In suitable patients the DIEP (Deep Inferior Epigastric artery Perforator) flap undoubtedly provides the best reconstruction. The technique uses an ellipse of skin and underlying fat from the lower abdomen to reconstruct the breast. In many patients there is redundant tissue in this area which is removed for reconstruction and improves the appearance of the abdomen, as in an abdominoplasty. In the DIEP flap technique the blood supply to this lower abdominal skin is defined and dissected out of musculature in the abdominal wall. In the majority of cases the muscle is split which avoids any functional compromise of the abdominal wall musculature.
The skin and fatty tissue (flap) is transferred to the chest wall and its blood supply re-connected to blood vessels either behind the breast bone or under the arm using microsurgical techniques. The flap is then tailored to create a new breast.
The DIEP flap is a complex operation and does carry with it significant risk and may even fail completely. It is, however, well tolerated in fit individuals and once established offers a very gratifying method of reconstruction with its main advantage being that all your own tissue is used, which will then age with you and there is no significant risk of deterioration once the procedure has been established.