DIEP flap

A DIEP flap is a type of breast reconstruction in which blood vessels called deep inferior epigastric perforators (DIEP), and the skin and fat connected to them are removed from the lower abdomen and transferred to the chest to reconstruct a breast after mastectomy without the sacrifice of any of the abdominal muscles. However, abdominal musculature may be denervated by the DIEP dissection.

The DIEP flap is similar to the muscle-sparing free TRAM flap but only requires the removal of skin and fat. Unlike with the TRAM procedure no muscle is sacrificed. However the DIEP flap - as the TRAM flap - requires an incision into the abdominal ( rectus ) muscle. The blood vessels, or perforators, required to keep the tissue alive lay just beneath or within the abdominal muscle. Therefore, a small incision is made in the abdominal muscle in order to access the vessels.

After the skin, tissues and perforators (collectively known as the "flap") have been dissected, the flap is transplanted and connected to the patient's chest using microsurgery. The plastic surgeon then shapes the flap to create the new breast. As no abdominal muscle is removed or transferred to the breast patients may experience less pain post-operatively and a faster recovery compared to TRAM flap patients - but this has not been documented in numerous scientific studies. In fact studies comparing abdominal results with the muscle sparing free TRAM and the DIEP show equal abdominal results in terms of strength and incidence of hernia/bulge. Abdominal strength is also maintained long-term following the DIEP and the muscle sparing TRAM flap procedure.

Many women who undergo this form of reconstruction enjoy the added benefit of a flatter abdomen, with results that mimic a “tummy tuck” procedure.. As with all types of breast reconstruction however, 2 or 3 stages performed a few months apart are often required to complete the reconstruction process and to obtain the best cosmetic result.

Unfortunately, due to the complexity of the surgery few breast centers offer DIEP flap breast reconstruction. The operating time may be twice as long as with the muscle sparing free TRAM and the blood flow to the DIEP flap may not be as good as that to the muscle sparing TRAM operation - something to seriously consider and ask about prior to choosing this method. However, with better preoperative imaging of the blood vessels in the abdomen (using CT-scan) operative time and complication rate can be further reduced in DIEP flap breast reconstruction. It remains unfortunate that despite stated advantages, little data exist to support a claim of superiority of DIEP flaps over TRAM flap breast reconstruction (see 10.1097/PRS.0b013e3181ea42d3).