One of the most recent developments in breast reconstruction is the use of perforator flaps such as the DIEP, SIEA, or SGAP flaps. The DIEP/SIEA flaps involve using tissue from the abdomen as is done with a TRAM flap (see TRAM Flap Reconstruction). However, with a DIEP or SIEA flap the abdominal muscles of the abdomen are left intact. The blood vessels needed to keep the flap alive are microsurgically dissected by the surgeon through the abdominal muscle, enabling the surgeon to use the overlying tissue without removing the abdominal muscle. The DIEP and SIEA flaps utilize the same tissues but involve somewhat different blood vessels. The determination as to which of these two flap types to use is made by the surgeon, often at the time of the surgery itself, and is based upon the best available vessels in a particular patient's anatomy.

Patients have the same long scar across the abdomen as those who have a TRAM flap, and achieve much the same flatter abdominal contour after surgery. However, patients typically experience fewer complications due to muscle loss and have quicker recuperation periods than patients with TRAM flaps.

More detail on the DIEP/SIEA flaps can be obtained at our website www.DallasDiep.com. You can also download a brochure (Adobe pdf format) by clicking here.

The SGAP (and related IGAP) flaps involve using tissue from the buttocks region to create the new breast. The same microsurgical technique is utilized as with the DIEP/SIEA. For patients who are unable to have a DIEP/SIEA, perhaps because of a prior abdominal surgery or because there is not sufficient abdominal tissue, the SGAP may be an option. Information on the SGAP can also be found at our website www.DallasDiep.com.

Currently, Dr. Duffy is one of only a handful of surgeons in the country who is experienced with perforator flaps such as the DIEP and SIEA flaps and was the first to perform them in this part of the state. He is very excited to be able to offer this option to patients.

• Since the reconstruction involves using the patient's own tissues, the risks of implant reconstruction are avoided.
• Most patients have less postoperative pain than after a TRAM flap and are therefore able to leave the hospital sooner, and return to normal activities quicker than after a TRAM flap.
• Because the abdominal muscle is not removed, patients have less risk of developing hernias at the site where the flap is removed than patients who have had a TRAM flap.
  It is typically easier to match the contralateral natural breast with the patient's own tissue when compared with implant reconstruction.
• Patients essentially end up with a "tummy tuck" at the same time as the breast reconstruction.

• DIEP/SIEA flap reconstruction generally requires a longer and more difficult surgery at the first stage when compared with implants or TRAM flaps.
• Patients will have a scar across the lower abdomen where the flap is obtained.