The benefits of the DIEP flap are many and varied. Obviously, the goal of any breast reconstruction is to recreate the shape of a breast. Implants and autologous tissue reconstruction will both achieve this goal to some extent. But that is where the similarities end for many patients.
Perhaps the greatest benefit of the use of DIEP flap (compared to an implant) relates to the fact that it feels just like a breast should, as well as looking like one. Whereas an implant feels cold and firmer than a normal breast and there may be rippling or palpable edges, the fat from the lower abdomen which is harvested with the DIEP flap has a feel very similar to that of a normal breast. It is soft, warm and malleable. The reconstructed breast will fill a bra the same way as the patient’s other breast. The DIEP flap can be lifted and modified at the same time as the patient undergoes a mastopexy or reduction on her other breast for symmetry. And the DIEP flap will last a lifetime: it will age with you and change shape as a breast should.
Implants simply cannot achieve what a DIEP flap can achieve in many cases.
Of course, we cannot discuss the relative benefits of a DIEP flap compared to an implant reconstruction without discussing radiotherapy.
Many women will need radiotherapy after their mastectomy. I have mentioned in previous articles the fact that radiotherapy is very damaging to the tissues. It damages the blood supply to the area treated and induces a scar-like response, resulting in hardness, pain and tightness. When radiotherapy and an implant reconstruction are combined, there are many risks which relate to these effects. I counsel patients that after radiotherapy, an implant (whether placed before or after the radiotherapy) can be lost due to wound breakdown or infection; there may be severe contracture of the capsule your body forms around the implant resulting in a painful, misshapen breast; there may be thinning of the skin on the chest and the implant may be even more readily felt than previously. All of which adds up to radiotherapy and implants not being the best of friends. To combat these problems, we use “acellular dermal matrices” (a bit like artificial skin) to wrap the implant, all in an attempt to ensure create a "firebreak" of sorts between the radiotherapy affect tissue and the area that has been operated on. This works to an extent (it depends a bit on who you ask) but it certainly isn’t perfect.
On the other hand, the DIEP flap is a thick layer of healthy skin and fat with a blood supply (unlike an implant!). By placing this tissue into the envelope of breast skin which remains after a mastectomy, a degree of resilience is offered against the harmful effects of the radiotherapy. Whilst it would be disingenuous to suggest that an autologous tissue reconstruction will prevent the side effects of radiotherapy, it is safe to say that the risks to the reconstructed breast are lessened.
The DIEP flap is obviously not without its problems, and there are certainly risks. As we have discussed, for some patients a DIEP flap is definitely the wrong operation. But in many cases, when weighing up the pros and cons, the DIEP flap is the best breast reconstruction technique currently available to women who have had or will have a mastectomy.