Monday, January 5, 2015

Anatomy of the DIEP Flap: Video Animation of the DIEP Breast Reconstruction Procedure



video

This is a schematic, animated cartoon of the DIEP procedure.  The video starts with area on the left chest where the blood vessels (internal thoracic artery and vein)  are prepared and the breast pocket delineated.  It moves to the lower abdominal area which shows the right side of the abdomen, the skin and fat, being dissected toward the deep inferior epigastric artery through the rectus muscle.  The Perforators, the branch blood vessels, are of good quality and the flap is then carefully disconnected from the abdomen and then transplanted to the chest via the blood vessels.  A very careful Microsurgical Anastomosis (Reconnecting of the blood vessels) is performed by hand, under high magnification with specialized suture and instruments between the Internal Thoracic vessels (Aka internal mammary).    Once finished,  the flap is placed inside the chest skin and shaped to fill the area as a breast.

A unilateral DIEP flap for breast reconstruction typically takes 4-6 hours of careful dissection and meticulous preparation.  The procedure requires an inpatient stay of 3 to 5 days.   A doppler and occasionally, a CT angiogram, is helpful in the preoperative planning.    A team approach with 2 experienced MicroSurgeons will decrease operative time and increase microsurgical success.    The DIEP flap breast reconstruction represents the very best that cutting edge surgery can offer for autologous breast reconstruction.   The procedure can be performed at the same time as the mastectomy, or in a delayed fashion to address breast implant issues, contracture, radiation damage, and wounds.

DIEP flap connected to the Internal Thoracic Artery via Microsurgical Anastomosis


This image shows the DIEP flap connected to the chest blood vessels (internal thoracic artery and vein).   The DIEP flap contains the dominant, main blood supply to the lower abdominal skin and fat.  It must have "good perforators" or branch vessels from the Deep Inferior Epigastric Artery and Vein to be a usable flap.