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Autologous Free Flap Surgery in Hull, York, Grimsby, Lincoln & London


The DIEP is often our primary choice for Microsurgical breast reconstruction due to the presence of adequate tissue volume in the lower abdomen coupled with the reliable blood vessels that supply the skin and fat in this area compared to the inner thigh or buttock alternatives. However, if abdominal tissue is unavailable (previous abdominal flap or tummy tuck, or an extremely thin tummy area), a free flap from the inner thigh area (the TUG flap) is an excellent choice for reconstruction of the breasts. In our practice, the Buttock flap is only occasionally used as our third choice.

Tummy Tissue (DIEP, SIEA & TRAM flaps)


In free DIEP flap excess abdominal skin and fat from the lower part of the abdomen is used. The blood vessels, which run through the abdominal rectus muscle, are meticulously freed prior to transfer to the chest to reconnect the tiny blood vessels and this requires us to use a microscope to connect them (microsurgery). The tissue is then shaped to fit the mastectomy defect with a small skin patch from the abdomen which will be used later to reconstruct the nipple. For patients who are having delayed reconstruction, the abdominal skin is used to replace the missing breast skin.

The abdominal muscle is preserved with minimal damage to enable it continue to support the tummy. Because your own tissue is used to re-build your breast this method optimally achieves the shape and feel of the opposite breast. In a DIEP flap, the operation leaves a horizontal scar on the lower abdomen, similar to that created in a cosmetic tummy tuck, resulting in a slimmer abdominal shape that is appreciated by most women. It is successful in >96% of patients.

A SIEA flap (Superficial Inferior Epigastric Artery) is similar to a DIEP flap but is based on a superficial vessel, hence there is neither involvement nor damage to the abdominal musculature. Because the vessels are often smaller and less reliable, we infrequently use this method.

Muscle sparring TRAM flap is used in 5-10% of patients in whom the blood supply coming through the muscle is either too small or ill-defined, to safely obtain the flap a small segment of muscle is also taken. When the skin and fat is transferred still attached to the muscle it is called a Pedicled TRAM flap, free TRAM & DIEP flaps are advances from the former. It is now infrequently performed with a slower recovery and higher risk of abdominal weakness and hernia.

Risks & Complications (Cosmetic Surgery Guide)
  • <2% complete flap failure in unilateral; 5-8% in bilateral reconstruction.
  • <4% Re-exploration rate for flap related problems.
  • Hypertrophic (lumpy) scars occur in about 5% of patients.
  • Numbness on the lower tummy skin improves with time.
  • Breast and Abdominal wound infection and wound breakdown.
  • Lumpiness of breast and delayed healing (fat necrosis)
  • Asymmetry: inevitable on the breast and donor site, improved with revision.
  • Dog ears (skin folds) are common and easily by minor surgery if necessary.
  • Potential donor site problems occurring in about 6% include: tightness and discomfort; fluid collection; bulge and hernia; loss of the navel (rare).
  • Long term problems - few.
  • Blood clots in the calf and lungs can occur after any major operation.
  • Anaesthetic risk although rare will be discussed with your Anaesthetist.
Procedure (DIEP flap)

PURPOSE
Breast Restoration

OP TIME
7-8 hours

ANAESTHESIA
General

ADMISSION
3-5 days

RECOVERY
4-8 weeks

POST-OP
Dressings; 9-12 days,
Clinic review; 2-4 weeks

TRAM flap breast reconstruction; muscle, skin and flat taken from the abdomen to form a new breast
DIEP flap reconstruction: Only abdominal skin and fat taken to form new breast, hence recovery faster