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Even many highly skilled and experienced breast reconstruction specialists still are not familiar with the DIEP flap technique. On a basic level, a DIEP flap is very similar and yet very different from a TRAM flap. The same piece of skin and fat is used in both techniques to reconstruct the breast, but TRAM flap reconstruction removes the rectus abdominus muscle because it includes the blood supply. Muscle does not contribute to the size or the shape of the breast - it merely hides the blood supply to the overlying tissue. With the DIEP flap, the blood supply to the overlying skin and fat has been dissected from the muscle and included with the tissue to be transferred. The additional time spent to do this dissection leads to a significantly reduced hernia rate and a more speedy and less painful recovery.
The DIEP flap is not experimental and has been performed in this country for over 15 years. The success rate (i.e. flap survival), in the hands of an experienced surgeon, is quite high. I personally have performed nearly 1,000 DIEP flap breast reconstructions with a success rate of better than 99.5% and a hernia rate of less than 1%. This risk of hernia is essentially the same as a patient who has had a paramedian abdominal incision.
For those of you who have had a patient leave your area because they desired this procedure, and for those of you who have referred a patient to me, I look forward to participating in your patient's care and to returning this patient back to your supervision and direction. On this site I offer some guidance for evaluating the health of a breast flap, and I hope to post additional resources in this section as time permits. I welcome discussion with you either by e-mail or by phone of any aspect of the care plan or postoperative course.