Deep Inferior Epigastric Perforator Flap

About the Procedure

If you have a mastectomy to treat or prevent cancer, breast reconstruction can surgically recreate a natural-looking breast. One option for breast reconstruction is a deep inferior epigastric perforator (DIEP) flap procedure.

In a DIEP flap, the surgeon first excises skin and fat from the lower abdomen. This process does not require removing any of the rectus abdominus muscle, which houses the artery and vein that serve as the primary blood supply to skin and fat of the lower abdomen.

The excised abdominal tissue, or "flap," is then transferred to the mastectomy area. There, blood flow is restored by reconnecting the artery and vein to a set of vessels in the chest wall. The surgeon then shapes the flap to form a new breast.

Unlike the TRAM flap, the DIEP flap avoids using abdominal muscle. DIEP flaps thus take longer to complete. However, they may involve less postoperative pain and may reduce the risk of hernia formation.

Please note: A DIEP flap leaves a scar that extends along the lower abdomen, from one hip to the other. As a result, the recovery period may be longer than with breast construction with implants or tissue expanders.

Breast Reconstruction at Massachusetts General Hospital

Our plastic surgeons have extensive experience in all types of breast reconstructive techniques, including the newest and most innovative procedures. When appropriate, we combine techniques, using flaps, implants and nipple tattooing to achieve the most natural-looking outcome.

All forms of breast reconstruction after mastectomy have inherent risks, which will be fully discussed during your consultation.

Qualities of Candidates

You may be a good candidate for DIEP flap reconstruction if you:

• Are not a candidate for implant reconstruction
• Have had failed reconstruction using a breast implant
• Have had radiation administered to your chest wall
• Have sufficient tissues in your lower abdomen to create one or both breasts
• Have never had surgery on your abdomen
• Prefer to reconstruct one or both breasts using your own tissue

You may not be a good candidate for DIEP flap reconstruction if you:

• Are not a candidate for implant reconstruction
• Have had failed reconstruction using a breast implant
• Have had radiation administered to your chest wall
• Have sufficient tissues in your lower abdomen to create one or both breasts
• Have never had surgery on your abdomen
• Prefer to reconstruct one or both breasts using your own tissue

Other Reconstruction Options

Depending on your particular situation, other flap options to create the new breast may include:

• Latissimus dorsi flap: Uses tissue from the upper back
• Superficial inferior epigastric artery (SIEA) flap: Uses tissue from the lower abdomen
• Superior or inferior gluteal artery perforator (SGAP/IGAP) flap: Uses tissue from the buttocks
• Transverse rectus abdominus myocutaneous (TRAM) flap: Uses tissues from the lower abdomen
• Transverse upper gracilis (TUG) flap: Uses tissue from the inner thigh and underlying gracilis muscle

The TUG flap and SGAP/IGAP flaps are generally used with patients who lack enough abdominal tissue for the DIEP or SIEA flap.