DIEP (Deep Inferior Epigastric Perforator) Flap Reconstruction

Dr. Grace Ma and Dr. Drew Metcalfe specialize in DIEP flap procedures. Microsurgical advances in the past few years have opened the doors for improved and safer reconstruction using tissue from your own body only. The DIEP (deep inferior epigastric perforator) flap procedure is one of the most advanced forms of breast reconstruction available. This procedure uses abdominal skin and fat to create a soft, natural appearing breast after mastectomy. Unlike the TRAM flap which removes abdominal muscle as well as skin and fat, the DIEP flap ONLY removes the abdominal skin and fat for use in reconstruction. Because no muscle is sacrificed, patients experience less pain after surgery and a quicker recovery. More importantly, patients maintain their abdominal wall strength long-term and are not at the same risk for hernias or bulges as are TRAM flap patients.

During the DIEP procedure, the tiny blood vessels supplying the skin and fat of the abdomen are carefully dissected down to the main vessel called the deep inferior epigastric artery and vein without removing the intervening muscle. The prepared tissue (“flap”) is then disconnected from the body and transplanted to the chest using microsurgery. The tissue is sculpted to create the new breast.

Because this tissue feels very similar to breast tissue, it is an ideal choice for breast reconstruction. In addition to reconstructing the breast, the appearance of the abdomen is improved much like a tummy tuck.

Advantages of the DIEP flap include:
1. Preservation of the rectus muscle
2. Decreased risk bulges and hernias
3. Less post-operative pain compared to the TRAM

Nipple and areolar reconstruction follow as well as minor revisionary procedures for “fine-tuning”. Scars fade substantially with time. For many women the reconstructed breast may have a more youthful appearance than their original breasts and typically does not age or sag significantly over time.

While the DIEP flap is the workhorse of microsurgical breast reconstruction, some patients may not be suitable candidates for the DIEP flap. In these cases, other options exist for autologous tissue reconstruction.