DIEP Flap Breast Reconstruction

A DIEP (deep inferior epigastric perforator) flap rebuilds a breast after mastectomy using the patient's own lower-abdominal skin and fat. It is a free flap: the tissue is completely detached and its blood supply is reconnected in the chest with microsurgery. Only the small perforator vessels and the deep inferior epigastric artery and vein come with the flap, sometimes with a small piece of the rectus muscle around the perforator. The muscle itself stays in the abdomen, and this is the main difference from a TRAM flap. Because the muscle is spared, the abdominal wall has much less damage, and in many centers DIEP and SIEA flaps have replaced the free TRAM as the first choice for breast reconstruction with the patient's own tissue. The operation has two parts that two surgeons can do at the same time: raising the flap on the abdomen and preparing the recipient vessels in the chest, which are most often the internal mammary vessels. The artery is usually sewn by hand under the microscope and the vein is often joined with a coupler. A rebuilt breast made from the patient's own tissue feels soft, ages naturally and changes with body weight, and it avoids implant problems such as capsular contracture. The abdominal donor site is closed much like an abdominoplasty, which also contours the abdomen. The case is long and needs an experienced microsurgeon. The most common problems are wound problems such as infection, seroma, hematoma and delayed healing. Clotting in the connected vessels can cause loss of the flap, and fat necrosis can occur. At the donor site, an abdominal bulge, hernia or weakness can develop. Obesity, smoking, prior abdominal surgery and clotting disorders raise the risk; a prior abdominoplasty rules out a DIEP flap.