In this procedure, a breast form is created by taking skin and fat and sometimes muscle from the lower abdomen (tummy). There are three types of breast reconstruction surgery using tissue from the lower abdomen; a DIEP flap, a SIEA flap and a TRAM flap. In a DIEP and SIEA flap only skin and fat is used, but in a TRAM flap muscle is also used.
In this section we have only interviewed women who have had a DIEP flap. For more information on SIEA, TRAM flaps and other please see Breast Cancer Care’s website.
In a DIEP flap the muscle through which the blood vessels come is left in the abdomen. The tiny blood vessels that keep the skin and fat alive are very carefully cut out as far as the larger artery and vein in the groin (the deep inferior epigastric perforators). The flap of skin and fat is then moved to the chest and the blood vessels joined to blood vessels of the same size in the armpit or chest wall. The appearance of the new breast is usually very good and feels very natural. More medical information about breast reconstruction can be found on the Macmillan Cancer Support website.
Some women had a DIEP flap reconstruction at the same time as a mastectomy. One, who had invasive breast cancer in one breast and DCIS in the other, had both breasts reconstructed at the same time as her mastectomy. Several said they were given lots of information about the different types of reconstruction before making a decision. One woman, though, said the information she was given wasn’t very helpful and she would have liked to have seen how a DIEP flap reconstruction looked on women who’d had it. Others contacted women on internet forums to learn about their experiences of the operation and satisfaction with the results. One woman said she was concerned about the length of time the operation would take and about being under general anaesthetic for so long.
One woman said she had a DIEP flap reconstruction two years after a mastectomy because she felt lop-sided with only one breast and was getting back ache.
Many women felt anxious before surgery because of what their reconstructed breast might look like or because it was their first ever operation and it would be a long one (see Mastectomy: The operation
). When they came round, several said they were in no pain, though had some discomfort because of the drainage tube. A few women said they remembered coming round and having a bad reaction to the drugs they had been given. Some said that, shortly after coming round, they were encouraged by nurses to move their arm but it was often sore. It was also difficult to walk unaided because of the surgery to their stomach. One said it was difficult to stand or lie flat because the skin on her abdomen felt very tight. Several remembered having frequent checks by nurses and a visit from the physiotherapist, who recommended exercises.
Most women were in hospital for about a week, but it is now more common that women stay only a few days. Back home, they were careful not to lift heavy objects or over-exert themselves physically (see Mastectomy: physical and emotional recovery
). Some women said it took them a few weeks before they felt they were getting back to normal.
Most women said they were happy with how their new breast looked, several saying they thought it was ‘brilliant’ or ‘fantastic’ the first time they saw it. One said she asked her husband to look at the scars soon after surgery because she was so pleased with the results, while another said she hid the scars from her husband for a while. Some women later had surgery to match the healthy breast with the reconstructed one, as well as nipple reconstruction (see Nipple reconstruction
). For one woman, having a breast reconstruction was also a huge emotional experience.
A few women experienced problems some weeks after their operation. One developed an uncomfortable swelling under her arm, which she hopes will be corrected during further surgery to resize her other breast (mastopexy). Another developed a hernia where the tissue had been removed from her abdomen, which was fixed in another operation. She was also surprised to find a few hairs growing on her reconstructed breast; this was because the skin had originated from the pubic area of her abdomen.
With hindsight, some women said they would have liked more information about a DIEP flap reconstruction. A few women with larger breasts advised others to think about the breast size they wanted before surgery because it was possible to have a smaller breast than before. One of these women was now planning to have surgery to reduce her healthy breast. Through a breast cancer charity, another had been put into contact with someone who’d had a DIEP flap reconstruction. They both felt that there was very little information available to women about reconstructive surgery and set up their own support group (see Support from other women with DCIS or breast cancer
One woman was waiting to have a mastectomy and an immediate DIEP flap reconstruction. She read as much as she could about reconstructive surgery and found talking to her plastic surgeon and breast care nurse helpful. She is going to have a slightly smaller sized new breast because there isn’t enough tissue on her stomach for the same sized breast, and, later, a breast reduction to the healthy breast.
More experiences of breast reconstruction can be found on the Healthtalk Breast Cancer site.
Breast reconstruction using tissue from your bottom or thigh
Breast reconstruction can also be done using skin and fat from the upper or lower buttocks. An SGAP flap uses skin and fat from the upper buttocks and IGAP flap from the lower buttocks. A TMG flap uses tissue from the outer part of the thigh. A Tug flap uses skin, fat and a small strip of muscle from the upper inner thigh. These methods of reconstruction are not offered routinely and only a few surgeons in the UK can do this surgery and you may need to travel to a specialist hospital.
We have not yet interviewed anyone who has had a SIEA, TRAM, SGAP, IGAP or TUG flap for breast reconstruction. If you have had these surgeries and and you would like us to include your story on this website, please email firstname.lastname@example.org.