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Anatomy Involved in the DIEP Flap
The DIEP flap technique, which differs from the TRAM flap technique, creates a living natural breast mound from a flap of skin and fat tissue taken from the lower abdomen. Basically, this is the skin and fat that is between the belly button and the pubic hairline. The blood supply to this piece of flesh comes primarily from perforating blood vessels through the rectus abdominus muscle. These are tiny vessels that are often about a millimeter in size. These perforating blood vessels are attached to internal thoracic vessels from above and to the deep inferior epigastric blood vessels from below. Obviously, the blood vessels that are closer provide the stronger head of pressure or better blood supply to the tissue.
For the lower abdominal skin the main blood supply is the deep inferior epigastric vessels. The perforating vessels from one rectus muscle primarily supply the skin and fat from that side of the abdomen. Because of the communication of the blood vessels from one side to the other, some skin on the opposite side of the abdomen will survive on its contralateral blood supply.
The DIEP flap requires one set of perforators from one rectus muscle to make one breast. A bilateral breast reconstruction requires the perforators from both rectus muscles to make two breasts.
In the DIEP flap the skin, fat, and perforating blood vessels are separated from the rectus muscle. No rectus muscle is removed. The rectus muscle is the muscle that primarily supports the abdomen. It is the main sit up muscle. The entire flap is isolated on two blood vessels, namely the deep inferior epigastric artery and vein. These blood vessels are then cut and the flap is completely unattached to the body. It is positioned on the chest and then with microsurgery the deep inferior epigastric vessels are sewn to the internal thoracic blood vessels. In such fashion blood supply and life is reestablished to this flap.
Click here to see the surgical technique Dr. Keller uses to join the blood vessels for continued blood supply to the breast flap.
Interestingly, the body doesn't recognize that this piece of abdominal tissue is now in a different location. If a woman who has had DIEP flap breast reconstruction were to gain weight and the weight that she gained always went to the abdomen before the surgery, then the breast will get larger. The opposite of this is also true.
To learn more about DIEP flap breast reconstruction, click here to request a phone consultation from Dr. Keller, a renowned plastic surgeon specializing in reconstructive flap procedures. You can also call the practice at 516-482-1100 to schedule an appointment.