Breast Reconstruction

Natural Breast Reconstruction Using Your Own Tissue

A diagnosis of breast cancer can be life-changing. For many women, treatment involves a mastectomy to remove one or both breasts. Breast reconstruction offers the opportunity to restore breast shape and help patients move forward following cancer treatment.

One of the most advanced techniques available is Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction, a microsurgical procedure that uses your own abdominal skin and fat to create a natural-looking breast without sacrificing the abdominal muscles.

Dr Namal Munasinghe offers personalised breast reconstruction, working closely with breast surgeons and the multidisciplinary breast cancer team to develop an individual treatment plan that is tailored to your needs.

What Is a DIEP Flap?

A DIEP (Deep Inferior Epigastric Perforator) flap is an advanced microsurgical breast reconstruction procedure that transfers skin and fat from the lower abdomen to reconstruct the breast following mastectomy.

Unlike older techniques such as the traditional TRAM flap, the DIEP flap preserves the abdominal muscles by carefully dissecting the tiny blood vessels (perforators) that supply the abdominal tissue. This helps maintain abdominal strength while providing sufficient tissue to reconstruct the breast.

For many women, the procedure also provides an effect similar to an abdominoplasty (tummy tuck), with removal of excess lower abdominal skin.

How Does DIEP Flap Reconstruction Work?

During surgery, skin, fat and the small perforating blood vessels are carefully harvested from the lower abdomen.

Using an operating microscope, these blood vessels are connected to blood vessels in the chest (most commonly the internal mammary artery and vein) to establish blood flow to the transferred tissue.

The abdominal tissue is then shaped to create a new breast that is customised to your body and desired breast size.

Because living tissue is transferred, the reconstructed breast feels warm, soft and natural.

Immediate or Delayed Reconstruction

DIEP flap reconstruction may be performed:

Immediate Reconstruction

At the same operation as the mastectomy.

Potential advantages include:

• One major operation

• Preservation of the breast skin envelope where appropriate

• Earlier restoration of breast shape

Delayed Reconstruction

Performed months or years after mastectomy once cancer treatment has been completed.

Delayed reconstruction may be recommended for women who require radiotherapy or when immediate reconstruction is not suitable.

The most appropriate timing will be discussed with your breast surgeon, oncologist and plastic surgeon.

Who May Be Suitable?

DIEP flap reconstruction may be appropriate for women who:

• Require breast reconstruction following mastectomy

• Prefer reconstruction using their own tissue

• Have sufficient lower abdominal tissue

• Wish to avoid permanent breast implants

• Are in good general health

• Do not have medical conditions that significantly increase surgical risk

Not every patient is suitable for a DIEP flap. Previous abdominal surgery, body habitus, smoking and other medical conditions may influence the available reconstructive options.

Advantages of DIEP Flap Reconstruction

Potential advantages include:

• Uses your own living tissue

• Soft, natural appearance and feel

• No permanent breast implant

• Long-lasting reconstruction

• Ages naturally with your body

• Less risk of capsular contracture

• Preservation of abdominal muscles

• Lower risk of abdominal weakness compared with older muscle-sacrificing techniques

• Improved abdominal contour following tissue harvest

Potential Risks

As with any major operation, DIEP flap reconstruction carries risks.

These include:

• Bleeding

• Infection

• Delayed wound healing

• Partial or complete flap loss

• Fat necrosis

• Blood clot within the flap blood vessels

• Donor site wound complications

• Abdominal bulging or hernia (less common than older flap techniques)

• Scarring

• Need for further revision procedures

These risks and any others relevant to your individual circumstances will be discussed thoroughly during your consultation.

Recovery

DIEP flap reconstruction is a major surgical procedure.

Most patients remain in hospital for several days while the flap is closely monitored.

Recovery generally includes:

First Few Weeks

• Regular walking encouraged

• Temporary lifting restrictions

• Support garments for the abdomen

• Gradual improvement in mobility

Six to Twelve Weeks

Most patients progressively return to normal daily activities during this period, although recovery varies between individuals.

Additional procedures such as nipple reconstruction, fat grafting or symmetry surgery may be performed several months later if required.

Your Consultation

During your consultation, Dr Namal will discuss:

• Your breast cancer treatment

• Your reconstructive goals

• Immediate versus delayed reconstruction

• Implant and autologous reconstruction options

• Whether DIEP flap reconstruction is suitable

• Expected recovery

• Potential risks and benefits

• Likely need for staged procedures

Every reconstruction is planned individually, with consideration given to your anatomy, cancer treatment and personal preferences.

Frequently Asked Questions

Will my reconstructed breast feel natural?

Because the reconstruction uses your own tissue, the breast typically feels softer and more natural than an implant-based reconstruction. Individual results vary.

Will I have an abdominal scar?

Yes. The scar is usually positioned low on the abdomen, similar to the scar from an abdominoplasty (tummy tuck), although the exact appearance varies between individuals.

How long does the operation take?

DIEP flap reconstruction is a complex microsurgical procedure and generally takes significantly longer than implant-based reconstruction. The exact duration depends on whether one or both breasts are being reconstructed and other individual factors.

Can both breasts be reconstructed?

Yes. Bilateral DIEP flap reconstruction may be an option for selected patients undergoing bilateral mastectomy.

Will I need further surgery?

Many women undergo additional procedures such as fat grafting, nipple reconstruction or surgery to improve breast symmetry after the initial reconstruction.

Why Choose Dr Namal Munasinghe?

Dr Namal Munasinghe is an Australian-trained Specialist Plastic and Reconstructive Surgeon with expertise in microsurgical breast reconstruction.

Working closely with breast surgeons, oncologists and the multidisciplinary breast cancer team, he provides personalised reconstructive care for women undergoing breast cancer treatment. From your initial consultation through to your recovery, he is committed to providing compassionate, evidence-based care while ensuring you understand your treatment options and feel supported throughout your reconstructive journey.