Ductal Carcinoma in Situ (DCIS)
Breast reconstruction using tissue from your tummy: DIEP flap, SIEA flap, TRAM flap. Or your bottom or thigh: SGAP, IGAP,TMG,TUG.
In this procedure, a breast form is created by taking skin and fat and sometimes muscle from the lower abdomen (tummy). There are three types of breast reconstruction surgery using tissue from the lower abdomen; a DIEP flap, a SIEA flap and a TRAM flap. In a DIEP and SIEA flap only skin and fat is used, but in a TRAM flap muscle is also used.
In this section we have only interviewed women who have had a DIEP flap. For more information on SIEA, TRAM flaps and other please see Breast Cancer Care’s website.
In a DIEP flap the muscle through which the blood vessels come is left in the abdomen. The tiny blood vessels that keep the skin and fat alive are very carefully cut out as far as the larger artery and vein in the groin (the deep inferior epigastric perforators). The flap of skin and fat is then moved to the chest and the blood vessels joined to blood vessels of the same size in the armpit or chest wall. The appearance of the new breast is usually very good and feels very natural. More medical information about breast reconstruction can be found on the Macmillan Cancer Support website.
In this section we have only interviewed women who have had a DIEP flap. For more information on SIEA, TRAM flaps and other please see Breast Cancer Care’s website.
In a DIEP flap the muscle through which the blood vessels come is left in the abdomen. The tiny blood vessels that keep the skin and fat alive are very carefully cut out as far as the larger artery and vein in the groin (the deep inferior epigastric perforators). The flap of skin and fat is then moved to the chest and the blood vessels joined to blood vessels of the same size in the armpit or chest wall. The appearance of the new breast is usually very good and feels very natural. More medical information about breast reconstruction can be found on the Macmillan Cancer Support website.
Some women had a DIEP flap reconstruction at the same time as a mastectomy. One, who had invasive breast cancer in one breast and DCIS in the other, had both breasts reconstructed at the same time as her mastectomy. Several said they were given lots of information about the different types of reconstruction before making a decision. One woman, though, said the information she was given wasn’t very helpful and she would have liked to have seen how a DIEP flap reconstruction looked on women who’d had it. Others contacted women on internet forums to learn about their experiences of the operation and satisfaction with the results. One woman said she was concerned about the length of time the operation would take and about being under general anaesthetic for so long.
After talking to her plastic surgeon and looking on the internet, Jane opted for a DIEP flap reconstruction. She was worried about the general anaesthetic.
After talking to her plastic surgeon and looking on the internet, Jane opted for a DIEP flap reconstruction. She was worried about the general anaesthetic.
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I went to see the plastic surgeon about what to do. And they went through all the options of reconstruction, the different flaps or not having any at all or whatever. They made a very determined pitch for DIEP Flap. They talked about it being the golden standard. And I picked up, I picked up that it clearly was. And I did a bit of research of my own on the net to find out about all these things. So I was quite willing to be persuaded that it was the thing to have.
But I was always faintly amused by this kind of feeling that I got, that this was what they’d really like doing. And so this is what they would like to do on me. But that can work to your advantage because if I think, if surgeons are really engaged in and excited by a procedure, they’re probably going to do it well. So they did it.
I was slightly concerned by how long I would be under the anaesthetic for the DIEP flap because, as you know, it’s almost like a whole day in the operating theatre. But they were quite careful to paint me a picture of the comparative risks. And how being under general anaesthetic for an extra two or three hours was really hardly any more risky, than being under for four hours and I was convinced by that. So that was fine.
One woman said she had a DIEP flap reconstruction two years after a mastectomy because she felt lop-sided with only one breast and was getting back ache.
Many women felt anxious before surgery because of what their reconstructed breast might look like or because it was their first ever operation and it would be a long one (see Mastectomy for DCIS: The operation). When they came round, several said they were in no pain, though had some discomfort because of the drainage tube. A few women said they remembered coming round and having a bad reaction to the drugs they had been given. Some said that, shortly after coming round, they were encouraged by nurses to move their arm but it was often sore. It was also difficult to walk unaided because of the surgery to their stomach. One said it was difficult to stand or lie flat because the skin on her abdomen felt very tight. Several remembered having frequent checks by nurses and a visit from the physiotherapist, who recommended exercises.
Jane didn't get much rest because the nurses regularly checked her breast but she was in no pain at all. She felt slightly nauseous and had an injection to treat that.
Jane didn't get much rest because the nurses regularly checked her breast but she was in no pain at all. She felt slightly nauseous and had an injection to treat that.
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After that they [nurses] don’t leave you alone of course, after a DIEP flap. And they look at it all time. It seems like every ten minutes, they looked at it. I think it’s probably something like every hour. So people would come in constantly and take your pyjama top down and have a look at it and make sure the temperature was fine. They were all making very reassuring noises and saying, “Oh that’s lovely and warm,” and so on, but it doesn’t make for much rest.
And I think the progress after that was fairly normal. I was on a flat bed for a day and then I was allowed two pillows for a day. And I can truly say I had absolutely no pain whatsoever. I was completely pain free. I would just classify it as discomfort of various kinds, because obviously I had drains in. And I think the closest I came to pain was the back ache actually because I was on my back for so long, sort of a whole day in theatre and a whole day on a flat bed, that I really had quite a lot of back ache by the time I was allowed to have pillows and do something different. But that’s all.
And I had a slight, slight nausea. Not immediately after the operation. That was fine. So I think the nausea, I suspect was probably something to do with the antibiotics in the drip. Because it only kicked in after, I don’t’ know, 6, 8 hours, something like that. But it wasn’t severe and they gave me they gave me a pill for it, which didn’t really work and then they gave me an injection for it and that worked fine.
Maisie had a double mastectomy and both breasts reconstructed at the same time. She found it difficult to walk on her own at first but was determined to get well and be home for Christmas.
Maisie had a double mastectomy and both breasts reconstructed at the same time. She found it difficult to walk on her own at first but was determined to get well and be home for Christmas.
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I was, went in on the 19th, I had the operation on the 20th and I was out on the Christmas Day. Because I said to myself I’m not staying in for Boxing Day, I’m going home for Christmas [laughs]. So what I did, what you have to do is eat everything they give you and get your family to bring stuff in for you as well. So I ate the breakfast although I wasn’t hungry, I ate lunch and I asked my family to bring in tomatoes and olives and stuff for me to eat in-between. So by the second day, I couldn’t get up but the third day I made myself get out of bed. And I was walking about and everything, you know, go take a shower by myself.
But some times you have to have assistance because I had a cut, I had a caesarean to build the breast. Look at my breasts, big breasts [laughs]. I had a caesarean and they built my breasts for me which was really good [laughs]. And, you know, you needed help because you had all the drips and everything. But in the end I just got them to give me some bags. And I had one drip in this hand. Sorry I had a drip in this hand with two drips hanging out and then I had another bag, Marks and Spencer’s bag. So you should have seen me bending over because I had a cut and I couldn’t walk straight. I was walking like that when I was going to the hospital, going to the toilet. And taking a shower and then you know but I’m thinking, “What the hell, I want to get out so I might as well get up and do what I have to do instead of sitting in bed. And if I want to get out I eat the food”.
And the food was very good, the caterers and the nurse and everybody was really nice. And I just, you know, I was out on Christmas Day and that was really, really, really good.
And you had Christmas with your family at home?
Yeah. Everybody waited for me to come because if I didn’t come out they would have brought the food. And I said, “I’m not having them bringing the food and everything”, so I just get myself ready and everything. But the good thing, as I said, the plastic surgeon said I could be out on Christmas Day and I didn’t know that. So I just made myself get better and I was out on Christmas Day. And, as I say, that’s good but I was thinking, “What the hell? That’s not good.” I just wanted to get out of the hospital.
Most women were in hospital for about a week, but it is now more common that women stay only a few days. Back home, they were careful not to lift heavy objects or over-exert themselves physically (see Mastectomy for DCIS: physical and emotional recovery). Some women said it took them a few weeks before they felt they were getting back to normal.
Beverley was petrified the night before surgery and hardly slept. After surgery, she found the first three days uncomfortable and didn't get much rest, but said it was all worth it.
Beverley was petrified the night before surgery and hardly slept. After surgery, she found the first three days uncomfortable and didn't get much rest, but said it was all worth it.
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I finally got the op and I was absolutely petrified. I knew it was going to take a long time, it could take up to eight hours. And I could remember feeling totally neurotic about it all. We went away and had a short break just to get away for a while and I had to go in the day before.
And like all hospitals, the day before they had got so many people in, the place was so busy they hadn't got a bed for me. And I knew I was to have to have a private room because they have to keep you at a certain temperature. But they hadn't got anywhere for me so I had to sit around and it was one of the hottest days of the year and I had to sit in the waiting room. And it was absolutely baking. And I remember just getting up and pacing around. In the end they sent me off for tests and by the time I came back, about half past four, five o'clock from the test, they had got me a bed.
I spent the entire night awake, couldn't go to sleep. I think they got fed up with me, the nurses on the ward, because by the morning I was pacing up and down the ward. And going down, it was a relief in the end just to go down. When I woke up after the operation it really wasn't that bad. It was a wonderful high of morphine so [laughs] that part really wasn't too bad. And back on the ward, I was back in my own private room so that was good. But they had to keep me hot and as it was so hot, they didn't have to put any heaters in but they couldn't give me anything to cool me down either. So I had to have lots of cloths on my head just to try to keep my head cool. And my temperature unfortunately went way up because of it.
And it was a bit uncomfortable for the first three days because they have to keep checking you every, well it starts off every fifteen minutes for the first six hours. And then it's every half an hour for the next day and a half and then they go down to two hours and four hours and they gradually lengthen it out. Because they have to check that the reconstruction isn't failing and that the blood vessels are open and everything is OK. So you don't get any sleep for the first three days and so it makes you pretty tired. But it was worth it because the reconstruction is absolutely brilliant. They did an absolutely brilliant job. So I’d recommend anyone to get it done.
When Jane first came home, she was tired, couldn't move her arm very much and had discomfort around the scar on her stomach. She felt she was back to normal about four or five weeks later though.
When Jane first came home, she was tired, couldn't move her arm very much and had discomfort around the scar on her stomach. She felt she was back to normal about four or five weeks later though.
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When I came home, although I was tired and I had, I couldn’t move my arm very much, I wasn’t allowed to and I wasn’t kind of my normal self, nevertheless I managed to stagger to Sainsbury’s the next day. I was unable to, I dropped a Kiwi fruit on the floor of Sainsbury’s and I was unable to bend down and pick it up. And that was my second slightly weepy moment, which was a bit funny. Presumably because I was not quite my normal self and had just come out of hospital. And so I was picking this Kiwi fruit up and dropped it on the floor and then couldn’t pick it up, and felt, “Oh dear, I can’t even pickup a Kiwi fruit, I’m so weak.” But I had gone to Sainsbury’s, that’s the main point [laughs]. So that’s, I felt that well.
And then I had to sit in a particular chair, which was very comfortable. Which was almost like a garden chair, it just turned out to be the chair where I could have cushions round, which supported my left arm comfortably. And in bed I had to have pillows all around my left arm I remember. So my husband was kind of, I could wave at him across this raft of pillows in bed because that’s how I slept there. So I didn’t sleep on my side for quite some weeks. I just slept on my back with this arm raised.
I had lots of exercises to do and I did those religiously. And they were hugely helpful and I think I would counsel anybody after this operation to be absolutely religious and scrupulous about doing them because they were just so good. And you can really measure your progress too because one week you can do this and the next week you can do something else. And that really makes a difference. You really feel you’re making progress when that happens. I did those, probably I did those longer than I needed to. I probably did them for about 4 or 5 months after the op, just to keep it limber.
I went up into town to have my hair done two weeks after I came out of hospital and I would have said that by then, although I was feeling worried, slightly worried about people knocking into me, and also very worried about the Tube because, you know, the Tube gates have a habit sometimes of just closing on you for no good reason and I was really worried that they would close on me because of my tummy.
One wonderful by-product of having a DIEP flap is that you get a fantastic tummy tuck. I haven’t had a flat tummy for about 20 years I think and I have now got the most wonderful flat stomach. But of course a scar across it as well. And that gave me quite a lot of discomfort and I couldn’t stand up straight for about a week or two weeks after the op because the tummy tuck had been pulled so straight. So that was quite significant. So the thought of it being actually knocked by somebody or crushed in the Underground gates was a bit worrying. But nevertheless I felt, I must admit, I felt very close to normal after about two to three weeks after the op. I didn’t go back to work I suppose until seven weeks I think after the op. But it could have been four or five easily I think if I’d really wanted to. I could have coped.
Most women said they were happy with how their new breast looked, several saying they thought it was ‘brilliant’ or ‘fantastic’ the first time they saw it. One said she asked her husband to look at the scars soon after surgery because she was so pleased with the results, while another said she hid the scars from her husband for a while. Some women later had surgery to match the healthy breast with the reconstructed one, as well as nipple reconstruction (see Nipple reconstruction). For one woman, having a breast reconstruction was also a huge emotional experience.
Beverley said she would recommend a DIEP flap reconstruction to other women. She is happy with her new breast and said an added benefit of the surgery was a tummy tuck.
Beverley said she would recommend a DIEP flap reconstruction to other women. She is happy with her new breast and said an added benefit of the surgery was a tummy tuck.
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I'd recommend it, I mean, for some women I know it seems an awful big operation to have but, to my mind, it was fully worth it. Just a few weeks out of my life and I’m a, you know, I feel much more, I don't have to worry about a prosthesis and everything else. It's all just there, it's just as normal really.
And any scars have kind of faded?
The scars are fading, yeah. There were, the worst scar really is the one across the tummy because it's the entire length of my tummy but that's coverable.
Yeah. Is it quite low?
It's just below my bellybutton. Just about there. But you can put a bikini on and cover it up and, you know, there's no problem with that. So, no, it’s fine. I've actually got a flat tummy so that was another advantage, you get a tummy tuck as well. So [laughs]….
A few women experienced problems some weeks after their operation. One developed an uncomfortable swelling under her arm, which she hopes will be corrected during further surgery to resize her other breast (mastopexy). Another developed a hernia where the tissue had been removed from her abdomen, which was fixed in another operation. She was also surprised to find a few hairs growing on her reconstructed breast; this was because the skin had originated from the pubic area of her abdomen.
With hindsight, some women said they would have liked more information about a DIEP flap reconstruction. A few women with larger breasts advised others to think about the breast size they wanted before surgery because it was possible to have a smaller breast than before. One of these women was now planning to have surgery to reduce her healthy breast. Through a breast cancer charity, another had been put into contact with someone who’d had a DIEP flap reconstruction. They both felt that there was very little information available to women about reconstructive surgery and set up their own support group (see Support from other women with DCIS or breast cancer).
Jane advises women with larger breasts to consider whether they would prefer to be a size smaller. She plans to have a breast reduction but wishes she had thought about this before her reconstruction.
Jane advises women with larger breasts to consider whether they would prefer to be a size smaller. She plans to have a breast reduction but wishes she had thought about this before her reconstruction.
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There was one thing I regretted and that’s that they asked me quite early on, the plastic surgeons, how do you feel about the actual size of your breasts, do you want, because my breasts were slightly large and I think they were concerned that they might not be able to match the size. I think there’s some women are proud of large breasts and don’t want them to be reduced. And I think in my efforts to be sensible and calm and concerned about things you should be concerned about and not concerned about things you shouldn’t be concerned about I neglected to say, “Well actually, since you’re messing about with my breasts, I’d quite like to be smaller.” And I think they would have done it at the time.
Just the one breast smaller or both?
Well, no, both because I knew that all the time that there would be a tidy-up operation later. And I did say at one stage, “I don’t really, I really don’t mind being a bit lop-sided for a while”, you know. But I don’t think they realised that I really meant that seriously. So I feel in a way I missed a chance to have a breast reduction on the National Health. It’s not a serious issue but I think it means if you’ve got preferences like that, you should be very, think about them and be very clear about them rather than be a bit diffident or think, “Oh well, it’s not very important at the moment to think about things like that.” Because it probably is.
Deciding which type of reconstruction to have was difficult. Liz has chosen to have a DIEP flap reconstruction with a slightly smaller breast than before. Her healthy breast will be matched later.
Deciding which type of reconstruction to have was difficult. Liz has chosen to have a DIEP flap reconstruction with a slightly smaller breast than before. Her healthy breast will be matched later.
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It took me a while to make the decision of the type of surgery and reconstruction. The type of reconstruction, because I didn’t know which one to go for and that was the hardest part for me. I don’t seem to be thinking about the cancer, I still maybe haven’t quite, accepted that in one way or another, I’ve no idea. But I think, that part is the part for me to decide whether I’m going to have an implant, or a complete reconstruction of my own tissue. But that’s, you know, she was actually quite helpful the surgeon considering she was very busy and she has lots to do. She was very helpful in helping to direct me to the people that could help me.
Yeah, so did you talk to the plastic surgeon about the different options, or you were just given leaflets to read?
I was given the leaflets to read, and I was given the booklet, the standard booklet which I find is very helpful. But I then had an appointment with a breast nurse, who is my breast nurse, who deals with, in the local hospital, who deals with these issues, and she’s very, obviously very qualified. And she’s lovely, she’s very kind and understanding, and so I phoned her and spoke to her. And then I went to see her, and she helped me I think to a certain extent but it was actually when I went to see the plastic surgeon. And I’ve seen her twice because I couldn’t make a decision the first time.
The other one [operation] was to take the tissue and the fat from the stomach and then reconstruct. Now my problem with that, or not so much a problem, was the fact that she said that I didn’t have enough there to rebuild the same size. In actual fact that didn’t bother me, so she’s saying if I go down a size, what will happen with that type of reconstruction for me, is I will, she’ll be able to do a size less with what I have of my own tissue from my stomach and she will then be able to reduce the other one in six months time. So, for a while, I’ll be a bit lop sided, but I’m not that huge. But so she’s going from a D cup to a C cup and she said, don’t worry, I’ll do a fabulous job for you. And when she said that, I thought to myself, hey you know, Pamela Anderson, eat your heart out [laughs].
More experiences of breast reconstruction can be found on our Breast Cancer site.
Breast reconstruction using tissue from your bottom or thigh
Breast reconstruction can also be done using skin and fat from the upper or lower buttocks. An SGAP flap uses skin and fat from the upper buttocks and IGAP flap from the lower buttocks. A TMG flap uses tissue from the outer part of the thigh. A Tug flap uses skin, fat and a small strip of muscle from the upper inner thigh. These methods of reconstruction are not offered routinely and only a few surgeons in the UK can do this surgery and you may need to travel to a specialist hospital.
We have not yet interviewed anyone who has had a SIEA, TRAM, SGAP, IGAP or TUG flap for breast reconstruction. If you have had these surgeries and and you would like us to include your story on this website, please email hexi@phc.ox.ac.uk
Last reviewed July 2017.
Last updated July 2017.
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