||The neutrality of this article is disputed. (October 2013)|
A DIEP flap is a type of breast reconstruction in which blood vessels called deep inferior epigastric perforators (DIEP), as well as the skin and fat connected to them, are removed from the lower abdomen and transferred to the chest to reconstruct a breast after mastectomy without the sacrifice of any of the abdominal muscles.
The DIEP flap reconstruction procedure is similar to the muscle-sparing free TRAM flap procedure, but it only requires the removal of skin and fat. Unlike in the TRAM procedure, however, no muscle is sacrificed. The DIEP flap—like the TRAM flap—requires an incision into the abdominal (rectus) muscle, as the blood vessels, or perforators, required to keep the tissue alive lie just beneath or within this muscle. Therefore, a small incision is made in the abdominal muscle in order to access the vessels.
After the skin, tissues and perforators (collectively known as the "flap") have been dissected, the flap is transplanted and connected to the patient's chest using microsurgery. The plastic surgeon then shapes the flap to create the new breast. As no abdominal muscle is removed or transferred to the breast, patients typically see a lower risk of losing abdominal muscle strength and may experience a faster recovery compared to TRAM flap patients. Studies comparing abdominal results with the muscle-sparing free TRAM and the DIEP show that abdominal wall hernias occur less frequently in DIEP patients, although the abdominal wall bulge rates are similar for both procedures.
Many women who undergo this form of reconstruction enjoy the added benefit of a flatter abdomen, with results that mimic a “tummy tuck” procedure. However, one risk of these procedures is the potential denervation of the abdominal musculature following the DIEP dissection. In addition, as with all types of breast reconstruction, two or three stages performed a few months apart are often required to complete the reconstruction process and to obtain the best cosmetic result.
Due to the complexity of the surgery, few breast centers offer DIEP flap breast reconstruction. The operating time may be twice as long as with the muscle-sparing free TRAM, and the blood flow to the DIEP flap may not be as good as that of the muscle-sparing TRAM operation—something to seriously consider about prior to choosing this method. However, with better preoperative imaging of the blood vessels in the abdomen (using CT-scan), operative time and complication rates can be further reduced in DIEP flap breast reconstruction. Despite the claimed advantages, little data exist to support a claim of superiority of DIEP flaps over TRAM flap breast reconstruction.
- DIEP flap Breastcancer.org. Retrieved 10 July 2015.
- Garvey PB, Buchel EW, Pockaj BA, Casey WJ 3rd, Gray RJ, Hernández JL, Samson TD. "DIEP and pedicled TRAM flaps: a comparison of outcomes." 2006 May. 
- Teunis T, Heerma van Voss MR, Kon M, Macaré van Maurik JF. CT-angiography prior to diep flap breast reconstruction: A systematic review and meta-analysis. Microsurgery. 2013 Jul 9. doi: 10.1002/micr.22119. [Epub ahead of print]
- DIEP flap entry in the public domain NCI Dictionary of Cancer Terms