DIEP Flap Procedure Gives People With Breast Cancer a Different Option for Reconstruction

After mastectomy, some people chose breast reconstruction, most commonly in the form of implants, which often need to be replaced. A more natural breast using the person’s existing abdominal tissue is achievable with the deep inferior epigastric perforator (DIEP) flap procedure, currently performed through Lehigh Valley Institute for Surgical Excellence.

“With DIEP flap reconstruction, you’re using your own body’s tissue. Where an implant might be too high risk or not a preference, we can utilize primarily the abdominal tissue that would otherwise be discarded in a ‘tummy tuck,’ harvesting that tissue on a blood vessel called the deep inferior epigastric artery,” explains Lino Miele, MD, plastic surgeon with Lehigh Valley Institute for Surgical Excellence. “We bring that up to the chest, make a new breast mound with it and connect the blood vessel to a vessel in the chest.”

This microsurgical reconstructive technique is muscle-sparing, which means there is a lower risk for muscle weakness. Ideal surgical candidates are otherwise healthy individuals who have a body mass index of less than 35 and don’t have a clotting disorder.

DIEP is a longer procedure than traditional implant reconstruction, so it may result in longer recovery times.

However, Dr. Miele and Nathan Miller, MD, plastic and reconstructive surgeon with Lehigh Valley Institute for Surgical Excellence, are teaming up for a co-surgeon approach to lessen the duration and its effects.

“The two of us will work together simultaneously to reduce the operating time, which is a huge plus for the patient and also the network,” says Dr. Miele, noting that it took him about 10 hours to perform DIEP flap at another institution on his own. He anticipates shortening it to six to eight hours through co-surgery. “It’s still long, but much better for the patient. Saving them any minutes we possibly can under anesthesia is important so they can recover faster.”

Dr. Miele, who was born and raised in the Lehigh Valley, is board certified in plastic surgery and had fellowship training in advanced reconstruction, including microsurgery. Most recently, he was Director of Breast Reconstruction at MD Anderson Cancer Center at Cooper in New Jersey.

“Anyone involved in the multidisciplinary approach to breast cancer should know that I establish the importance of communication – making sure everyone is on the same page because it is a team-based approach,” Dr. Miele says. “I’m excited to work with all of the talented physicians here.”