Surgical-technical aspects of the free diep flap for breast reconstruction

Abstract

The transverse rectus abdominis myocutaneous (TRAM) flap has been the gold standard for breast reconstruction in the last decade. The free deep inferior epigastric perforator (DIEP) flap and the superior gluteal artery perforator (S-GAP) flap are both refinements or “upgrades” of the conventional myocutaneous lower abdominal and gluteal flaps. The harvested skin and fat paddles are similar but none of the underlying muscle is sacrificed. The preservation of the continuity of the muscle fibers, the muscle's motor innervation, and the vascularization by collateral blood vessels ensures normal function of the muscle, only split during surgery, and the muscles that interact with it. The free DIEP and S-GAP flap have comparable complication rates to the free TRAM flap, making these flaps safe and reliable techniques. Although still a very low risk is involved, especially total flap loss, free perforator flap surgery for breast reconstruction is the surgical technique in which the least perioperative and postoperative complications are involved and this offers the patient the best long-term aesthetic result. Additionally, by sparing the donor site muscle and restoring sensation, the normal breast anatomy is imitated in the best possible way; except for a donor site scar, no other damage is caused to the body. The free DIEP flap is the first choice for breast reconstruction because of the inherent characteristics of the lower abdominal wall.