DIEP flap breast
reconstruction has its earliest roots in TRAM flap breast
reconstruction. TRAM flap (transverse rectus abdominus myocutaneous)
flap breast reconstruction was first described in 1979 by both Robbins
and Holmstrom. It was popularized by Hartrampf and Scheflan in the
United States in the early 1980's. The TRAM flap is an attached flap
that involves sacrifice of at least one entire rectus abdominus muscle.
The free TRAM flap, which involves only sacrifice of a small piece of
rectus abdominus muscle, was the natural evolution and occurred in the
1980s.
In Japan, Koshima described isolating skin and the
subcutaneous tissue based upon blood vessels that perforate the rectus
abdominus muscle. He was able to transfer this flesh to another body
area (not breast) utilizing microsurgery and without sacrifice of the
rectus abdominus muscle.
In 1993, Dr. Allen described transfer of the skin and
subcutaneous tissue of the lower abdomen to the breast without loss of
the rectus abdominus muscle for breast reconstruction.
With this flap the skin, and perforating
blood vessels are utilized.
Microsurgery revitalizes the flap.
No muscle is removed.
DIEP flap breast reconstruction is a technique that is
both an evolution and a refinement of TRAM flap breast reconstruction.
