The size of the reconstructed breast depends on how much excess tissue you carry.

Timing of breast reconstruction

One of the first decisions to discuss with your breast and reconstructive surgeons is the timing of your breast reconstruction. There are three main options available:

  1. Immediate reconstruction
    Reconstruction is performed at the same time as your mastectomy, using either implants or your own natural tissue (such as a DIEP flap). This option can help reduce the number of surgeries and preserve the natural breast shape and skin.

  2. Delayed reconstruction
    The mastectomy is done first, followed by any necessary treatments like chemotherapy or radiotherapy. Reconstruction is then performed at a later time, once all cancer treatment is complete.

  3. Delayed-immediate reconstruction
    A temporary reconstruction is done at the time of mastectomy using tissue expanders - these act as placeholders to maintain the shape and skin of the breast. After all cancer treatments are completed, the expanders are replaced with your final reconstruction using either implants or your own tissue (such as a DIEP flap).

The best timing for your reconstruction will depend on several factors, including:

  • Your personal preferences.

  • Your cancer treatment plan (especially if radiotherapy is required).

  • Your breast surgeon and reconstructive surgeon’s recommendations.

These options and what may be best for you will be discussed during your consultation, with the goal of guiding you through a treatment plan that supports both your recovery and your long-term outcomes.

What is a DIEP flap?

  • A DIEP flap is a type of breast reconstruction that uses your own skin and fat taken from your lower tummy (abdomen) to create a breast. “DIEP” stands for Deep Inferior Epigastric Perforator, the name of the blood vessels used in this procedure. This operation is usually performed to reconstruct the breast after mastectomy. It involves taking the flap from your tummy and connecting the blood vessels in the flap to the blood vessels in your chest wall using microsurgery. The DIEP flap is then shaped to create a breast mound.

  • Unlike some older methods, a DIEP flap doesn’t involve removing any abdominal muscle.

  • The DIEP flap reconstruction may be performed at the same time as your mastectomy (immediate reconstruction) or at a later date (delayed reconstruction). 

Who is suitable for a DIEP flap?

Dr Law will help you decide if this procedure is suitable for you. It may be a good option if:

  • You want a natural look and feel.

  • You prefer not to have implants.

  • You have enough tummy tissue.

You may still be eligible even if you’ve had previous abdominal surgery (e.g. hysterectomy, caesarean, appendicectomy), unless the scarring is extensive.

However, this surgery may not be suitable if:

  • You’re very slim or very overweight.

  • You smoke, or are not able to stop smoking around the time of surgery.

  • You have certain health conditions.

Procedure information for DIEP flap

  • In planning for this surgery:

    • Consultation
      The consultation with Dr Law will begin with a conversation about your goals and expectations. As part of the consultation, clinical photographs will be taken, and the procedure will be explained in detail - covering what it can and cannot achieve. Dr Law will also discuss the surgical process, possible risks, and complications.

    • CT Angiogram
      Before your surgery, you will need a CT angiogram – a special scan of your tummy’s blood vessels to help plan your operation. You’ll receive a referral form at the time of consultation.

    • Blood Tests
      You’ll be referred for routine blood tests before surgery.

    • Smoking
      Please stop smoking as soon as you are able to, as smoking increases the risk of complications from surgery. If possible, please stop smoking at least six weeks before your surgery.

    • Anaesthetist
      You will receive a phone call from a fully qualified anaesthetist to discuss your general health, and to ensure your anaesthetic will be as smooth as possible.

    • You will be given instructions ahead of time regarding fasting and other practical information.

  • On the day of surgery:

    • You will be fasted, and you will usually arrive early in the morning to hospital to get checked in.

    • You will meet the anaesthetist and nursing staff who will check your health and details.

    • Dr Law will meet you and will draw marks on your skin to guide surgery, and photos will be taken.

    The main steps in this operation are:

    • The DIEP flap is taken from the tummy. Dr Law takes care to preserve the nerves that supply your rectus muscle, to help preserve your abdominal strength as much as possible.

    • The blood vessels in the chest are prepared. The blood vessels are accessed by removing a very small segment of rib to get to them.

    • The blood vessels in the DIEP flap are connected to the blood vessels in the chest using a microscope.

    • The DIEP flap is then shaped to look like a breast.

    • The tummy is closed much like a tummy tuck.

    • You will usually have drains in the breast and in the tummy.

  • Recovery can vary between individuals. In general:

    Immediately after surgery:

    • You will wake up in the recovery area, in a “beach-chair” position.

    • Pain and nausea are managed with medications.

    • You will be connected to drips and have several drains connected to you.

    • You’ll be kept warm and wear leg compression devices to prevent blood clots.

    • You may feel sore, especially when moving your arms or tummy – this improves over a few days.

    Hospital stay:

    • You will generally stay in hospital for 5-7 days. During this time, the DIEP flap will be monitored closely.

    Discharge:

    • It is possible that you may go home with some drains still in place.

    • It is best to have someone look after you for the first few weeks as you recover at home.

    • You will be given specific instructions from Dr Law’s team regarding the care of your wounds and activities to avoid.

Risks & Complications

  • All surgery carries risks and may include:

    • Drug reactions.

    • Allergic reactions.

    • Infection.

    • Bleeding and haematoma (blood clot).

    • Seroma (fluid collection).

  • Risks specific to DIEP flap surgery will be discussed with you during your consultation and will also be provided in your consent paperwork. These include:

    • Fat necrosis (lumps in the breast).

    • Flap failure (1-2%).

    • Abdominal bulge or hernia.

    • Poor scars and wound healing problems.

Dr Jenaleen Law caring female Plastic Surgeon Sydney Chatswood Darlinghurst

Plastic, Reconstructive
& Aesthetic Surgery,
Sydney

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