A DIEP is a piece of tissue (flap) composed of fat and skin, taken from your lower tummy (abdomen), to create the feel and shape of a breast. The tissue and its blood vessels are carefully detached from your abdomen before being reconnected to a new blood supply in your chest. It is called DIEP because the blood vessels taken from the abdomen are called the deep inferior epigastric perforator blood vessels. It is a complex operation that takes about 5-7 hours. DIEP flaps give warm, soft and pliable reconstructed breasts that resemble natural breast tissue, and are therefore considered the gold standard for breast reconstructive procedures. In addition, the removal of tissue from your abdomen results in a flatter tummy, as if you have had a tummy tuck (abdominoplasty). After the skin, tissues and perforators (the flap) have been carefully dissected, the flap is connected to your chest using microsurgery. Mr Saour then shapes the flap to create the new breast. As no abdominal muscle is removed or transferred to the breast area you should experience less pain post-operatively and a faster recovery compared to other flap procedures. Abdominal strength is also maintained long-term after the DIEP flap procedure. The surgery involved is very complex, and few breast centres offer DIEP flap breast reconstruction. Nearly all breast reconstructions require two or more operations. When using the DIEP flap, whilst as much of the reconstruction is done at the time of the main flap transfer operation, there is often a need for a second very small operation to refine and adjust the reconstruction, as well as undertake a nipple reconstruction. Despite the need for more than one operation, the result should be life-long and the reconstruction should age with you naturally. It should also change with your body weight in a similar way to your breast. This is one of the major differences between flaps and implants, as implant-based reconstructions frequently needed revision surgery as the years go by.

Mr Saour will discuss the suitability of this procedure with you. In general it is a good choice if you want a natural feel and look, do not want an implant and need to have either one or both breasts reconstructed, and have an adequate amount of tissue on your tummy. You can still have a DIEP reconstruction if you've had some abdominal surgery (hysterectomy, caesarian section, appendicectomy, bowel surgery) unless the scarring on your abdomen is extensive. If you are very slim, very overweight, smoke or have health problems like diabetes then the procedure may not be suitable for you.

A DIEP reconstruction is a major operation performed under a general anaesthetic and usually requires a hospital stay of 4-6 days. A urinary catheter is used to drain urine while you are confined to bed during the first few hours after the operation. Some drains are positioned in the abdomen and the breast. These are usually removed in the three days following surgery. You will be given some intravenous antibiotics for 48 hours to help reduce the chances of early post-operative infection. You will also be given a blood-thinning injection of heparin to reduce the risk of deep vein thrombosis.

You will wake up in the recovery area before being transferred to the high dependency ward. It is usual to feel drowsy and a little disorientated for some time post-operatively. If you have pain or feel sick, you should tell the nursing staff so that they can give you the appropriate medication. The breast(s) will feel a little sore after surgery particularly when the arms are moved, but this rapidly improves over the first few days. It is likely that your hips and knees will be bent, perhaps on cushions or with the bed bent in the middle, to take the strain off the abdominal wound. You will be given a device to control your own pain-killing medication (PCA or Patient Controlled Analgesia). The nurse will teach you how to use this, but essentially you press the button on the control if you feel pain. There is a lock-out on the device so that it is impossible for you to overdose on the medication. A warming blanket is also usually in place for the first night to stop you getting cold, and some intermittent compression devices on the calves to keep the blood circulating in the legs and again reduce the chances of deep vein thrombosis.

You will have an incision on your breast and one on your abdomen. The breast incision will contain a patch of visible skin from the tummy so that Mr Saour can check that the flap is working well. The abdominal incision will be a horizontal line just below the bikini line. There will also be an incision around the belly button (umbilicus). All the sutures are dissolvable except for a small number within the umbilicus. All incisions produce scars, which usually settle down over several months. However some scars can be troublesome. Hypertrophic scars are red, raised and itchy for several months following the operation. These can be treated but may result in a wide stretched scar. Keloid scars are larger and more difficult to treat but these are extremely rare following breast reconstruction.

Drains will be used in both breast and the abdomen to drain away excess fluid following the operation. They usually exit the wound through a separate tiny incision, and are usually removed in the days following surgery, depending on the amount of fluid that is drained. Occasionally the abdominal wound produces a large amount of fluid and patients prefer to go home with their drain still in place. If this happens, you would need to return to the hospital a few days after discharge for removal of the drain.