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Why is a deep inferior epigastric artery perforator (DIEP) flap beneficial?

Jess Ting, MD
Plastic Surgery

A DIEP flap provides a natural-appearing breast reconstruction after mastectomy without using an implant. A woman's own excess abdominal skin and fat is used to create a new breast after the diseased breast is removed. Another benefit of a DIEP flap (or any TRAM flap) is that the abdomen is thinner and trimmer after surgery, similar to the effect of a "tummy tuck".

A DIEP flap is different from a pedicled TRAM flap because the skin and fat is completely detached from the body and then reattached using microsurgical techniques. Under a microscope, the artery and vein providing circulation to the transplanted tissue are connected to an artery and vein in the chest.

A DIEP flap is a further refinement of the microvascular TRAM flap in which only the skin and fat and blood vessels (perforators) nourishing that tissue are used without the surrounding muscle. The rectus abdominus (six-pack) muscles are preserved. Preserving the six-pack muscles provides the theoretical advantages of decreased pain, better abdominal muscle strength, and decreased risks of hernias and bulges in the abdomen.

A DIEP flap is beneficial because the resultant breast is usually as soft and supple as a natural breast and has a degree of naturalness that is difficult to achieve with implants. There are also benefits to using DIEP flaps or other autologous flaps (using your own body tissues) compared to implants when the breast is to receive radiation treatment.

A DIEP reconstruction following breast cancer is beneficial because it produces decreased donor site damage as well as using the patient’s own tissue. In traditional transverse rectus abdominis musculocutaneous (TRAM) flap procedures, the muscle is cut away leaving a likely weakness. The DIEP is designed to decrease such collateral damage. This will allow a patient to maintain core strength. The advantage of having her own tissue for a reconstruction is variable depending upon the goals of the patient and the condition of the defect. Some patients do not wish to have implants for a reconstruction; therefore having her own tissue is more desirable. If the condition of the chest defect is poor, such as can occur after radiation, DIEP will be beneficial in replacing the damaged skin with more supple tissues.
Stuart A. Linder, MD
Plastic Surgery
The main advantage of the deep inferior epigastric perforator flap is that it spares the whole rectus abdominis muscle. It includes only the skin and fat and preserves the abdominal wall competence. It is similar to performing a tummy tuck with the perforator vessels that are brought to the breast as a free flap with microvascular surgery.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.