Lymph Node Transfer with DIEP Flap

Lymph node transfer with DIEP flap is a new, advanced procedure for patients undergoing breast reconstruction which can help to prevent lymphoedema, a common condition in patients who have undergone breast reconstruction. The procedure is not widely available as it requires an expert team of specially trained physicians to perform it.

Cleveland Clinic Abu Dhabi is one of the few centers in the UAE that provides the DIEP flap procedure, now considered the gold standard treatment for breast reconstruction, and one of only a small number of centers globally to offer lymphovenous anastomosis, a cutting-edge procedure to prevent lymphoedema in breast cancer patients.

Breast reconstruction

Breast reconstruction is surgery that restores the shape of the breast(s) after a mastectomy. A mastectomy is surgery that removes the breast(s) to prevent or treat breast cancer.

What is DIEP flap?

Traditional flap surgery in breast reconstruction involves taking tissue from one area of the body, usually from the abdomen, and relocating it to build a new breast. The complex procedure can be done at the same time as the mastectomy (called immediate reconstruction), or at a later time (called delayed reconstruction).

A DIEP flap is an innovative type of flap procedure. DIEP stands for deep inferior epigastric perforator. During this procedure, only fat and skin are removed, and the abdominal muscle is left in place. This is advantageous as it means more abdominal strength is retained and recovery is faster. The blood vessels from the abdominal tissue are reattached to the breast via intricate microsurgery.

What is lymphoedema?

Lymphoedema is a condition that affects some people following breast cancer treatment. It is a swelling, usually in the arm, hands or fingers, that is caused by a build-up of fluid within the body’s tissues. It can also cause pain, discomfort, numbness and dry skin.

Lymphoedema happens as a result of damage to the lymph nodes during surgery or radiotherapy. It is a long-term condition, which can be controlled but is unlikely to go away completely.

Lymph node transfer with DIEP flap

Lymph node transfer combined with DIEP flap is a procedure which can successfully manage lymphoedema when lymph nodes are damaged or removed during breast reconstruction surgery.

The surgery involves harvesting superficial lymph nodes from the groin, which are attached to the DIEP flap. The lymph nodes taken are identified as not being responsible for fluid drainage in the donor area, therefore won’t cause lymphoedema when harvested. Special dyes and intraoperative imaging are used to identify which lymph nodes are involved in draining the donor area, ensuring these important lymph nodes are left in place.

The lymph nodes are taken, whilst remaining attached to the DIEP flap, via blood vessels. The surrounding tissue is removed, and the lymph node’s blood vessels are attached under the arm. The abdominal muscles are left intact during a DIEP flap procedure, and the stomach is closed.

The surgeon makes an incision under the arm, releasing any scarring which can make lymphoedema worse, and creates a pocket for the new lymph nodes. The surgeon will identify which blood vessels the lymph nodes will be attached to.

Once the breast flap has been reattached to the new blood supply, it is then inset to form a breast. Breast skin that has been removed during the mastectomy is replaced with an area of skin from the abdomen.

Incisions are closed and a drainage tube is fitted which removes any excess fluid or blood from the breast and abdomen.

Recovery time varies, but many patients can resume gentle activities, such as driving, after 2 weeks, and gentle exercise after 4 weeks.