Once it is determined during consultation that you are in fact a candidate for an autologous tissue flap to be harvested from your abdomen, the rest is up to your internal anatomy. Dr Small always first dissects out the Superficial Inferior Epigastric Arteries to evaluate their suitability for a flap to be based on them. Although the literature states that around 10-15% of patiens are candidates for the SIEA procedure, in fact, much fewer that that are safe candidates. We have found the flap to be much less reliable than a DIEP and better suited when the breast to be reconstriucted is very small. Dr. Small then explores the perforating vessels of the Deep Inferior Epigastric Artery. Those vessels are much beter suited for reconstruction ona regular basis. Rarely, usually when there has been prior gynecologic surgery, a free muscle sparing TRAM is performed if their is concern about the ability of the vessels to support the flap.

It is basically a factor of blood supply. The operation that is performed (DIEP vs SIEA vs Free TRAM) is the operation with the best blood supply to prevent fat necrosis with the least toll on the abdomen.

Like any type of procedure, recovery after a DIEP Flap varies from patient to patient. We have had patients back to work in 3 weeks and some who have taken up to three months to resume pre-operative activities. We tell all preoperative patients that typical recovery after DIEP Flap surgery is around 6 weeks. That is six weeks until you are able to get back to your normal routine. Most people are standing completely upright after 10-14 days (as any tummy tuck patients). By the sixth week, they are driving completely on their own and may resume all normal preoerative activities. But again, it may be longer in some patients.

Patients who are the most motivated to do well, simply do better. A healthy and forward thinking attitude most certainly helps in the recovery. A strong social network is also invaluable.

The key to this answer is that DIEP or Implant based reconstruction is in fact “a process”. No patient wakes up with a complete breast consisting of a skin envelope, tissue or an implant to make it protrude, and a nipple-areolar complex. It requires several stages before the reconstructive process is complete. Only the first stage (either the DIEP or insertion of the tissue expander) is a procedure that requires hospitilization. The other stages are all ambulatory procedures that have minimal recovery. Some in fact, (nipple reconstruction or tatoo placement) can be done in the office.
A rough estimate of the total reconstructive process in an woman who is undergoing IMMEDIATE DIEP or implant based reconstruction without the knowledge of the final pathology available at the the time of initial consultation is 3-9 months. Obviously, the need for chemotherapy, possible need of radiotherapy, and allowing for time for vacation, breaks and possible complications, all play a role in total time until completion. The reconstructive process is obviously much quicker when there is no need for chemotherapy (ie delayed reconstruction or when done for prophylactic reasons BRCA etc).