A DIEP flap is similar to a muscle-sparing free TRAM flap, except that no muscle is used to rebuild the breast. (A muscle-sparing free TRAM flap uses a small amount of muscle.) A DIEP flap is considered a muscle-sparing type of flap. DIEP stands for the deep inferior epigastric perforator artery, which runs through the abdomen.
In a DIEP flap, fat, skin, and blood vessels are cut from the wall of the lower belly and moved up to your chest to rebuild your breast. (In a properly performed DIEP, no muscle is cut or removed; if you’re having DIEP flap, make sure this will be the case.) Your surgeon carefully reattaches the blood vessels of the flap to blood vessels in your chest using microsurgery. Because no muscle is used, most women recover more quickly and have a lower risk of losing abdominal muscle strength with a DIEP flap compared to any of the TRAM flap procedures.
Because the DIEP flap procedure requires special surgical training as well as expertise in microsurgery, not all surgeons can offer DIEP and it's not available at all hospitals. If you're considering a DIEP flap, you may have to research the surgeons and facilities that offer what you want. Your doctor may be able to refer you to plastic surgeons who specialize in DIEP flap reconstruction. (For more information, see Finding a Qualified Plastic Surgeon.)
Tissue can be taken from your belly for breast reconstruction only once. So if you're thinking about prophylactic removal and reconstruction of the other breast, you might want to make that decision before you decide on reconstruction. If you have DIEP flap reconstruction on one breast and then later need reconstruction on your other breast, tissue for the second, later reconstruction will have to come from your buttocks or back. Or you can have reconstruction with an implant.
Because skin, fat, and blood vessels are moved from the belly to the chest, having a DIEP flap means your belly will be flatter and tighter -- as if you had a tummy tuck. Still, a DIEP flap does leave a long horizontal scar -- from hipbone to hipbone -- about one-third of the way between the top of your pubic hair and your navel. In most cases, the scar is below your bikini line. After the skin and fat are removed from your belly, the abdomen is closed. No mesh material is required to support the abdominal wall, as may be the case with a TRAM flap. Your navel is then brought back out through a separate incision and reshaped.
While DIEP flap breast reconstruction is popular because it doesn't move or cut muscle (which usually means a shorter recovery time than a TRAM flap), a DIEP flap isn't for everyone. It's not a good choice for:
- Thin women who don't have enough extra belly tissue. However, there is a newer “stacked” approach that can sometimes work for these women.
- Women who already have had certain abdominal surgeries, including colostomy (surgery that attaches the large intestine to an opening in the abdominal wall) or abdominoplasty (tummy tuck). This does not include midline incisions extending from the belly button to the pubic region or other routine abdominal operations.
- Women whose abdominal blood vessels are small or not in the best location to do a DIEP flap. (A new approach called APEX FlapCM may be useful in this situation, but availability is very limited.)
Learn more about DIEP flap reconstruction on these pages:
- DIEP Flap Reconstruction: What to Expect
- DIEP Flap Surgery Risks
- APEX FlapCM: A New Approach to DIEP Reconstruction
Photographs included in this section are images of surgical procedures performed by the Center for Restorative Breast Surgery and have been generously donated to Breastcancer.org.