DIEP Flap

About DIEP Flap

Nowadays the most updated post-mastectomy procedures to replace a woman's breast as naturally as possible, are based on "autologous free tissues transfer". The "DIEP" flap is one of this techniques; it consists in the use of an ellipse of fat and skin from the lower abdomen below the umbilicus, and was firstly described by the Japanese plastic surgeon Isao Koshima.

The name comes from the acronym of “Deep Inferior Epigastric Perforator”, which are the vessels that come from the deep inferior pelvis and “perforate" the muscle wall to vascularize the overlying fat tissue and skin.

These perforator vessels, approximatly 1 mm large (up to 4 mm large in depth), are fundamental as they have to be reconnected to the axillary vessels, in order to rehestablish perfusion in the tissues transferred from the abdomen to the thoracic wall, as a natural part of the body.

The flap was then utilized for breast reconstruction for the first time in 1994 by Robert J. Allen, a plastic surgeon from United States; before then a similar technique named "TRAM" (Transverse Rectus Abdominis Myocutaneous) was used; it consists in the transfer of part of the abdominal rectus muscle, requiring the use of a prosthetic mesh to avoid the risk of abdominal bulging or erniation. It is important to remark that the DIEP flap procedure does not transfer abdominal muscle, respecting the Rectus Abdomini muscle itself and its innervation, hence does not require the use of prosthetic mesh and presents a reduced incidence of erniaton, around 0,3%.

Finally, breast reconstruction with DIEP flap may end up, for many women, with a better appearence of the breast, looking younger, stiffer and higher.

It is true that is impossible to replace a breast gland with all of its functions, but looking at today's results, especially concerning consistency, heat, naturalness in shape and position, persistency of results, and extremely rare complications with no risk of capsule contracture, the DIEP flap procedure can be defined as an "Intervention for Restoration of the MAmmae" or with the acronimus "IRMA". This explains the origin of the name Irma, given to the protagonist of the 3D Video showing the procedure on this web site, and then extended also to Prof. Santanelli di Pompeo's equipe.

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Show video "Mastectomy and Reconstruction with DIEP Flap"

(Warning! This video contains scientific material; due to crudeness of the images its view is not suggested to an emotional audience.)

Go to FAQs on DIEP

Go to Surgical Results

  • 1) IRMA before operation; 2) Intraoperative step of DIEP flap transfer from the abdomen to the thorax; 3) Scars on the new breast and on the abdomen; 4) Scars covered by the swimsuit.
  • CT Angiography examination is useful to visualize the vascularization of the abdomen with the perforator vessels
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Redazione Barbara Fabiani