DIEP is routinely performed by Dr. Howard at Northwestern Medicine Lake Forest Hospital, but his is one of few practices in the country to offer several unique DIEP flap microsurgical reconstruction methods.
Before and After Photos
Occasionally, in thinner women, an alternative to the traditional DIEP flap may be needed to provide adequate volume or shape for the breast. In this surgery, two DIEP flaps are created, and each is independently connected to blood vessels in the chest. The flaps are then placed one on top of another, or “stacked,” to provide breast reconstruction volume and projection.
Superficial Inferior Epigastric Artery (SIEA) Perforator Flap
The SIEA perforator flap utilizes the same excess lower abdominal tissue as the DIEP flap. However, the blood vessels to this flap version come from a different pathway in the groin and do not perforate through the muscle or abdominal wall. This procedure is not always possible because these alternative blood vessels are generally smaller and not always present for use.
Transverse Upper Gracilis (TUG) Flap
The TUG flap utilizes skin and fat from the upper, inner thigh, with underlying blood vessels that perforate through muscle on the inner thigh. The tissue is prepared and transferred to the breast, where the blood vessels are reconnected using microsurgical techniques in an identical manner to the abdominal flap. The resulting incision is generally in the groin to buttock crease.
Profunda Artery Perforator (PAP) Flap
The PAP flap is very similar to the TUG flap, but uses slightly different blood vessels from the inner thigh. This tissue may be removed in a transverse groin or vertical thigh direction, depending on the fatty tissue distribution. The resulting incision location will either be in the groin crease or along the inner thigh.
Thoracodorsal Artery Perforator (TAP or TDAP) Flap
The TAP flap is a portion of skin and fatty tissue from
the mid-lateral back that may be used for local transfer to the breast. This tissue
and blood vessel transfer does not require microsurgical blood vessel
reconnection. This tissue often does not have enough volume to fully
reconstruct the breast and may require the additional use of an implant to increase