The Deep Inferior Epigastric Perforator (DIEP) flap relies on the blood vessels that are the primary suppliers to the skin and fat of the lower abdomen. Unlike the TRAM flap, the DIEP flap procedure removes this lower abdominal skin and fat without having to harvest any of the rectus abdominis muscle. Instead, the flap of tissue gets its blood supply from the tiny feeder vessels that are teased out of the muscle.

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The flap of tissue is lifted completely free of the abdomen, with none of the tunneling under the skin associated with more conventional flap procedures. A microscope is used to reconnect the flap to a set of blood vessels on the chest wall. It is then fashioned into the shape of a breast.

“Why does the DIEP Flap take so much longer than a TRAM flap?”

The removal from the surrounding muscle of the tiny blood vessels that feed the flap, and their reconnection to other blood vessels in the chest, make for a longer and more technically demanding surgery.

“What advantage does it offer?”

By minimizing injury to the muscles of the abdominal wall, a DIEP flap promises less pain and a lower hernia risk than a TRAM flap, without sacrificing the “tummy tuck” benefit of the more conventional procedure.