Deep inferior epigastric perforator flap reconstruction

Deep inferior epigastric perforator flap (DIEP) reconstruction is a type of breast reconstruction surgery. It essentially involves the transfer of the patient's own skin and subcutaneous tissues from the lower abdominal wall to the chest to form the breast mound.


The operation spares the rectus muscle, which results in fewer complications and a faster return to normal activities.

Radiographic features


The normal glandular breast parenchyma appears replaced by abdominal adipose tissue. Preliminary CT angiography of the inferior epigastric arteries is also often required for surgical planning.


  • fat necrosis: reported to occur in around 6-18% of cases .
  • hematoma +/- seroma formation
  • vascular compromise: can occur from either arterial or venous compromise and can lead to flap failure
  • tumor recurrence within or around the flap
  • donor site complications: e,g, hernia

Differential diagnosis

On imaging consider

  • TRAM flap reconstruction: absence of atrophied rectus abdominis muscle and its vascular pedicle in the reconstructed breast differentiates a DIEP from a TRAM flap
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