Breast reconstruction
Unfortunately, breast cancer is very common. It has been determined that one in nine women is at risk of being affected by this disease during her lifetime. After performing a (partial) mastectomy, there are many possibilities to make their breast(s) aesthetically pleasing again.
Breast reconstruction can be performed immediately after the amputation; or afterwards when the patient has recovered from the amputation. This also depends on any radio- or chemotherapy.
Breast reconstruction is possible for many women into old age. There are several options for reconstructing a breast. We mainly distinguish between techniques in which protheses or the body’s own tissue is used. In some cases, a combination of both is recommended. This choice differs per patient and the plastic surgeon will make this decision together with you.
DIEP flap reconstruction
A frequently performed procedure is the DIEP flap reconstruction, in which only the body's own tissue is used.
In the DIEP flap breast reconstruction, a new breast is made with skin and fatty tissue from the abdomen. This procedure spares the straight abdominal muscles. A CT scan of the abdomen is made beforehand to map the small blood vessels in the abdominal wall.
Small blood vessels (perforants) are searched for that run from the skin, through the fatty tissue via the muscles to the main blood vessels in the groin. These blood vessels are carefully exposed, sparing the muscles.
After the blood vessels are perforated at the level of the main vessels, the DIEP flap is brought to the chest region. The blood vessels are connected to the blood vessels in the chest next to the sternum by means of the operating microscope (the anastomosis is performed). Sometimes a piece of rib has to be removed to get a better view of the blood vessels in the chest.
If the blood circulation to the DIEP flap is working properly, a breast is formed by shaping the flap.
Then, the defect at the level of the abdomen is closed. The navel is brought out through a small opening in the skin and sutured further. Eventually there will be a scar at the height of the abdomen in the bikini line and around the navel.
This extensive procedure takes on average 6-8 hours.
! It is very important to have realistic expectations about breast reconstruction! It is important to note that the reconstructed breast may differ in shape, size and feeling compared to a natural breast. However, most women who undergo breast reconstruction are very satisfied with the final result. This often leads to more self-confidence and a mental boost.
For some women, this DIEP flap reconstruction is not an option or not the best option. The surgeon will discuss this with you and, if necessary, indicate which option is suitable for you.
Preparation
- You must be fasting for this procedure under general anaesthetic.
- Timely smoking cessation is very important to prevent wound healing problems.
- When taking blood thinners, you should stop them in time. Be sure to discuss this with the surgeon during the consultation.
Postoperative course
- You will stay in the hospital for 3-5 days. During the first days, the flap reconstruction will be closely monitored for the presence of good blood flow.
- You are not allowed to make any strenuous (sporting) efforts for 6 weeks.
- It is very important to mobilize as soon as possible after the procedure (within the pain limits), in order to prevent thrombosis, among other things.
- After this reconstruction, one or two corrective interventions are usually required after a few months for symmetrization. This is a shorter procedure that takes place in the day hospital.
- Finally, a nipple reconstruction can be performed. This can be done under local anaesthetic; three months after the last corrective procedure. Ultimately, a nipple tattoo can also take place; not earlier than 4 months after nipple reconstruction.
Possible complications
As with any surgery, this procedure carries a risk of bleeding, infection or impaired wound healing. A rare (approximately 1 to 2%) but dramatic complication of the DIEP flap breast reconstruction is that the blood flow to the displaced tissue appears to be insufficient, which can lead to complete death of the flap reconstruction. It is also very important to mobilize in time, otherwise there is a greater risk of pneumonia, pulmonary embolism or thromboses in the leg.
As with any surgery, this procedure carries a risk of bleeding, infection or impaired wound healing. A rare (approximately 1 to 2%) but dramatic complication of DIEP flap breast reconstruction is that the blood flow to the displaced tissue appears to be insufficient, which can lead to complete death of the flap reconstruction. It is also very important to mobilize in time, otherwise there is a greater risk of pneumonia, pulmonary embolism or thromboses in the leg.