Empowering access: How DIEP flap and autologous tissue transfer empower breast cancer survivors

After conquering breast cancer, many survivors are left with a simple question: "What's next?" This is especially true for women who have undergone mastectomy or are considering undergoing mastectomy.

Many women want to reclaim their body following breast cancer and mastectomy. One possible next step is to opt for breast reconstruction. Some reconstructions are performed using breast implants, but there are options available that involve reconstruction without the use of implants. One such method is a DIEP flap, or deep inferior epigastric artery perforator flap, which is an autologous tissue transfer using tissues from the patient's own body for reconstructing the breast.

ASPS Member Surgeons Mary Lester, MD, and Rozbeh Torabi, MD, shared their insights on DIEP flaps and autologous tissue transfers and how they can provide empowerment to breast cancer survivors.

The basics of DIEP flap and autologous tissue transfer

One of the most commonly used methods of breast reconstruction without implants is the DIEP flap. This involves the use of the patient's own tissues from different locations within the body to reconstruct the breast.

"The DIEP flap can be performed either at the time of mastectomy or any time after," said Torabi. "We use the patient's abdominal tissues, which is usually the same tissue we remove during an abdominoplasty, taking the skin, fat and the vessels."

Once this tissue is successfully removed, the flap is then transferred to the chest and the vessels are reconnected via a process known as "anastomosis."

"When I'm talking to patients, usually one of the ways I describe what we're doing is that we're taking advantage of a typical tummy tuck," said Lester. "Instead of throwing that tissue away, we do microsurgery to reconstruct. It's a muscle-sparing technique – women don't have to experience too much of a difference in their day-to-day lives."

Other methods of autologous tissue transfer involve using tissues from other places in the body.

"Most microsurgeons that do breast reconstruction have adapted to the inner thigh being the second choice, sometimes called a PAP or TUG flap," said Lester. "It's a crescent of tissue taken from the inner thigh and is a good option for women who are pear-shaped or who have already had a tummy tuck. Most women have a little extra fatty tissue there, and you can hide the scar more easily."

In addition to using the thigh, there are tissues in the shoulder that can be used for autologous tissue transfer.

"Most often, it's a good choice for an older patient or one who has health problems that you'd be worried about doing a longer surgery on with a longer recovery," said Lester.

A life-changing procedure

When thinking about work done with women who have survived breast cancer and are in the process of undergoing or have already undergone mastectomy, there is a great focus placed on empathy and empowerment.

"The goal of reconstruction is to get you looking good in clothes so that you can wear, in general, what you want without feeling self-conscious," said Lester. "If we do it right, the patients can sort of put that cancer behind them. Every time they look in the mirror, they don't see it looking back at them."

A part of this focus on empathy and empowerment lies in the surgeon-patient relationship and unlocking exactly what they want to achieve with their DIEP flap or autologous tissue transfer procedure.

"I work with the patient and tailor the reconstruction based on the patient's wants and needs," said Torabi. "I do quite a bit of liposuction to reshape the entire body. Sometimes, we place implants to fulfill the patient's goals."

Yet, occasionally, doctors must advise patients to put these procedures on hold when further chemotherapy or radiation treatment is needed.

"Our first and foremost goal is to treat cancer and prevent any further cancer with radiation and chemotherapy, then reconstruction can take the forefront," said Torabi.

Although reconstruction must sometimes be delayed, there are still options to begin the process during the mastectomy, which also gives the patient more opportunity to consider their reconstructive options.

"We have switched, if they have invasive cancer, to not doing the flap immediately," said Lester. "We'll do the mastectomy and place a tissue expander. This allows the patient to have time and extra breathing room to make a choice. When you have so many doctor's appointments in a short amount of time, it can be overwhelming to the patient."

These procedures can be one of the most rewarding and poignant parts of the job for plastic surgeons specializing in breast reconstruction.

"With a DIEP flap, it's sort of bittersweet," said Lester. "I take care of those patients, and we have such a great relationship for 6-9 months, and then they go away, and I don't see them anymore. They don't need me anymore, so they're done and move on with life. That's why it's one of my favorite operations to do."

Plastic surgeons play a critical role in allowing women who have battled breast cancer to reclaim their bodies after a mastectomy and move on with their lives.

"We're really lucky as plastic surgeons because we can always do something to make it better," said Lester. "We're typically seeing people when they've had bad news or at the end of their rope, and we get to help them. Every time they look in the mirror, they don't see it looking back at them. It's about helping them move on. It's something that you can get past and survive – when I'm able to do that for a patient, it's the best part of my job."

Part of that healing is knowing all your options for breast reconstruction if that's the path you choose to take.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.