DIEP Flap for One-Stage Reconstructiion of the Breast and Nipple after Breast Cancer

The DIEP flap has become a standard procedure for this author when reconstructing the female breast after a mastecomy in breast cancer. In the first breast reconstructions using a DIEP flap, the dissection of the flap was tedious. The shaping of the breast was often left for a secondary procedure after 6 - 8 months when the tissue had “settled.” The secondary procedure included correction of volume, shape, and reconstruction of a nipple.

After more than 350 DIEP flaps since1999, the flap is faster and safer to harvest and more effort is put into shaping the breast in a one–stage procedure, also including the reconstruction of the nipple. By using the remaining breast as a template, the DIEP flap is already shaped before the a. epigastrica inferior pedicle is divided in the abdomen. In some cases, the remaining breast is reduced by a concomitant mammoplasty.

The shaping of the breast with the described technique includes a certain amount of folding of the flap. This folding stresses the circulation both in the arterial and the venous blood flow. Pitfalls were discussed.

It is a major advantage to reconstruct the breast and nipple in a one–stage operation. The patient can be “finished” with her reconstruction and does not need to wait for the next operation. However, the technique does have a learning curve, and partial necrosis should be avoided.