Please take a look at the article I recently finished for the QMP Plastic Surgery Pulse.  Here is the link to the main page of the Plastic Surgery Pulse.  http://www.plasticsurgerypulsenews.com/2/  This is a newer Online Journal.  I was asked to give an article so I chose to give a technical analysis of a DIEP Flap.  Here is the direct link to my article. http://www.plasticsurgerypulsenews.com/2/article_dtl.php?QnCategoryID=18&QnArticleID=43  Please read the article and allow me to answer any of your questions!

Diep flap surgery in the past was limited by a patient tissues.  I am speaking directly to those patients seeking reconstruction with their own tissues who do not want implants under any circumstances.  In many instances patients who were deemed to thin or those on the other hand who were felt to be to obese were denied the opportunity for this type of breast reconstruction.  Several thoughts have changed regarding DIEP flap surgery and breast reconstruction.  Since the introduction of the bipedicled DIEP flap, double stack DIEP, stacked DIEP flap more women who are relatively thin have been given the opportunity to have breast reconstruction surgery using their own tissue in the form of the DIEP flap.   This is particularly advantageous in situations where patients are having skin sparing mastectomy surgery.  This allows for the most complete breast reconstruction result where the mastectomy or breast skin has been saved by the breast surgeon and the plastic surgeon has the opportunity then to perform breast reconstruction surgery either with the abdominal tissue like a DIEP flap for optimal reconstructive outcomes.

The DIEP flap is an outstanding flap and ideal for large soft issue defects.  It has long been praised for the ability of this flap to provide a natural appearing breast reconstruction.  In addition to its utility in breast reconstruction this tissue flap is useful in a variety of other situations like arm and leg reconstruction after tumor removal like sarcoma.  In fact recently we have used the DIEP flap to care for patients with different sarcoma like angiosarcoma and fibromyoid sarcoma.  These patients have benefited from the quality and amount of skin and fat that can be transferred for their  arm and leg reconstruction just like the DIEP flap when it is used for breast reconstruction.  After multiple types of cancer surgeries the DIEP flap can be used.  Also it is very modifiable after the initial surgery has been performed.  Unlike a muscle flap and skin graft which has been traditionally performed for a number of years the DIEP flap is easily contoured through a combination of techniques involving liposuction of the fat and resection of the excess tissues.  Removal of the fat of the flap in the vertical dimension and the flap can be then stretched as well to flatten it even more.  This makes it ideal for the upper and lower extremity.  Of note this does remove the excess abdominal tissue that would normally be discarded in a tummy tuck procedure.  This procedure can be performed in a number of patients of different heights and weights.  If you are in need of reconstruction of the breast, large are or leg wounds the DIEP flap is a ideal source of healthy tissue.

The DIEP Flap is a skin and fat flap that Plastic Surgeons use to perfom total breast reconstruction after mastecomy for breast cancer using microsurgery. I like to think of the DIEP Flap as the rifinement of the procedure popularized in the 80's, the TRAM Flap. the main difference is the the DIEP Flap is a muscle and nerve preserving procedure. The results of DIEP, SIEA, TRAM, MS TRAM, are essentially all the same in terms appearance of the breast reconstruction. The differences are found in the effects on the anterior abdominal wall. I believe this is most important in bilateral breast reconstruction where the disturbance or removal of both rectus abdominus muscles can leave a patient with an incredibly weak abdomen. These patients can also have bulges, feelings of pressure, and abdominal discomfort, that occur even without removal of muscle. I firmly believe that the most natural breast reconstruction appearance is dervied from the patient's own tissue. As I was typing this blog when one of my DIEP Flap patient's came in for a post operative visit. She is doing quite well. So well that I have to remind her that she should take it easy since she is less than 2 weeks after her surgery. I had sent a post out on Twitter regarding some thoughts about DIEP flap reconstruction using both DIEP Flaps for unilateral breast reconstruction. That's right I said use both for the one side. Having done DIEP flaps where I use one half of the abdomen or seventy-five percent of the abdomen to create a breast reconstruction I now feel that in a unilateral breast reconstruction that both DIEP flaps should be used. this way the Plastic Surgeon doesn't waste any of the tissue. In a bilateral case the Plastic Surgeon would be unable to perform the reconstruction in this manner because of the need to reconstruct both sides. Of course this is only my opinion and will not necessarily be shared by everyone. I hope this patient and many of my other DIEP flap patient's both with unilateral and bilateral will allow me to show their photos so that other patients can really understand the size, shape and symmetry that can be achieved with the DIEP Flap.

To date I have performed DIEP Flap reconstruction for patients from several states in the Midwest including Michigan, Indiana, Illinois, Missouri, and Wisconsin. I have even had patients travel from Phoenix, Arizona. My practice still provides care mainly for those patients in Milwaukee, Madison, Kenosha, Racine, Green Bay, Sheboygan, Two Rivers, Janesville, and the surrounding areas of Wisconsin, Illinois and Michigan.