DIEP flap surgery - so why all the hype? If you are a woman facing mastectomy due to breast cancer you have a decision to make: do you want breast reconstruction? If the answer is "yes", plastic surgery and particularly DIEP breast reconstruction, may hold the key. Although reconstruction cannot replace the breast(s) you were born with or allow you to breastfeed, it can restore your natural silhouette and make you feel "whole" again following mastectomy. Depending on your health, breast reconstruction can be performed immediately after your mastectomy so you can wake up with new breasts already in place. While the cosmetic results with immediate mastectomy reconstruction are generally superior, reconstructive surgery can also be performed at a later time once the cancer treatment has been completed.

DIEP flap surgery represents today's gold standard in breast restoration. Advances in breast reconstructive techniques have made it possible to use excess skin and fat from the abdomen (rather like the tissue removed during a tummy tuck) to construct a new, "natural" breast without the need for implants or the sacrifice of abdominal muscle. The DIEP (Deep Inferior Epigastric Perforator) flap is a sophisticated modification of an existing surgery known as the TRAM (Transverse Rectus Abdominus Myocutaneous) flap.

TRAM surgery is a common breast reconstruction technique that requires the rectus abdominus (sit-up) muscle to be sacrificed and relocated to the upper abdomen. Unfortunately, this technique can be associated with significant post-operative pain, prolonged recovery, loss of abdominal muscle strength (up to 20%), abdominal bulging (or "pooching"), and even abdominal hernia.

DIEP breast reconstruction is similar to the TRAM procedure but spares the rectus abdominus muscle. SKIN AND FAT ONLY are removed from the abdomen, transplanted to the chest and connected using microsurgery to create the new breast. NO MUSCLE is sacrificed. As the sit-up muscle is left behind in its natural place many of the above complications are avoided and the patient essentially receives a tummy tuck at the same time. There also tends to be far less pain and a quicker recovery time because the abdominal muscles are left in place.

Knowing the significant advantages of DIEP flap surgery it is easy to understand the reason for all the hype, especially for active individuals who donít want to sacrifice the strength of their abdomen. A breast that has been reconstructed with fat and skin will also look and feel more natural than an implant reconstruction and will last longer without the long-term risks that can be associated with implants. Unlike an implant, the reconstructed breast also ages like a natural breast.

As with all types of breast reconstruction however, 2 or 3 stages performed a few months apart are often required to complete the reconstruction process and to obtain the best cosmetic result. Unfortunately, due to the complexity of the surgery very few centers in the US perform the DIEP procedure so many patients will have to travel for the procedure. The good news is that many of these specialist centers will accommodate out-of-state and even international patients. So how do you find a top DIEP flap surgeon? To learn if a breast center or plastic surgeon near you offers this advanced procedure, please check the following websites:

www.diepbreastreconstruction.org/diepdocs1.htm and www.breastrecon.com/id10.html

The lists on these websites seem fairly thorough. Having said that, currently there are only about 40 plastic surgeons in the US that routinely perform DIEP breast reconstruction. Before choosing a DIEP surgeon ensure that he/she is a plastic surgeon certified by the American Board of Plastic Surgery and has extensive experience with this type of surgery (preferably over 100 procedures). Ask about the success rate in their hands (most specialists boast a flap survival rate of 97% to 99%+) and how many cases they have performed.

Unfortunately, some patients will face difficulties in gaining access to specialists offering DIEP breast reconstruction even though insurance companies are federally mandated to pay for the cost of breast reconstruction. Here again it pays to seek out plastic surgeons who specializing in these procedures as typically an insurance specialist is available to help patients with insurance issues.