Medical services

The different clinical services constitute the backbone on which the healthcare activity of MD Anderson Cancer Center Madrid is organised.


DIEP flap breast reconstrution

The procedure consists of taking skin and fat from the abdomen, together with an artery and a vein to keep the tissue alive, and transplanting it to the chest area of the same patient.

The artery and vein that feed the tissue (the deep inferior epigastric perforators, or artery and vein) are grafted to the internal mammary artery and vein under microscope at the edge of the sternum, between the ribs, so that the blood flow to the transplanted tissue (the DIEP flap) is recovered.

The skin, fat and vessels are removed without damage to the abdominal wall muscles (avoiding hernias, eventration, bulging and weakening of the abdominal wall), and furthermore, the procedure is less painful than traditional techniques.

Reconstruction can be carried out at the same time as the mastectomy and is called immediate breast reconstruction. It is the most recommended for all patients because it helps soften the emotional blow of a cancer diagnosis and amputation.

In patients for whom immediate reconstruction is not suitable for medical reasons or because the patient herself chooses not to submit to the procedure, the operation can be done on completion of chemotherapy and radiotherapy treatments and is then called delayed breast reconstruction.

Once skin and fat from the abdomen has been implanted in the breast being reconstructed, it is shaped to look like a natural breast, to feel like and have exactly the same consistency as the healthy breast, and in time will change in the same way as the healthy breast.

DIEP is the acronym for the blood vessels that feed the skin and fat of the abdomen – Deep Inferior Epigastric Perforators.

DIEP Flap Breast Reconstruction is the evolution of a procedure known as TRAM, in which skin and fat from the abdomen are also taken, but by sacrificing all or part of the rectus abdominus muscle, which provides blood flow to the skin and fat. A consequence of TRAM is a weakening of the abdominal wall and a risk of hernia, eventration or bulging. It is a very painful procedure and, in many cases requires the use of synthetic mesh to reinforce the abdominal wall, in addition to possible complications and the costs derived from these.

It is also an alternative to latissimus dorsi myocutaneous flap breast reconstruction where all of the back muscle is sacrificed, and which also requires a silicon gel implant to lend shape and volume.

Of course, all surgical procedures have certain risks and for technical reasons there can be no guaranteed results, but with this technique our results endorse us.

To be able to remove the fat and skin from the abdomen in one piece with the blood vessels, without sacrificing the rectus abdominus muscle, the blood vessels, which measure only millimeters, must be dissected through the muscle tissue without causing damage to the vessels. The procedure is laborious and complex and requires microsurgery techniques in which experience is fundamental to achieving good results and avoiding complications.

  • The patient’s own tissue is used to reconstruct the breast, so implants and other implantable materials are not used and, therefore, all the complications associated with the use of implants are avoided.

  • Any present and future costs of implant use are avoided: implants do not last forever and will have to be replaced several times during the patient’s lifetime.

  • The reconstructed breast changes volume as the patient does: as it is live tissue, if the patient gains weight, the breast gets larger, and if the patient loses weight, so does the breast, so symmetry is maintained throughout the patient’s life.

  • It is not a painful procedure: from the second day after surgery, the patient keeps any discomfort under control with paracetamol.

  • The tissue tolerates radiotherapy, unlike reconstructions using tissue expanders and implants or only implants.

  • In the case of delayed breast reconstruction in patients treated with radiation, by using healthy, unradiated tissue, the reconstructed breast’s blood circulation and capacity to regenerate means the breast heals better.

  • By taking fat from the abdomen, the patient has the advantage of esthetic improvement to the abdominal contour, like having an abdominoplasty or ‘tummy tuck’.

At our center we carry out immediate DIEP Flap Breast Reconstruction, that is, the procedure is done at the same time as the mastectomy. This requires careful coordination between the two surgical teams (breast and abdomen) and nuclear medicine (in cases of sentinel gland biopsy). The patients comes out of surgery with a breast reconstructed using her own tissue and without the emotional impact of seeing herself having lost a breast. This is done in just one procedure, having to go through one post operative period and without the use of implants.

In our hands, the surgical procedure takes about six hours. After surgery the patient spends the first night in the ICU to make sure blood flow to the flap is correct. She will be moved to a room on the first day after surgery and will stay in hospital for six or seven days.