Like all surgery, DIEP flap surgery has some risks. Many of the risks associated with DIEP flap surgery are the same as the risks for mastectomy. However, there are some risks that are unique to DIEP flap reconstruction.
Tissue breakdown: In rare instances, the tissue moved from your belly to your breast area won't get enough circulation and some of the tissue might die. Doctors call this tissue breakdown “necrosis.” Some symptoms of tissue necrosis include the skin turning dark blue or black, a cold or cool-to-the-touch feeling in the tissue, and even the eventual development of open wounds. You also may run a fever or feel sick if these symptoms are not addressed immediately. If a small area of necrosis is found, your surgeon can trim away the dead tissue. This is done in the operating room under general anesthesia or occasionally in a minor procedure setting. If most or all of the flap tissue develops necrosis, your doctor may call this a “complete flap failure,” which means the entire flap would need to be removed and replaced. Sometimes the flap can be replaced within a short timeframe, but in most cases the surgical team will remove all the dead tissue and allow the area to heal before identifying a new donor site to create a new flap.
“If necrosis is going to be a problem, it will happen in the short term — within the first few days after surgery,” says Frank J. DellaCroce, M.D., F.A.C.S., plastic surgeon and co-founder of the Center for Restorative Breast Surgery. “If it doesn’t, then you know the tissue is getting enough blood supply and long-term issues with this are not a concern.”
Lumps in the reconstructed breast: If the blood supply to some of the fat used to rebuild your breast is cut off, over time, the fat may be replaced by firm scar tissue that will feel like a lump. This is called fat necrosis and the lump is usually not noticeable until the rest of the flap softens and the swelling is gone (6-8 months). These fat necrosis lumps may or may not go away on their own. They also might cause you some discomfort. If the fat necrosis lumps don't go away on their own, it's best to have your surgeon remove them. After having mastectomy and reconstruction, it can be a little scary to find another lump in your rebuilt breast. Having them removed can give you greater peace of mind, as well as ease any discomfort you might have.
Hernia or muscle weakness at the donor site: A hernia happens when part of an internal organ (often a small piece of the intestine) bulges through a weak spot in a muscle. Most hernias occur in the abdomen. They usually develop when someone who has a weak spot in an abdominal muscle strains the muscle, perhaps by lifting something heavy.
If you have a DIEP flap, you have a small risk of hernia. Your risk of hernia is much lower with a DIEP flap than with any type of TRAM flap. This is because a DIEP flap uses no muscle to rebuild your breast. Still, after any abdominal surgery, there is some risk of hernia.
Hernias can be painful and can cause a noticeable bulge in your abdomen. Hernias usually are treated by surgically repairing the opening in the muscle wall. The surgery is generally done on an outpatient basis.