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Developed at Penn Medicine, Mi-DIEP Approach to Breast Reconstruction Virtually Eliminates Need for Post-Surgical Opioids

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Suhail Kanchwala, MD and Ari D. Brooks, MD

Plastic surgeon Suhail Kanchwala, MD, has developed a novel approach to breast reconstruction surgery that reduces post-surgical pain to levels that virtually eliminate the need for opioids during recovery.

Known as minimally invasive deep inferior epigastric perforator (mi-DIEP), the procedure allows the majority of patients to be managed with short hospital stays and over-the-counter medications. In addition to a radical reduction in pain, the hallmarks of the mi-DIEP technique include quicker recovery to normal function and superior cosmetic results.

Dr. Kanchwala works closely with surgeon Ari D. Brooks, MD, Director of Endocrine and Oncologic Surgery at Pennsylvania Hospital, who performs the mastectomy surgeries for breast cancer that are the foundation of his approach to breast reconstruction.

The mi-DIEP technique is a type of autologous (free flap) breast reconstruction, a procedure that restores the breasts with skin and fat from the lower abdomen. Free flap reconstructions offer greater durability in comparison to implant-based procedures, have been shown to help avoid infection and other complications, and may offer a more natural, more aesthetic result. Before the development of the mi-DIEP, however, patients recovering from autologous breast reconstruction were often hampered by chronic pain and the need for narcotics post-surgery.

Breast Reconstruction Surgery Recovery Without Narcotics 

Incising the abdominal muscles has been the main source of pain and morbidity for mastectomy patients during reconstruction surgery. Laparoscopic mi-DIEP breast reconstruction virtually removes the need to cut into the abdominal wall muscles, allowing surgeons to make a much smaller incision, which avoids the need for narcotic painkillers and allows patients to go home sooner.

“Many of these patients wake up as if they haven’t had a surgery,” Dr. Kanchwala said. “We’ve seen patients who would normally be in the hospital for five days, go home in one to two days.”

The need to reduce the pain and resultant narcotic use in breast reconstruction surgery had its origins in research that showed that a up to 10% of breast reconstruction patients introduced to narcotics after surgery became prolonged users of these drugs.

“The technique we’ve developed here at Penn addresses this reality head-on,” Dr. Kanchwala explained. “It’s a team approach—not only among clinicians, but with patients. All patients are enrolled in a coordinated Enhanced Recovery Protocol, which means from the minute they enter the hospital, our focus is on their recovery and getting them back to normal as fast as possible.”

Dr. Kanchwala observes that of the more than 120 minimally invasive procedures he’s completed in the last year, 70% of patients did not require any narcotics for pain management during the perioperative or recovery period. Instead, patients received over-the-counter medications, such as ibuprofen or acetaminophen.

When asked to elaborate on the origin of the mi-DIEP procedure, Dr. Kanchwala notes that experience is the key to innovation. “We’ve paired our surgical advances with similar progressive ideas in anesthesia and postoperative care,” he says. “Nothing we're doing now is the same as it was even a year ago.”

Penn: Highest Volume for Free Flap Breast Reconstruction

Penn Medicine is now the highest-volume center for free flap breast reconstruction in the world—performing over 700 tissue-based breast reconstructions every year. In 2017, surgeons celebrated the 5,000th free flap reconstructive surgery at Penn.

For the past 12 years, Joseph M. Serletti, MD, FACS, has overseen the Division of Plastic Surgery as Chief, and he has emerged as a strong champion of these autologous reconstructions.

“We are committed to bringing modern, cutting edge procedures to the Delaware Valley,” Dr. Serletti said of Penn Medicine and his Division, which, in addition to autologous breast reconstructions, participates in complex abdominal, head and neck, and limb reconstructive surgeries.

“Everything we do is based in evidence,” Dr. Serletti explained. “We’re constantly tracking our patient outcomes to make sure our work is top quality.”

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The Penn Physician Blog is a resource for health care professionals featuring Penn Medicine physicians and their research, innovations, programs and events. 

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