Like all surgery, DIEP flap surgery has some risks. Many of the risks associated with stacked DIEP flap surgery are the same as the risks for mastectomy. However, there are some risks that are unique to stacked 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 the tissue isn’t getting enough blood supply, you’ll know it within a few days after surgery, based on the appearance of these symptoms. Otherwise, you know the tissue is getting enough blood supply and long-term problems with tissue breakdown 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, the fat may be replaced by firm scar tissue that will feel like a lump. This is called fat necrosis. 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 stacked DIEP flap, you have a small risk of residual muscle weakness, but the risk of hernia is much lower than with any type of TRAM flap. This is because a DIEP flap uses no muscle to rebuild your breast.