FLAP on PERFORATION OF THE DEEP LOWER EPIGASTRIC ARTERY (DIEAP): represents the first choice, among the abdominal flaps, in breast reconstruction. It is a thin adipose-cutaneous flap, vascularized by "perforating vessels" which, starting from the deep inferior epigastric artery, lead with a vertical course to supply the integuments of the lower abdomen. Unlike the TRAM, the dissection of the flap provides for preserving the muscles and aponeurosis of the abdominal wall by lifting only the portion of skin and subcutis located between the navel and the pubis.

There is therefore no need to place nets for abdominal wall reinforcement when closing the donor site. Furthermore, sparing the rectus abdominis reduces the morbidity of the donor site, postoperative pain and hospital stay.
This flap currently represents the most brilliant method in breast reconstruction.



The reconstruction with the DIEP flap allows today to achieve a result of great similarity and symmetry with the healthy contralateral breast, it involves an aesthetic improvement extended to the whole trunk for the contextual improvement of the abdomen, with a stable result over time since the reconstructed breast it will be "dynamic" or will undergo modifications with aging of the tissues in a similar and symmetrical way to the healthy breast, contrary to what happens in prosthetic reconstructions.

This method is also very useful in cases subjected to radiotherapy, i.e. in all cases it is risky to resort to a prosthetic reconstruction.

The ideal candidates are women who have a rather voluminous breast and an abundant abdomen, patients who have undergone a radical mastectomy with abundant skin resection and therefore have the skin of the mastectomy area rather taut, patients who have performed a prosthetic reconstruction burdened by complications or with an inadequate aesthetic result and finally women who do not wish to insert a breast implant.



SIEA (superficial inferior epigastric artery):

This free flap of the lower abdominal wall is vascularized by the superficial inferior epigastric artery, a branch of the femoral artery. Its removal does not damage the muscular and fascial structures of the abdominal wall. The intervention is quick and easy.