At the botonics International Breast Unit, we specialist in the gold standard DIEP flap double breast reconstruction. While this is considered the most technically demanding of all reconstruction techniques, it offers the best balance of natural results, with minimisation of muscle loss along with the bonus of a tummy tuck like reduction in skin and fat.
If you can’t find the answer to your question here, please don’t hesitate to contact us. We are more than happy to help!
Frequently Asked Questions
Am I a good candidate for microsurgical breast reconstruction?
DIEP flap reconstruction is considered the state of the art reconstruction because of the results achieved with the minimum impact on the donating site. However, if you have already had an abdominoplasty (tummy tuck) surgery, or do not have sufficient skin and fat on your abdomen, you will probably need to consider an alternative reconstruction technique.
Are there any other options if I’ve already had a tummy tuck?
Yes, we are able to perform breast perforator flap breast reconstruction using other techniques (e.g. TRAM, SGAP, SIEA flap, PAP flap, etc.) which harvest the tissue from alternative sources on the body. Which technique is most appropriate for you can be discussed at your consultation or via Remote Assessment.
Why is the DIEP flap better than other options?
First, the abdomen is a good donor site because if usually has excess skin and fat available to harvest. Second, the DIEP technique harvests the donor tissue without sacrificing any of the underlying abdominal muscles, as occurs using the TRAM technique. Third, many women enjoy the bonus of a flatter stomach similar to the results of a tummy tuck.
What are the disadvantages of the DIEP flap option?
This technique takes much longer in theatre (about twice as long) as other techniques and requires the utmost in skill and experience. This is especially true when a double breast reconstruction is performed. During a double DIEP flap reconstruction, we sometimes opt to have two surgeons working as a team.
How long does the DIEP flap surgery take?
The time in theatre depends on whether the procedure is a single or double breast reconstruction, and whether one or two surgeons are performing the procedure. Times range from 4 – 10 hours in theatre.
How long do I need to stay in the hospital after my DIEP flap reconstruction surgery?
The number of nights you need to stay in hospital depends on whether you have a single or double reconstruction, and your underlying health and ability to recover. Most women stay 4 – 7 nights in hospital.
Can I have a mastectomy and reconstruction at the same time?
Yes, if you are considering having a mastectomy then many women prefer to have the reconstruction at the same time. This is referred to as an ‘immediate reconstruction’ and avoids having to go through two recovery periods. A ‘delayed reconstruction’ refers to reconstruction as a stand alone procedure, following the mastectomy.
If I’ve already had a DIEP flap reconstruction to one breast, can I have it done to my other breast?
If your abdomen has already been used as the donor site for a breast reconstruction, there will not be any tissue available to harvest for a second procedure at a later date. For this reason, if a double breast reconstruction may be necessary and the DIEP flat technique is preferred, it is best to do both breasts at the same time.
I live outside of the UK. Is it possible for me to be assessed before I travel to London?
Yes, a large number of our breast reconstruction patients are from abroad and so we have a well refined process to assess your medical suitability and prepare you for a breast reconstruction procedure prior to your travel.
Will my reconstructed breasts look natural?
Our aim is to produce as natural looking a result as is possible given the post-mastectomy starting point, available donor tissue and artistry of the surgeons. Using donor tissue usually produces a more natural looking and feeling breast than the use of implants. Please see our breast reconstruction photo gallery to examples of patient results.
Where is the scar following a DIEP flap breast reconstruction?
The donor flap is taken from the lower abdomen just below the naval. The resulting scar is along the bikini line. There will also be minimal scarring at the incision points around the areola.
What is autologous breast reconstruction?
Autologous reconstruction means using the patient’s own tissues for reconstruction. It refers to all types of flap reconstructions and is distinct from breast reconstruction using implants.
What is implant breast reconstruction?
Implant reconstruction usually involves multiple procedures and carries a greater risk of complication. It involves the use of an expander to stretch the skin over time, after which the expander is removed and replaced with an implant. If you have had or plan to have radiotherapy, we recommend against implant reconstruction due to the increased risk of capsular contracture (hardening of the breast due to scar formation around the implant).
What are the benefits of autologous breast reconstruction as opposed to implant reconstruction?
Breasts reconstructed with your own tissue look, feel and behave more naturally than implants. If you gain or lose weight, your breasts will increase or decrease in size.
What are the benefits of implant reconstruction?
Because it is a more simple operation, surgery and recovery time for an implant reconstruction is shorter. However, multiple small procedures are usually necessary to achieve the final result. Since no flap is required, there are no donor site scars.
What is a flap?
A flap is a plastic surgery term referring to a section of skin and fat which is transferred from one part of the body to another. Flap surgery is used for reconstructions on many areas of the body when trauma has occurred for any reason (e.g. cancer, burns, acid attack or other trauma). In order for a flap to survive a transplant procedure, blood vessels need to be transferred along with a flap and reconnected. The main blood vessel from the donor site is usually used to name the flap and differentiate between different reconstruction techniques.
What is a DIEP flap?
DIEP stands for Deep Inferior Epigastric Perforator and refers to the blood vessels that run under the ‘six pack’ abdominal muscles.
How long after Chemotherapy do I need to wait before having my pre-surgical blood test?
You must wait at least 6 weeks after you finish chemotherapy before having pre-surgical blood tests.
Can the DIEP reconstruction be done as part of the mastectomy?
Yes, we are able to do an immediate reconstruction of your breasts which means you will wake up with your new breasts and only have a single surgery and recovery period.
What about nipple reconstruction?
The areola is formed of a disk of skin from the abdomen at the time of reconstruction. However the nipple is normally created 6-12 months later or, in the case of an immediate reconstruction, part of the nipple from your natural breast can be re-attached – this is referred to as a nipple-sharing graft. The darker colour is achieved via tattooing, which is done in hospital 3-6 months later (2-3 sessions).
Will I need any additional adjustment surgery? If so, when and is this included in the price?
There is a high possibility your new breast(s) will need additional adjustment or ‘symmetrisation surgery’ to improve the aesthetic look and symmetry, and this could be in the form of a contralateral mastopexy (uplift) or reduction. At the same time, often some scar revision is necessary for the abdomen. As mentioned above, the nipple is reconstructed around the same time (6-12 months following your original procedure). There may be some additional costs involved.
How long after a mastectomy do I have to wait to have DIEP Flap reconstruction
This depends on whether you are undergoing radiotherapy, in which case you would need to allow time for the associated inflammation to subside. Basically you need to allow for full recovery following the mastectomy, before undergoing reconstructive surgery. This could be up to one year and your surgeon will be able to advise you when you are/will be ready.
Are there any risks to being under general anaesthetic for a long period of time, if so what measures are taken?
All our breast reconstructions are performed in one of the top hospitals in the UK, with all the necessary facilities and equipment.
What is a skin sparing mastectomy?
One of the benefits of having an immediate reconstruction is that you save the skin during the mastectomy, which is the same colour so aesthetically you will get a slightly better result. The skin on the abdomen tends to be slightly darker.
For how long have your surgeons been performing DIEP Flap breast reconstructions? And how many DIEP Flaps have they performed?
Mr Falladhar has been performing micro-surgery since 2001, and has done hundreds of DIEP Flap reconstructions. Mr Jallali currently performs around 80 DIEP Flap procedures each year and since 2009 he has done approximately 500.
What kind of success rate do your surgeons have?
Our surgeons here in London are some of the best in the world and have a 99% success rate.
Do you offer prophylactic mastectomy?
Yes and this is generally done as an immediate reconstruction (at the same time as the mastectomy).
I am from abroad, how long before I can fly home?
When it’s appropriate: it will generally be after 3 weeks, but best to check with your botonics Surgeon.
I’ve been told to give up smoking 6 months prior to my reconstruction surgery, can I use nicotine patches, chewing gum or e-cigarettes?
No, as it is the nicotine that is responsible for the vasoconstriction, which affects the blood vessels and microcirculation. This causes issues with healing of the abdomen, as the blood vessels need to recover from the flap surgery.
Are the results permanent?
Yes, unlike reconstruction with implants, the results are permanent.
After I’ve healed in full can I go back to my normal life and activities?
Yes you will be able to return to the life you had before, including all forms of exercise.
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Summary of treatment
- Procedure time
- Hospital stay
- Sensitivity period
- Back to work
- Full recovery
- Duration of results