There are several options to reconstruct the breast following mastectomy. Depending upon the degree of pre-operative ptosis of the breast, the patient may be a candidate for a nipple sparing mastectomy. A nipple sparing mastectomy may be performed through an inframamary incision. For a DIEP flap reconstruction, the operative surgeon often needs access to blood vessels in the chest, usually either the internal mammary or the thoracodorsal vessels. Certain patients will have an anatomy that allows access to the internal mammary vessels from the inframammary fold access.
The lower abdominal tissue is then dissected free from the abdomen with a vascular leash that can then be reattached to the blood supply in the chest. When the patient has a nipple sparing mastectomy the skin on the patients chest is preserved as best as possible. In some patients the skin may become slightly ischemic depending upon anatomy. Frequently during DIEP flap surgery, the abdominal skin is kept burried beneath the breast skin to see how much of the mastectomy skin will survive. Once the mastectomy skin has declared itself, the abdominal skin that was kept burried beneath the breast skin can be delivered. In some patients, all of the skin between the nipple and the inframammary fold can survive and only the vascularized fat from the abdomen is used to reconstruct the breast.
This is an example of a bilateral DIEP flap reconstruction following a bilateral mastectomy.