(See also Autologous (own-tissue) Reconstruction)
Evolution in standard TRAM reconstruction (including removal of muscle tissue) has progressed to the point where all of the muscle can be spared. This is referred to as a DIEP reconstruction. The DIEP breast reconstruction represents one of the most advanced forms of breast reconstruction. A DIEP (Deep Inferior Epigastric Perforator) flap uses the skin and fat from the abdomen below the level of the belly button. Unlike the TRAM flap, however, the blood vessels that keep the skin and fat alive are traced through the muscle, delivered out of the muscle, then transferred to the chest along with the abdominal skin and fat using microsurgical techniques. The muscle is left in place and is not sacrificed. As a result, there is rarely the need for adding mesh to reconstruct the abdomen. There is still the hip-to-hip incision repair similar to a “tummy tuck” as well as a repair around the belly button.
This procedure has gained popularity with active patients who don’t want implant-based reconstruction, but also want to limit the damage associated with TRAM flaps. This is particularly true with cases of reconstruction after double mastectomy. Although more technically challenging than traditional TRAM reconstructions, the potential benefits of a DIEP reconstruction have resulted in this being the preferred method of reconstruction for our clinic in patients who would like their own tissue for reconstruction and are candidates for such a reconstruction.