DIEPflap

The DIEP flap, or deep inferior epigastric perforator flap, is a type of autologous tissue transfer used for reconstructive surgery, most commonly to restore a breast after mastectomy. The flap uses skin and fat from the lower abdomen, nourished by perforating branches of the deep inferior epigastric vessels, and preserves the rectus abdominis muscle. Because muscle is spared, abdominal wall strength is typically better preserved than with older abdominal flaps.

Preoperative planning involves mapping perforator vessels, usually with CT angiography or MR angiography, to select robust perforators. The donor site is the lower abdomen, and the resulting contour often resembles a tummy tuck. Potential donor-site complications include seroma, wound healing problems, and, less commonly, abdominal wall weakness or hernia.

During the operation, the chosen skin and fat are dissected as a free flap and transferred to the chest. Microsurgical techniques reconnect the flap’s vessels to recipient arteries and veins in the chest, allowing immediate blood flow. The procedure is individually tailored and can be performed on one or both breasts, often requiring two teams to shorten operative time.

Advantages include preservation of abdominal muscle, natural breast feel and appearance, and the possibility of sensation return. Disadvantages include longer operative time, a steep learning curve, and risks such as fat necrosis, partial flap loss, or need for revision surgery. Not all patients are candidates, particularly those with insufficient perforator vessels or previous abdominal surgery.

Outcomes with DIEP flap reconstruction are generally favorable, with high patient satisfaction and durable results. Alternatives include the TRAM flap, SIEA flap, or other regional or autologous options, each with its own risk profile and recovery considerations.