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History of the DIEP Flap
DIEP flap breast reconstruction has its earliest roots in TRAM flap breast reconstruction. TRAM flap (transverse rectus abdominus myocutaneous) 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 mid 1980's.
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.