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The First Cut is the DIEPest

| April 18, 2017 August 2, 2023 | |

first cut is the diepestUntil you are in the position where you must decide on which type of breast reconstruction you want or what type is best for your body and individual situation, you probably never realized how many options there are.

While breast reconstruction can never mimic natural breasts completely, there is an option that comes quite close. DIEP flap breast reconstruction involves removing blood vessels, tissue, and skin from the abdominal area and transplanting it to the chest to create the new breasts. For more information on the specifics of DIEP flap, visit the Midwest Breast website.

While DIEP flap results in reconstructed breasts with the most similar appearance and feels too natural breasts, there are some common issues that many women contemplating surgery have concerns about.  I am going to answer some frequent questions I have heard in regards to having DIEP flap reconstruction.

Isn’t the surgery and recovery a lot longer and more invasive than implant reconstruction?

DIEP flap has the reputation of being the “big bad wolf” of breast reconstruction. The truth is, yes, the surgery is long. My double mastectomy and immediate DIEP flap was about ten hours total. The recovery is long; 6-8 weeks is typical. However, aside from one or two outpatient revisions, if needed, that is it! The first two to three weeks of recovery is challenging, which I would say the same for implant reconstruction, but very manageable with medications and rest. Looking back, it was such a temporary time. After those first couple of weeks, the recovery is more about getting your strength, range of motion, and energy back. You don’t have to worry about going in once a week for fills or an exchange surgery down the road. Either way, a mastectomy is a huge trauma to the body. If you prefer autologous reconstruction and you are a good candidate for the surgery, you should not be intimidated by it. The results are worth it!

Will my breasts be numb?

For the vast majority of patients, the answer to this question is yes. Even with skin-sparing mastectomies, the skin covering the reconstructed breasts will not have the sensitivity to touch or hot/cold temperatures. For this reason, it isn’t recommended to use a heating pad on the area. I think many women envision a feeling like being at the dentist when they hear the word numb. Where there is a feeling of being swollen or tingling. In my experience, it isn’t like that at all. I can still feel pressure or movement, and there is not a constant awareness of feeling numb. It really has not been a big issue at all.

Will I have abdominal bulges?

Initially, there is a lot of swelling, and it can be several weeks to months before your body is back to normal. Wearing compression garments will help with the swelling and any discomfort. I haven’t experienced any issues with bulges, hernias, or swelling beyond the initial recovery period, but I have heard of patients who do. The good news is, if you address these issues with the surgeons, they can often repair these issues. For some people, it may just be a matter of noticing their lower abdominal area more than before surgery because tissue from that area has been removed. Others may have a clinical bulge or weakness, and the doctors should evaluate that.

Should I do nipple reconstruction?

This is a personal decision, but I am pleased I opted to have nipple reconstruction. It makes a huge difference aesthetically and really minimizes the appearance of the scars. DIEP flap scars are often circular or oval in shape, so having nipples reconstructed into the middle of the circles gives a more “normal” appearance and made my reconstruction feel more complete. The surgery is very quick and minimally invasive. Initially, the nipples will be very swollen, but after a couple of months, settle very nicely. I enjoy looking down and seeing the slight nipple protruding instead of just a completely flat surface. Eventually, I will have areola tattooing to add the finishing touch of color. There are other options for nipples if you choose not to have them surgically reconstructed. You can get nipple tattooing and even 3D nipple tattoos. There are also prosthetic nipples that look very realistic.

These are just some of the common concerns regarding DIEP flap, but if you are facing the decision to have breast reconstruction, you should consider all of the options. Breast reconstruction is a choice, but it can be a healing experience and is meant to restore what was lost to the extent that it can. While certain aspects can never be the same as natural breasts, nipple sensation, and breastfeeding, for example, you can still feel whole. The new breasts will eventually feel as much a part of you as your own body because, with DIEP flap, they are absolutely your own living flesh and blood.

About the Author

Katrina Smith is the Social Media Coordinator/ Patient Liaison at Midwest Breast and Aesthetic Surgery. She is a devoted wife and mother of four boys.
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*Our blog entries are written in order to further educate our patients and raise awareness towards topics related to plastic surgery. Any solutions offered on this blog are intended to help possible patients develop educated decisions before undergoing a consultation with our doctors.

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