What should you know about mastectomy with DIEP flap reconstruction?

DIEP stands for deep inferior epigastric perforator. During microsurgery, the team moves abdominal skin and fat with its small blood vessels to the chest, connects those vessels to chest blood supply and shapes the tissue into a breast mound. The abdominal muscle is intended to remain in place. This is major surgery involving both the chest and abdomen, with scars in both areas and a period of reduced mobility. Reconstruction may be immediate or delayed, and the final shape can require later adjustment. A mastectomy may treat breast cancer or selected conditions such as Paget disease of the breast.

Meet both a breast surgeon and a reconstructive microsurgeon. They will assess abdominal tissue, previous operations, general health and whether chemotherapy before surgery or radiotherapy could change timing. Before the operation, plan for help with washing, meals, children and transport. In recovery, protect the abdominal incision, follow drain instructions, walk as advised and avoid lifting until cleared. Ask when you may drive, work, exercise and sleep comfortably. Breast reconstruction options can include implants or other tissue-based approaches, so compare their recovery and maintenance needs.

Call the surgical team urgently for a breast or flap that becomes suddenly pale, dark, cold, very swollen or increasingly painful, because the blood supply needs prompt assessment. Also report fever, worsening redness, pus, opening of the abdominal wound, persistent vomiting, calf swelling or new breathlessness. Emergency help is needed for severe breathing difficulty, fainting or chest pain.

Am I a suitable candidate for a DIEP flap? Where will the scars be, and how will abdominal strength be protected? Will reconstruction be immediate or delayed around other treatment? How long might drains and hospital recovery last? What happens if the flap blood supply becomes a concern?