DIEP abdominal flap
The DIEP (Deep Inferior Epigastric Perforator) procedure
The DIEP procedure is an evolution of the free TRAM flap. As with the free TRAM flap, tummy fat and skin are transferred to re-create the breast mound. Using fat to reconstruct the breast gives a natural feel to the new breast and in most people there is sufficient tissue available to create a moderate to large breast, although not as much as is available with a free TRAM flap reconstruction. In contrast to the pedicled or free TRAM flap no muscle is taken from the tummy, and therefore there is usually no need for a mesh in the abdomen. The chances of developing a hernia are therefore remote and the recovery is much quicker than that following a TRAM flap. Also, the process of re-establishing the blood supply with microsurgery is the same as that for the free TRAM flap. As with a TRAM a tummy tuck is carried out.
(DIEP flaps are always free flaps).
The deep inferior epigastric artery is the blood vessel which supplies blood to the Rectus Abdominus muscle. It also gives off side branches which travel through and around the muscle to the overlying fat. The DIEP flap uses these side branches or ‘perforators’ as its blood supply, with the result that the Rectus Abdominus muscle is entirely uncut during the operation. This reduces the risk of abdominal weakness compared to the free TRAM.
The procedure is not suitable for all women. ‘Perforators’ vary in size and are generally smaller in diameter than the main vessel. If the perforators are too small this type of reconstruction cannot proceed, as the risk of flap failure due to inadequate blood supply is too great. Sometimes it is often not possible to predict the size of these vessels until surgery is underway and your surgeon may have to change to a TRAM procedure.
The DIEP flap survives on a blood supply via one or two perforators. It is separated from the remaining tissues of the abdominal wall, completely detached from the body and moved to the site of the breast. The blood vessels are then reconnected to blood vessels which have been prepared near the breast and the tissue is moulded to form a new breast mound.
Advantages/disadvantages are as for free and pedicled TRAM procedures.