DIEP Flap Breast Reconstruction Definition
DIEP stands for Deep Inferior Epigastric Perforator flap, which is a muscle-sparing microsurgical breast reconstruction technique that uses skin, fat, and blood vessels from the lower abdomen to reconstruct the breast after mastectomy 1.
What the Acronym Means
- Deep: Refers to the deep inferior epigastric artery
- Inferior Epigastric: The specific artery system used (branches from the external iliac artery)
- Perforator: Small blood vessels (perforators) that penetrate through the abdominal wall muscle to supply the overlying skin and fat
Key Technical Features
The DIEP flap is a free flap procedure that:
- Uses the deep inferior epigastric artery (DIEA) perforators to create a vascular pedicle 1
- Harvests abdominal tissue (skin, fat, and blood vessels) without sacrificing the rectus abdominis muscle 1
- Requires microsurgical anastomosis to connect the flap's blood vessels to recipient vessels in the chest (typically internal mammary vessels)
Clinical Advantages Over Older Techniques
Compared to the traditional TRAM (transverse rectus abdominis muscle) flap, the DIEP flap results in:
- Less fat necrosis 1
- Reduced donor site morbidity (no muscle sacrifice) 1
- Better preservation of abdominal wall function 1
- Lower rates of abdominal hernias and bulging
Anatomical Variability
The perforator anatomy is highly variable between patients and even between the left and right sides of the same patient's abdomen 1. This variability necessitates preoperative imaging (typically CTA) to identify the optimal perforators based on:
- Vessel caliber (larger is better) 1
- Location (medially located preferred) 1
- Intramuscular course (shorter course through muscle is easier to dissect) 1
The DIEP flap is now considered the gold standard for autologous breast reconstruction due to its superior outcomes in terms of donor site morbidity and aesthetic results 2, 3.