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 (but no muscle at all) are cut from the wall of the lower belly and moved up to your chest to rebuild your breast. 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 do a DIEP flap 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.
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 halfway 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, your navel may be in the wrong place or distorted in some way, so your surgeon may have to reshape your belly button.
While DIEP flap breast reconstruction is popular because it doesn't move 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
- women who smoke
- women who already have had multiple abdominal surgeries
- women who plan on getting pregnant
Learn more about DIEP flap reconstruction on these pages: