Abdominal flap (DIEP) and free microsurgical reconstruction
Microsurgery is the highest level of surgical art and technical difficulty in breast reconstruction; not all plastic surgeons offer it.
The basic concept is to avoid to use synthetic material like silicone to restore the breast shape using a part of the own patient’s body; it can be described as a transplant using the same person tissues. Like heart or kidney transplant, the skin and fat transferred by the surgeon survive thanks to the connections of tiny arteries and veins (anastomosis) manually made by the surgeon under microscope magnification to restore blood circulation.
Soft tissues can be harvested by various part of the body. Nevertheless, the abdominal flap, named DIEP flap, is the most popular option to rebuild a breast because a woman often has enough volume in her abdomen to match the breast size, as a pleasant side effect, the abdomen will be flat and nicely shaped after surgery, which is usually appreciated.
In the long term, the patient can enjoy the advantages of having the breast restored in a single stage, has not to worry about implant maintenance (for example broken implant replacement) and can expect both breasts to age symmetrically.
In case of radiotherapy or delayed reconstruction with lack of tissue to build a new breast, abdominal flap finds its best indication against expander/implant reconstruction.