Deep inferior epigastric perforator (DIEP) flap

Case contributed by Dr. Chris O'Donnell

Presentation

Past history of extensive DCIS in the left breast. Treated by subcutaneous mastectomy including the nipple and deep inferior epigastric perforator (DIEP) flap from the anterior abdominal wall.

Patient Data

Age: 50 years
Gender: Female

Left breast tissue replaced by fat with a rounded morphology. Note there is no nipple and the only enhancement is in veins in the overlying skin. 

Pre-operative scan

mri

The pre-operative MRI shows extensive abnormal enhancement throughout the left breast consistent with DCIS.

Case Discussion

A DIEP flap is a type of breast reconstruction whereby deep inferior epigastric perforators (DIEP) and connected fat (and/or skin) are removed from the lower abdomen and transferred to the chest to reconstruct a breast after mastectomy without the sacrifice of any of the abdominal muscles.

The DIEP flap is similar to the TRAM flap but requires no muscle sacrifice. The perforators (i.e. blood vessels) required to keep the overlying tissue alive in the DIEP flap lay just beneath or within the abdominal muscle and must be dissected out. A preliminary CT angiogram of the inferior epigastric arteries is required for surgical planning of this dissection.

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