Advanced Microsurgical Technique Enhances Breast Reconstruction


Dustin L. Eck, MD
McLeod Plastic and Reconstructive Surgery

When a woman is faced with breast cancer the first goal is to perform an operation that removes the breast cancer. The second goal is to give the patient a cosmetic outcome that results in the breast looking as natural as it did before the surgery or even better in some cases.

Breast reconstruction surgery involves the expertise of a plastic surgeon. At McLeod Regional Medical Center, we offer multiple options for breast reconstruction. These options include implant-based reconstruction using silicone or saline breast implants to recreate the breast or flap-based reconstruction in which the patient’s own tissue is used to reconstruct the breast.

The most common flap procedure performed is a DIEP (deep inferior epigastric perforator) breast reconstruction. Most women are candidates for this surgery.

An advanced microsurgical technique that is used to rebuild the breast lost to mastectomy, the DIEP flap procedure requires a plastic surgeon with special surgical training as well as expertise in microsurgery. This form of surgery involves the use of small specialized instruments to operate on very delicate areas of tissue, such as nerves and blood vessels. The procedure is considered micro because the blood vessels are usually under three millimeters in size.

The DIEP flap technique is a much more complex and extensive procedure as opposed to breast reconstruction using an implant, however this technique avoids some of the complications associated with implants.

A cutting-edge procedure, the DIEP breast reconstruction involves removal of a flap of complete tissue, blood vessels (perforators) andexcess living tissue (skin and fat) from the lower abdomen below the navel or belly button. The plastic surgeon, aided by a microscope, transfers the flap of tissue from the abdomen to the chest connecting the dissected blood vessels from the abdominal tissue to the patient’s chest blood vessels. Once the vessels are attached, the surgeon works on shaping the breast.

The biggest benefit of this procedure involves rebuilding the breast with the patient’s own tissue which allows the plastic surgeon to create a more natural looking breast that is permanent and does not require maintenance or repeat surgery over time. We are essentially using the body’s tissue to heal itself. And, since the patient’s own abdominal tissue is used, it grows and changes with the patient over time. It also feels more like a natural breast. In addition, if the woman only has a mastectomy on side, it’s easier to match the shape, size and feel.

There are several benefits of the DIEP flap breast reconstructive technique over other types of reconstruction including reduced post-operative pain, less abdominal wall weakness post-surgery and a decreased chance of abdominal wall hernia formation.

Since muscle is not used to rebuild the breast, this technique preserves the abdominal muscles and retains more strength in the patient’s abdomen. An additional benefit of the DIEP flap procedure is it gives patients a “tummy tuck” which flattens and firms the abdomen by removing excess skin and fat.

If a woman decides to pursue the DIEP flap procedure she can choose to have it performed either the same day as a mastectomy, which is known as immediate reconstruction or the surgery may take place at a separate time known as delayed reconstruction.

Sometimes, a temporary implant reconstruction is used before DIEP breast reconstruction to allow the patient with a more advanced disease requiring radiation therapy to complete their cancer treatment prior to undergoing final breast reconstruction.

For more information on microsurgical breast reconstruction, please call McLeod Plastic and Reconstructive Surgery at (843) 777-7255.