New Breast Reconstruction Surgery Offers Cancer Patients Natural-Tissue Transplant Without Removing Muscle
12/16/2009

DALLAS — Surgeons on the medical staff at Texas Health Presbyterian Hospital Dallas are performing an advanced type of reconstruction surgery for breast cancer patients who have undergone mastectomy. The procedure, called a DIEP flap, is a highly specialized microsurgical procedure designed to transplant a woman’s own abdominal tissue to the chest, providing soft, natural tissue to restore the breast.

Dr. Jeffery Krueger
Dr. Jeffery Krueger
Click photo to download hi-res image

This is a significant technical improvement over the more common way of using abdominal tissue in breast reconstruction, said Drs. Gregg Anigian and Jeffery Krueger, plastic surgeons on the medical staff at Texas Health Dallas. At most medical centers around the country, similar tissue transplant surgeries for breast reconstruction are associated with the removal of all, or a significant portion, of the abdominal muscles, which compromises abdominal wall strength and contour.

With the DIEP (deep inferior epigastric artery perforator) flap, surgeons use microsurgery techniques to dissect out and transfer the fat and skin from the lower abdomen — while leaving the core abdominal wall muscles intact.

“The DIEP procedure features benefits that many women desire as they recover from breast cancer surgery,” Krueger said. “While using the patient’s own native tissue for restoring breast volume and shape, the DIEP procedure has the added advantage of reducing pain as well as abdominal wall bulge, hernia, and weakness typically found with other procedures, thus improving recovery and shortening hospital stays.”

Most women have a slimmer and more tightened appearance to their abdomen with the removal of abdominal tissue (similar to a tummy tuck), but the main benefit is using their own tissue to rebuild the breasts.

“That’s very important to many patients,” Krueger said. “They want to feel whole again, and would prefer the texture and behavior of natural tissue without the insertion of prosthetic breast implants. Plus, there is the added benefit of possibly improving abdominal contour.”

The DIEP flap has similarities to the older, more conventional TRAM (transverse rectus abdominus muscle) flap procedures. “The goal of each technique is to deliver lower abdominal tissue to the breast, but the DIEP procedure is the only one that saves the abdominal muscles attached to the tissue during transfer,” Anigian said.

The result is a reduction in both hospitalization and recovery times, doctors say.

Dr. Gregg Anigian
Dr. Gregg Anigian
Click photo to download hi-res image

“The purpose of taking muscle and tissue is to protect and preserve the blood vessels that supply the desired abdominal skin and fat with blood flow,” Anigian added, “but in the DIEP dissection, the blood vessels that nourish this tissue are identified and traced through the abdominal wall muscle to their source. Most patients are walking upright and feeling well within weeks instead of month with the older procedure.”

During the DIEP procedure, the tissue, with attached blood vessels, is removed from the abdomen. Recipient blood vessels are isolated in the chest, and the two sets of vessels are then reconnected. Blood flow to the DIEP flap is then re-established, and the living, transplanted tissue is sculpted and contoured to resemble new breasts.

“In the end, patients who undergo DIEP don’t lose range of motion or strength,” Anigian said. “That’s a big plus for women who want to get back to an active lifestyle, whether it’s raising a family, working, exercising or traveling.”

Although the DIEP flap and other highly specialized microvascular surgery techniques are usually perfected and refined at major university medical centers, Texas Health Dallas was one of the first hospitals in Texas to routinely offer the procedure.

“Early on, we recognized the significance of the DIEP flap and were convinced of its eventual importance to breast cancer patients,” Krueger said. “Our experience with this surgical technique, as well as other perforator flaps, has grown, enabling us the opportunity to offer the most up-to-date procedures to our patients.”

The DIEP flap may not always be the best reconstructive technique for every patient. Each individual must be carefully evaluated to determine if they are appropriate candidates.

About Texas Health Presbyterian Hospital Dallas
Texas Health Presbyterian Hospital Dallas is an 866-bed acute care hospital and recognized clinical program leader, having provided compassionate care to the residents of Dallas and surrounding communities since 1966. U.S. News and World Report has ranked Texas Health Dallas among the nation’s best hospitals in digestive disorders, orthopedics, and neurology and neurosurgery. An affiliate of the faith-based, nonprofit Texas Health Resources system, Texas Health Dallas has approximately 4,000 employees and an active medical staff of more than 1,000 physicians. For more information, call 1-877-THR-WELL, or visit TexasHealth.org/dallas.