DIEP Flap Breast Reconstruction

John C. Lincoln Center for Reconstructive and Plastic Surgery
9250 N. Third St., Suite 1003
Phoenix, AZ 85020
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DIEP flap breast reconstruction is a procedure in which a breast mound is formed from transplanted abdominal skin, fatty tissue and the deep inferior epigastric perforator (DIEP) blood vessels within the tissue.

The deep inferior epigastric vessels are an artery and vein located at the bottom of the rectus abdominis muscle — the so-called "sixpack" of stomach muscles — which provide blood supply to the lower abdomen. Because fatty tissue is removed from this area, women who undergo DIEP flap breast reconstruction often experience a flatter abdomen, just as one would have after a "tummy tuck" procedure.

DIEP Flap Breast Reconstruction: A Next-Generation Procedure

DIEP flap breast reconstruction is a highly complex procedure that is performed by plastic surgeons with vast expertise and training in microsurgery, a specialty in which surgeons operate on blood vessels less than 1 millimeter wide.

First performed in 1992, DIEP flap breast reconstruction is a next-generation variation of transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. The TRAM procedure became available in the early 1980s and is considered by many plastic surgeons to be the current standard of care.

DIEP and TRAM are similar in that they involve the removal and transplantation of the patient's own abdominal tissue, which greatly reduces the chances of rejection, which sometimes occurs when a foreign body — such as an implant — is introduced to the body. Both procedures can create a reconstructed breast that is realistic in both look and feel.

Yet, the two procedures differ in the kind of tissue that is removed from the abdomen. TRAM flap surgery requires the removal of muscle from the abdominal wall; DIEP does not. Because TRAM severely damages muscle tissue, the surgery weakens the patient's core strength and increases the risk of abdominal hernia and postoperative pain. Multiple procedures may be required to complete the reconstruction process. DIEP flap breast reconstruction, by contrast, offers the same benefits, without the negatives associated with TRAM flap surgery.

In DIEP flap breast reconstruction, blood vessels are carefully removed from the rectus muscle, rather than removing the muscle itself. These blood vessels provide the blood supply needed for the transplanted flap to survive once implanted on the chest wall.

Because of the complexity of DIEP flap breast reconstruction, as well as the intensive training required to perform the procedure, few medical centers offer the DIEP flap surgery. However, the DIEP flap breast reconstruction is available at John C. Lincoln's Center for Reconstructive and Plastic Surgery in Phoenix, Arizona.

Benefits of DIEP Flap Surgery

For the plastic surgeon with advanced training in microsurgery, DIEP flap breast reconstruction is a viable surgical option for some patients for several reasons:

  • Patients typically have fatty tissue to spare in the abdomen.
  • Abdominal tissue is easier to access than tissue located in other parts of the body, because the patient is lying down throughout the surgery.
  • DIEP can be performed during mastectomy, offering one less surgery and exposure to anesthesia. A plastic surgeon can dissect abdominal tissue while the general surgeon is performing a mastectomy.
  • DIEP does not lead to capsular contraction, which is a common problem with implant reconstruction following mastectomy.

In certain circumstances, DIEP flap surgery is not recommended. For example, a patient may have undergone abdominal surgery in the past, which disrupted DIEP blood vessels. Likewise, in some cases, the patient may be too thin, and not have a sufficient quantity of abdominal fat. In this event, a plastic surgeon can perform SGAP breast reconstruction, where tissue flap is removed from the buttock.