Breast reconstruction with free flap and microsurgery

Breast reconstruction using the DIEP flap (Deep Inferior Epigastric Perforator), developed in the USA, has revolutionised breast reconstruction by using the skin and fat from the lower abdomen, whereas reconstructions using the latissimus dorsi flap remained more common in Switzerland and France over the past 20 years. Similar to the latissimus dorsi flap, this technique uses the patient’s own tissues to recreate the breast. Instead of taking tissue from the back, the harvested tissue comes from the abdominal area located between the pubis and the navel.

This harvesting is performed while preserving the blood vessels to ensure that the transplanted tissues receive adequate vascularisation. The major advantage of this technique is that it does not require breast implants.

It is therefore particularly suitable for patients wishing to avoid implants and who have sufficient abdominal tissue. It does result in an additional scar, similar to that of an abdominoplasty.

This is a well-established microsurgical technique that requires a highly qualified surgical team, most often performed in a hospital setting because postoperative monitoring is too demanding for a surgeon working alone in private practice. The abdominal skin and fat are removed with their nourishing vessels, and the abdomen is closed as in an abdominoplasty. The harvested tissues are then reconnected to the thoracic vessels using vascular microsurgery to ensure proper blood flow to the flap. The tissues are also reshaped to form the breast.

CT angiography, also known as angioscanner or vascular imaging, is commonly used during preoperative planning for DIEP flap breast reconstruction. This examination precisely maps the vascular anatomy of the abdomen, identifies perforators (vessels that pass through the muscles to supply the skin and fat) and assesses the condition of the blood vessels, essential information for a successful surgery. In DIEP flap reconstruction, identifying and preserving these vessels is crucial to ensuring the vascularisation of the abdominal flap.

Hospital admission takes place the day before surgery. The procedure is performed under general anaesthesia and lasts between 4 and 6 hours with two surgical teams working simultaneously : one team harvests the abdominal flap while the other prepares the recipient site in the breast area. Hospitalisation lasts about one week, during which you will be monitored closely. Teamwork is essential, as it ensures an optimal outcome while reducing the risk of complications.

A one-month work leave is necessary, along with wearing an abdominal compression garment and a supportive bra to stabilise the reconstruction and promote healing. Antithrombotic treatment is prescribed for the first 15 days after surgery to prevent surgical complications. Physiotherapy sessions may be recommended to help regain mobility and flexibility after the procedure.

The results of DIEP breast reconstruction are immediately visible, but it takes several weeks for the swelling to subside and for the tissues to adjust naturally.

The DIEP flap not only reconstructs the breast but also enhances the appearance of the abdomen, making it an increasingly popular option among patients. It is currently the most widely used autologous breast reconstruction method in Switzerland and the USA.