Deep inferior epigastric perforator flap reconstruction
Deep inferior epigastric perforator flap (DIEP) reconstruction is a type of breast reconstruction surgery. It essentially involves the transfer of the patient's own skin and subcutaneous tissues from the lower abdominal wall to the chest to form the breast mound.
The operation spares the rectus muscle, which results in fewer complications and a faster return to normal activities.
CT/MRI (cross sectional imaging)
The normal glandular breast parenchyma appears replaced by abdominal adipose tissue.
Preliminary CT angiography of the inferior epigastric arteries is also often required for surgical planning.
- fat necrosis: reported to occur in around 6-18% of cases 2.
- haematoma +/- seroma formation
- vascular compromise: can occur from either arterial or venous compromise and can lead to flap failure
- tumour recurrence within or around the flap
- donor site complications: e,g, hernia
On imaging consider
- TRAM flap reconstruction : absence of atrophied rectus abdominis muscle and its vascular pedicle in the reconstructed breast differentiates a DIEP from a TRAM flap 2.
- 1. Lam DL, Mitsumori LM, Neligan PC et-al. Pre-operative CT angiography and three-dimensional image post processing for deep inferior epigastric perforator flap breast reconstructive surgery. Br J Radiol. 2012;85 (1020): e1293-7. doi:10.1259/bjr/30590223 - Free text at pubmed - Pubmed citation
- 2. Hedegard W, Niell B, Specht M et-al. Breast reconstruction with a deep inferior epigastric perforator flap: imaging appearances of the normal flap and common complications. AJR Am J Roentgenol. 2013;200 (1): W75-84. doi:10.2214/AJR.12.9270 - Pubmed citation
- 3. Chernyak V, Rozenblit AM, Greenspun DT et-al. Breast reconstruction with deep inferior epigastric artery perforator flap: 3.0-T gadolinium-enhanced MR imaging for preoperative localization of abdominal wall perforators. Radiology. 2009;250 (2): 417-24. doi:10.1148/radiol.2501080307 - Pubmed citation