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DIEP Flap Procedures Pioneered By Dr. Robert Allen

“Perforator flaps represent the state of the art in breast reconstruction. Replacing the skin and soft tissue removed at mastectomy with soft, warm, living tissue is accomplished by borrowing skin and fatty tissue from the abdomen.

A slim incision along the bikini line is made much like that used for a tummy tuck. The necessary skin, soft tissue, and tiny feeding blood vessels are removed. These tiny blood vessels are matched to supplying vessels at the mastectomy site and reattached under a microscope.

Unlike conventional TRAM flap reconstructions, use of our refined perforator flap techniques allow for collection of this tissue without sacrifice of underlying abdominal muscles. This tissue is then surgically transformed into a new breast mound. The abdomen is the most common donor site, since excess fat and skin are usually found in this area. In addition to reconstructing the breast the contour of the abdomen is often improved much like a tummy tuck.

Restoration of the nipple and areola follow. Scars fade substantially with time. For many women the reconstructed breast may be firmer and have a more youthful appearance than their natural breasts.”

GAP Flap

One reconstructive option to consider is having a new breast constructed using your own tissue. The tissue may come from your abdomen, buttock or thighs and consists of only fat and skin without the need to sacrifice important muscles. These leading-edge procedures are becoming the benchmark of breast reconstruction in the United States and have been performed in Europe for many years with excellent results. Over the years, the procedures have been refined to provide patients with a more natural result.

Superficial Inferior Epigastric Artery Flap

For some women the blood vessels just under the skin in the lower abdomen may be chosen as the feeding vessels for the required tissue. The procedure is otherwise the same as the DIEP flap.

PAP Flap
Profunda Artery Perforator Flap

This procedure allows the surgeon to use fat and skin from the posterior thigh underneath the buttock crease for your breast reconstruction. The main advantage of this procedure is the donor site scar falls in the crease of the buttock. This procedure is optimal for patients who have had previous surgery that precludes the use of the abdomen as a donor site.


Fatty tissue can be used from the abdomen (DIEP Flap), the back of the thigh (PAP Flap), the hips (LAP Flap) and the buttock region (GAP Flap). More and more we are also performing Stacked flaps, where we combine tissues from different parts of the body in tandem to reconstruct the breasts. The advantage is the use of the DIEP is a vascular carrier for these other flaps which at times have smaller blood vessels. The results are amazing and our patients are very satisfied.

Inferior Gluteal Artery Perforator Flap

Our newest development, the In-The-Crease IGAP is an excellent option for many women. Excess skin and fat are borrowed from the inferior buttock, leaving an improvement in buttock shape, and a scar that is completely hidden

Gluteal Artery Perforator Flap

For the thin woman or those with otherwise inadequate tummy tissue, the breast may be reconstructed with tissue borrowed from the gluteal area. Skin, fat, and the tiny feeding blood vessels are taken using a fine incision along the panty line.

TUG Flap
Transverse Upper Gracilis Flap

The TUG flap is an advanced microsurgical procedure where gracilis (inner thigh) tissue, namely skin and fat, is transferred to the chest wall to reconstruct a breast that has been removed by mastectomy.

Intercostal Artery Perforator Flap

For some women, an added benefit of the TDAP or ICAP flap is that it removes excess back or lateral chest tissue. A scar is left in the area of the donor site tissue, but it removes the fat roll in the back or lateral chest.

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