DIEP or deep inferior epigastric artery perforator flaps for breast reconstruction are commonly used in delayed breast reconstruction and following radiation therapy. Breast reconstruction with DIEP flaps typically require three stages of surgery to maximize the symmetry that is able to be obtained.
In the first stage, the skin and fat from the lower abdomen is harvested and then transferred to the chest with microsurgical anastomosis. The goal of the first surgery is to transfer the tissue to the breasts and allow all incisions to heal and both microsurgical grafts to take. Often when one breast has been radiated, the tissue characteristics differ between the two sides. The differences in the elasticity of the skin can allow the flaps to heal in slightly different positions, even though the flaps were placed symmetrically at the time of surgery.
Typically, the non-radiated side requires a second procedure to lift the newly reconstructed breast mound. At the same time that corrections are made to change the symmetry of the breast, changes can be made to correct any differences that exist in volume. This can be accomplished by removing some fat from one of the flaps or possibly the addition of an implant if the skin envelope is now healthy enough to accept and implant.