Deep Inferior Epigastric Artery Perforator (DIEP) Free Flap

The latest innovation in breast reconstruction is the concept of perforator free flaps, of which the deep inferior epigastric artery (DIEP) free flap is one. This surgery is an evolution of the TRAM flap procedure by using skin and fat from the abdomen without sacrificing the rectus muscle.

This can avoid complications such as a hernia, bulging or abdominal wall weakness in addition to possible mesh complications. This technique essentially provides the patient with a tummy tuck in addition to the breast reconstruction, but maintains the rectus abdominus (six-pack) muscles in their original location.

The blood vessels going to the fat and skin in a tummy tuck run through the rectus muscles. The blood vessels are isolated from the surrounding muscle fibers then disconnected so the flap can be brought to the breast area (free flap).

The blood vessels are then connected under a microscope to blood vessels in the chest area to re-establish circulation. Recovery time is usually more expeditious because the rectus muscle is spared.