Frequently Asked Questions

DIEP flap


Q: Why have I never heard about breast reconstruction with the DIEP flap before?

A: In other European countries and North America the DIEP flap is often the first choice for breast reconstruction after radical mastectomy for breast cancer, while in Italy this procedure is not widely diffused because it requires a high-level, specialistic surgical competence. The procedure is state-aided, yet not adequately refunded from the national health service, thus not all potential patients can benefit from DIEP flap.


Q: In which circumstances the DIEP flap procedure cannot be performed?

A: Whenever the abdomen presents scars and previous surgical procedures that interfered with vascularization; if it is not possible, or the patient is not willing, to undergo a surgical procedure that lasts more than 4 hours. If abdominal tissues are insufficient, even though today's trend is to still perform a small DIEP flap that will be successively integrated with lipofilling.


Q: In case I underwent breast reconstruction with expander and prosthesis and the result does not satisfy me, or some complications or capsular contracture occurred, can I still benefit from DIEP flap?

A: Yes, if the basic conditions are met, a reconstruction with DIEP flap can be performed even after an unsatisfactory reconstruction with prosthesis, or after capsular contracture.


Q: Can the DIEP flap be performed to both breasts?

A: Yes. Prof. Santanelli has been the first in Italy to perform a bilateral DIEP flap in 2005, and until today he has performed several of these procedures in patients who underwent prophylactic mastectomy to the contralateral healthy breast.


Q: Can the DIEP flap procedure be repeated?

A: No, the harvest of abdominal tissues is possible only once.


Q: What is the operative time and which are the intraoperative risks?

A: The operative time depends on the experience of the team. We perform the operation in a single stage in 3 hours and 30 minutes, comprising contralateral breast adjustment. In case of a bilateral procedure, the operative time is around 6 hours. Such a long anesthesia is not demanding on the body and, however, the patient is strictly monitored by the anesthesiologists, which are part and parcel of the IRMA Team.


Q: How will my belly be after the operation?

A: The belly will be flattened. During convalescence you should wear an abdominal binder, day and night, for one month from operation. You will experience a sensation of tension to the abdomen that will gradually assuage week after week, until it vanishes. Sensibility of the sovrapubic area will be slightly reduced, but it will improve. Instead, the “flattened belly” result remains unchanged.


Q: How will skin sensibility of the new breast be?

A: Quite reduced. Nevertheless this does not mean that you will not feel the entire organ. Sensibility is better when, according to the General Surgeon's needs, the native breast skin can be preserved along with the nipple. 


Q: Will I have to repeat the operation?

A: No. Since implants are not used, the reconstruction with autologous tissues does not require further operations. To enhance symmetry it might be necessary to perform additional procedures, however they are only minor and less demanding operations.


Q: Which are the risks of complications and failure of this procedure?

A: The major risk for the success of this procedure concerns vascularization, and occurs when the new anastomosed vessles fail to oxigenate tissues, or part of them. It is an exiguous minority of cases, varying from 0% to 10%. In prof. Santanelli's experience it happened in 0.4% of cases. Among other possible complications, the most common one is partial tissues necrosis (3% of cases in the IRMA Team experience), which is corrected by removing the small amount of skin and adipose tissue that did not survive after the operation, without any aesthetic drawback. For these vascular issues it is important to be a non-smoker.

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Redazione Barbara Fabiani