Diep flap surgery in the past was limited by a patient tissues.  I am speaking directly to those patients seeking reconstruction with their own tissues who do not want implants under any circumstances.  In many instances patients who were deemed to thin or those on the other hand who were felt to be to obese were denied the opportunity for this type of breast reconstruction.  Several thoughts have changed regarding DIEP flap surgery and breast reconstruction.  Since the introduction of the bipedicled DIEP flap, double stack DIEP, stacked DIEP flap more women who are relatively thin have been given the opportunity to have breast reconstruction surgery using their own tissue in the form of the DIEP flap.   This is particularly advantageous in situations where patients are having skin sparing mastectomy surgery.  This allows for the most complete breast reconstruction result where the mastectomy or breast skin has been saved by the breast surgeon and the plastic surgeon has the opportunity then to perform breast reconstruction surgery either with the abdominal tissue like a DIEP flap for optimal reconstructive outcomes.

The DIEP flap is an outstanding flap and ideal for large soft issue defects.  It has long been praised for the ability of this flap to provide a natural appearing breast reconstruction.  In addition to its utility in breast reconstruction this tissue flap is useful in a variety of other situations like arm and leg reconstruction after tumor removal like sarcoma.  In fact recently we have used the DIEP flap to care for patients with different sarcoma like angiosarcoma and fibromyoid sarcoma.  These patients have benefited from the quality and amount of skin and fat that can be transferred for their  arm and leg reconstruction just like the DIEP flap when it is used for breast reconstruction.  After multiple types of cancer surgeries the DIEP flap can be used.  Also it is very modifiable after the initial surgery has been performed.  Unlike a muscle flap and skin graft which has been traditionally performed for a number of years the DIEP flap is easily contoured through a combination of techniques involving liposuction of the fat and resection of the excess tissues.  Removal of the fat of the flap in the vertical dimension and the flap can be then stretched as well to flatten it even more.  This makes it ideal for the upper and lower extremity.  Of note this does remove the excess abdominal tissue that would normally be discarded in a tummy tuck procedure.  This procedure can be performed in a number of patients of different heights and weights.  If you are in need of reconstruction of the breast, large are or leg wounds the DIEP flap is a ideal source of healthy tissue.