DIEP flap
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One in nine women develops breast cancer on Long Island. Some are treated with lumpectomy and radiation, while for others appropriate treatment is a modified, radical mastectomy. Psychological and emotional benefits associated with breast reconstruction are huge. Implant reconstruction superficially appears consequences thereof frequently require further surgery. Additionally, the safety of breast implants is controversial.

The tissue or flesh that is most often used for breast reconstruction is lower abdominal skin and fat. Standard abdominal breast reconstruction is called a TRAM (transverse rectus abdominus myocutaneous) flap. The skin and fat of the lower abdomen along with an entire rectus muscle are utilized. The muscle only serves as the carrier of the blood supply to the skin and fat. The flap, attached only by muscle at the ribs, is folded on itself and tunneled up on to the chest. It is then shaped into a breast. The abdomen is closed by pulling the rest of the abdominal skin down like a great big window shade. Potential problems are a bulge of the folded muscle under the ribs and abdominal weakness or hernia formation.

In the free TRAM flap, only a small piece of muscle is included with the skin and fat. With the flap completely unattached to the body, it is placed on the chest and microsurgery used to reestablish blood flow. Even a small amount of muscle removal can lead to an abdominal hernia.

The state-of-the-art today is the DIEP (deep inferior epigastric perforator) flap. With this flap the skin, fat, and perforating blood vessels are utilized. Microsurgery revitalizes the flap. No muscle is removed. The perforating vessels are often a millimeter or less in size and tedious to dissect. Patients recover quickly with usually only a three day hospital stay. The abdominal scar is placed low on the abdomen because no muscle is removed. The perforator blood vessel dissection increases operating time but the body tolerates superficial surgery well. Remember this is NOT abdominal surgery. There are very few surgeons who are capable of performing DIEP flap breast reconstruction and I am proud to be one of the pioneers in this new technique.  For further information see www.breastflap.com


Copyright 2002-2004  Alex Keller, MD, FACS. pc.  All rights reserved.