A Surgeon's Perspective on DIEP Flap Breast Reconstruction

Below Dr. Alex Keller shares his thoughts about the surgical skill necessary to successfully perform DIEP flap reconstruction to create a natural breast for women who have undergone mastectomy.

The DIEP flap for me was the natural evolution of what breast reconstruction from the abdomen should be. I had spent many years previously doing both the TRAM flap and the free TRAM flap and taking care of the complications to the breast which included areas of fat necrosis, and complications to the abdomen which included hernias and infected synthetic meshes utilized to try to prevent a hernia. Abdominal tissue is the ideal replacement for breast tissue. In many patients it is readily available, and has the consistency of breast tissue, making the reconstructed breast feel very natural. At my New York breast reconstruction office, we no longer talk about whether it looks likes a breast, but rather about how it moves and jiggles like a breast.

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The learning curve to perform this operation well is quite steep. I say this even as a trained microsurgeon who, prior to undertaking DIEP flap breast reconstruction, had done thousands of microsurgical procedures. Not only does one have to pick the correct perforator or perforators that will perfuse this flap and keep it alive, but one must dissect these vessels that are often a millimeter or slightly larger in size. This requires a level of skill and determination to make it work that many surgeons simply do not possess.

The experience part of the equation is very important also. There are many variations of the blood supply and of the different perforators that can be confusing. This can lead to poor choices with a flap that has poor or no blood supply and failure. Experience makes a surgeon very familiar with the different anatomic variations and allows the surgeon to make the best possible choices. I have done over 900 DIEP flap breast reconstruction procedures with a success rate of better than 99.5%.

To find out if you may be a candidate for DIEP flap breast reconstruction, click here to request a phone consultation from Dr. Keller, a renowned New York City breast reconstruction specialist. You can also call the practice at 516-482-1100 to schedule an appointment.

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