DIEP/SIEA

Both the DIEP and SIEA flaps utilize excess abdominal skin and fat from the lower part of the abdomen. The difference between the two is the choice of blood vessels that nourish the flap tissue.

In the DIEP flap, the blood vessels are contained in the abdominal rectus muscle and advanced microsurgical techniques are used to safely separate the artery and vein from the muscle while preserving muscular integrity. Unlike the TRAM flap, only the essential structures are utilized which include the skin and fatty tissue; the muscle is not necessary for reconstruction. As a result of a less invasive procedure, patients are able to resume their pre-operative activities much sooner after surgery.

The blood vessels of the SIEA flap are more superficial and they travel in the fatty layer of the abdominal tissue. Therefore, less dissection is required than in the DIEP flap where the blood supply is deeper in the muscle. Since these vessels may be absent in some patients, the decision as to which flap is performed is made during the reconstructive surgery, based on the patient's anatomy.

In these procedures, the abdominal tissue is completely detached from the abdomen and re-attached to the small blood vessels in the breast area, resulting in a microsurgical tissue transfer. These tiny blood vessels require the surgeon to use a microscope to connect them together. Once this is complete, the blood flow to the tissue is restored. The tissue is then shaped to fit the mastectomy defect and a small skin patch is left. The skin patch from the abdomen will be used later to reconstruct the nipple. For patients who underwent a complete mastectomy, the abdominal skin is used to replace the missing breast skin.

The skill of the surgeon in DIEP and SIEA flap procedures is considerably more demanding than earlier methods of breast reconstruction. The operation can be lengthy due to the precise nature of this microsurgical procedure. However, the surgical effort is rewarded by excellent cosmetic results. The procedure is also less invasive, resulting in less pain and faster recovery. In the case of DIEP and SIEA flaps, the operation leaves a horizontal scar on the lower abdomen, similar to that created in a cosmetic tummy tuck, resulting in a slimmer abdominal contour that is appreciated by most women. Additionally, for both the DIEP and SIEA, we can now offer routine re-innervation where nerves are connected to facilitate gradual return of sensation in the reconstructed breast.