Published : 29 September 2025

How to Harvest Deep Inferior Epigastric Perforator Free Flap

  • Mohamad Rachadian Ramadan
  • Khanza Isdiharana Keusuma
  • Gary Ali
  • Anisa Ayu Maharani
  • Ayu Putri Balqis Sarena

Volume 12, Issue 2, Jurnal Plastik Rekonstruksi | Pages : 309-312

DOI: 10.14228/jprjournal.v12i2.47   Reader : 74 times PDF Download : 15 times

Abstract

Summary : The Deep Inferior Epigastric Perforator (DIEP) free flap is a microsurgical breast reconstruction technique that uses skin and subcutaneous fat from the lower abdomen while preserving the rectus abdominis muscle. This approach provides a natural breast mound with minimal donor-site morbidity compared to TRAM flaps, reducing risks of muscle weakness and abdominal wall hernia. Advantages include improved postoperative recovery, better abdominal contour, and long-lasting aesthetic results, as the reconstructed breast maintains its volume over time. However, it is technically demanding, requires longer operative time, and carries risks of flap loss or vascular complications if microsurgery fails. The procedure involves dissecting perforator vessels from the deep inferior epigastric system, transferring the tissue to the chest, and connecting vessels under a microscope. Expected outcomes include a soft, natural breast shape with improved patient satisfaction, though surgical expertise and careful patient selection are essential to minimize complications and ensure optimal results.

Data Availability

All data generated during this study are included in this published article [and its supplementary information files].

References

  1. 1. Wei FC, Mardini S, editors. Flaps and Reconstructive Surgery. 2nd ed. Edinburgh / New York: Elsevier (Saunders); 2016.
  2. 2. He WY, El Eter L, Yesantharao P, et al. Complications and patient-reported outcomes after TRAM and DIEP flaps: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open. 2020
  3. 3. Smit JM, Zeebregts CJ, Acosta R, Werker PM. Complications and patient-reported outcomes after TRAM and DIEP flaps: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open. 2020.
  4. 4. Nelissen SH, Perdieus D, Ackerman K, Niddam J, Stillaert F, Hens G. Bulging after Deep Inferior Epigastric Perforator Flap: New Insights and Suggestions. Plast Reconstr Surg Glob Open. 2023
  5. 5. Marwah A, Chandrappa AB, Vasudevan S, Rao AYNY, Sreekumar D, Shetty P, Bharathkar S, Somashekhar SP. Outcomes of Deep Inferior Epigastric Artery Perforator (DIEP) Flap in Indian Population—A Prospective Single-Institute Study. Indian J Plast Surg. 2024
  6. 6. Alves AS, Tan V, Scampa M, Kalbermatten DF, Oranges CM. Complications of immediate versus delayed DIEP reconstruction: a meta-analysis of comparative studies. Cancers (Basel). 2022;14(17):4272.
  7. 7. Murphy BD, et al. Indications and controversies for abdominally-based complete autologous tissue breast reconstruction. Plast Reconstr Surg. 2016.
  8. 8. Blondeel PN, Morris SF, Hallock GG, Neligan PC, eds. Perforator Flaps: Anatomy, Technique, & Clinical Applications. St. Louis: Quality Medical Publishing; 2013.
  9. 9. Srinivasa G, Alvarez RD, Singh NK, et al. Risks of autologous abdominal free flap breast reconstruction in patients with elevated body mass index. Plast Reconstr Surg Glob Open. 2025
  10. 10. Mahajan A, et al. Role of CT angiography in identifying ideal perforators during DIEP flap planning. Clin Radiol. 2022
  11. 11. Nahabedian MY. The DIEP Flap: Principles, anatomy, and technique. Plast Reconstr Surg. 2002;110(1):88-98
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Keywords

  • DIEP Free Flap
  • Breast Reconstruction
  • Perforator Dissection
  • Microsurgery

Author Information

Mohamad Rachadian Ramadan

Reconstructive Microsurgery Section, Division of Plastic Surgery, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.

Email: rachadian@ui.ac.id

ORCID : https://orcid.org/0000-0003-2231-9314

Khanza Isdiharana Keusuma

Reconstructive Microsurgery Section, Division of Plastic Surgery, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.

Email: Khnzz99@gmail.com

ORCID : https://orcid.org/0009-0000-0696-2495

Gary Ali

Reconstructive Microsurgery Section, Division of Plastic Surgery, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.

Email: GaryAliSuryanto@gmail.com

ORCID : https://orcid.org/0009-0006-0024-316X

Anisa Ayu Maharani

Reconstructive Microsurgery Section, Division of Plastic Surgery, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.

Email: anisaa4600@gmail.com

ORCID : https://orcid.org/0009-0002-6543-5534

Ayu Putri Balqis Sarena

Reconstructive Microsurgery Section, Division of Plastic Surgery, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.

Email: ayusarena16@gmail.com

ORCID : https://orcid.org/0000-0002-4944-6850

Article History

Submitted : 30 August 2025
Revised : 30 August 2025
Published : 29 September 2025

How to Cite This

Ramadan, M. R., Keusuma, K. I., Ali, G., Maharani, A. A., & Sarena, A. P. B. (2025). How to Harvest Deep Inferior Epigastric Perforator Free Flap. Jurnal Plastik Rekonstruksi, 12(2), 309–312. https://doi.org/10.14228/jprjournal.v12i2.47

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