{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:31:03Z","timestamp":1784248263988,"version":"3.55.0"},"reference-count":45,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Plast Surg"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Deep inferior epigastric perforator (DIEP) flap has become a standard of care in autologous breast reconstruction, offering reliable aesthetic outcomes and minimized donor site morbidity. Despite its advantages, substantial variability in perforator anatomy and intramuscular course presents technical challenges, and detailed knowledge, meticulous preoperative planning, and precise microsurgical techniques are the key to success. Advances in preoperative imaging, particularly computed tomography angiography (CTA), have enhanced perforator selection and flap design, improving operative efficiency and safety. DIEP flap reconstruction is applicable across a wide range of clinical scenarios, including immediate and delayed reconstruction, patients requiring or receiving irradiation, and those with low body mass index (BMI) or prior abdominal surgeries. Emerging innovations, including robotic-assisted flap harvest, image-guided navigation, and sensory neurotization, aim to further reduce donor site morbidity and improve functional and aesthetic outcomes. This review summarizes the anatomical foundations, surgical strategies, perioperative care, postoperative outcomes, and evolving techniques in effective DIEP flap breast reconstruction.<\/jats:p>","DOI":"10.1055\/a-2794-0652","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T23:53:17Z","timestamp":1770076397000},"page":"071-077","source":"Crossref","is-referenced-by-count":1,"title":["The DIEP Flap Revisit: A Cornerstone of Modern Autologous Breast Reconstruction Anatomy, Preoperative Planning, Surgical Technique, Outcomes, and Complications"],"prefix":"10.1055","volume":"40","author":[{"given":"Chia-Fang","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan, Taiwan"},{"name":"Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Chon-Fok","family":"Cheong","sequence":"additional","affiliation":[{"name":"Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan, Taiwan"},{"name":"Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Ling","family":"Kuo","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan, Taiwan"},{"name":"Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"},{"name":"Department of General Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"},{"name":"School of Medicine, National Tsing Hua University, Hsinchu, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung-Ju","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan, Taiwan"},{"name":"Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"issue":"11","key":"ref1","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1016\/j.bjps.2012.07.001","article-title":"Comparing the donor-site morbidity using DIEP, SIEA or MS-TRAM flaps for breast reconstructive surgery: A meta-analysis","volume":"65","author":"A Egeberg","year":"2012","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1097\/PRS.0b013e31818b7533","article-title":"Abdominal wall following free TRAM or DIEP flap reconstruction: A meta-analysis and critical review","volume":"124","author":"L X Man","year":"2009","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"108","DOI":"10.14712\/23362936.2023.9","article-title":"Vascular anatomy and variations of the anterior abdominal wall - significance in abdominal surgery","volume":"124","author":"S Kostov","year":"2023","journal-title":"Prague Med Rep"},{"issue":"10","key":"ref4","doi-asserted-by":"crossref","first-page":"e1960","DOI":"10.1097\/GOX.0000000000001960","article-title":"In-vivo quantitative mapping of the perforasomes of deep inferior epigastric artery perforators","volume":"6","author":"R Leung","year":"2018","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"701","DOI":"10.3390\/jpm12050701","article-title":"Improving the safety of DIEP flap transplantation: Detailed perforator anatomy study using preoperative CTA","volume":"12","author":"K Frank","year":"2022","journal-title":"J Pers Med"},{"issue":"S 04","key":"ref6","doi-asserted-by":"crossref","first-page":"S291","DOI":"10.21037\/gs.2019.04.10","article-title":"How to assess a CTA of the abdomen to plan an autologous breast reconstruction","volume":"8","author":"W M Rozen","year":"2019","journal-title":"Gland Surg"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1055\/s-2006-941716","article-title":"The deep inferior epigastric artery perforator flap (DIEAP) in breast reconstruction","volume":"20","author":"M Hamdi","year":"2006","journal-title":"Semin Plast Surg"},{"issue":"04","key":"ref8","first-page":"1","article-title":"Deep and superficial inferior epigastric artery perforator flaps","volume":"32","author":"A R Gagnon","year":"2006","journal-title":"Cir Pl\u00e1st Ibero-Latinoam"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1055\/s-0042-1748645","article-title":"The anatomic features and role of superficial inferior epigastric vein in abdominal flap","volume":"49","author":"S O Park","year":"2022","journal-title":"Arch Plast Surg"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1016\/j.jpra.2025.10.004","article-title":"Consistent position of the superficial inferior epigastric vein (SIEV) during deep inferior epigastric perforator (DIEP) flap raise: A radiological analysis","volume":"46","author":"H M Shepherd","year":"2025","journal-title":"JPRAS Open"},{"issue":"09","key":"ref11","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1055\/s-0040-1714426","article-title":"Impact of smoking status in free deep inferior epigastric artery perforator flap breast reconstruction: A multicenter study","volume":"36","author":"L Prantl","year":"2020","journal-title":"J Reconstr Microsurg"},{"issue":"11","key":"ref12","doi-asserted-by":"crossref","first-page":"e7257","DOI":"10.1097\/GOX.0000000000007257","article-title":"Impact of previous abdominal surgery on postoperative complication of deep inferior epigastric perforator flap breast reconstruction: A retrospective comparative study","volume":"13","author":"G Zinner","year":"2025","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"06","key":"ref13","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1002\/micr.22119","article-title":"CT-angiography prior to DIEP flap breast reconstruction: A systematic review and meta-analysis","volume":"33","author":"T Teunis","year":"2013","journal-title":"Microsurgery"},{"issue":"03","key":"ref14","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1016\/j.bjps.2012.09.025","article-title":"Clinical utility of CT angiography in DIEP breast reconstruction","volume":"66","author":"K A Keys","year":"2013","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"S 01","key":"ref15","doi-asserted-by":"crossref","first-page":"S6","DOI":"10.1097\/SAP.0000000000000244","article-title":"A strategic approach for DIEP flap breast reconstruction in patients with a vertical midline abdominal scar","volume":"73","author":"C C Chang","year":"2014","journal-title":"Ann Plast Surg"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/01.prs.0000185867.84172.c0","article-title":"Perfusion zones of the DIEP flap revisited: A clinical study","volume":"117","author":"C Holm","year":"2006","journal-title":"Plast Reconstr Surg"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.bjps.2024.07.030","article-title":"Perfusion area versus volume of the DIEP flap: A multivariable analysis of perforator and flap characteristics for estimation of perfusion area and volume","volume":"96","author":"J W Park","year":"2024","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1002\/micr.22420","article-title":"Benefits of superdrainage using SIEV in DIEP flap breast reconstruction: A systematic review and meta-analysis","volume":"37","author":"K T Lee","year":"2017","journal-title":"Microsurgery"},{"issue":"04","key":"ref19","doi-asserted-by":"crossref","first-page":"451e","DOI":"10.1097\/PRS.0000000000012157","article-title":"Oncoplastic entirely robot-assisted approach: Incorporating robotic surgery in both mastectomy and DIEP flap reconstruction","volume":"156","author":"W L Kuo","year":"2025","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref20","doi-asserted-by":"crossref","first-page":"590e","DOI":"10.1097\/PRS.0000000000010470","article-title":"Novel port placement in robot-assisted DIEP flap harvest improves visibility and bilateral DIEP access: Early controlled cohort study","volume":"152","author":"C Y Tsai","year":"2023","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1186\/s12885-024-12846-x","article-title":"Strategically shifting paradigms: The new era of DIEP flaps with minimally invasive mastectomy: A retrospective cross-sectional study","volume":"24","author":"T E Lin","year":"2024","journal-title":"BMC Cancer"},{"issue":"05","key":"ref22","doi-asserted-by":"crossref","first-page":"477","DOI":"10.21037\/gs.2019.08.08","article-title":"Applications of rib sparing technique in internal mammary vessels exposure of abdominal free flap breast reconstructions: A 12-year single-center experience of 215 cases","volume":"8","author":"Q Zhang","year":"2019","journal-title":"Gland Surg"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1055\/a-2717-4996","article-title":"Clinical scenarios using thoracodorsal and lateral thoracic vessels versus internal mammary vessels in bipedicled deep inferior epigastric perforator flap breast reconstruction: A comparative study","author":"C F Chen","year":"2025","journal-title":"J Reconstr Microsurg"},{"issue":"02","key":"ref24","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1097\/PRS.0b013e3181954cc1","article-title":"Shaping the breast in aesthetic and reconstructive breast surgery: An easy three-step principle","volume":"123","author":"P N Blondeel","year":"2009","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref25","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1097\/JS9.0000000000000871","article-title":"Six steps for a successful aesthetic free flap reconstruction after minimally invasive mastectomy: A retrospective case-control study","volume":"110","author":"A W Wong","year":"2024","journal-title":"Int J Surg"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"S575","DOI":"10.1097\/SAP.0000000000002874","article-title":"Abdominal plication for better cosmetic outcomes during deep inferior epigastric perforator flap breast reconstruction","volume":"86","author":"A Van Vliet","year":"2021","journal-title":"Ann Plast Surg"},{"issue":"06","key":"ref27","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1097\/JHQ.0000000000000358","article-title":"Optimizing unilateral deep inferior epigastric perforator flap breast reconstruction: A quality improvement study","volume":"44","author":"C S Stern","year":"2022","journal-title":"J Healthc Qual"},{"issue":"09","key":"ref28","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1055\/s-0039-1693454","article-title":"Inpatient flap monitoring after deep inferior epigastric artery perforator flap breast reconstruction: How long is long enough?","volume":"35","author":"K H Carruthers","year":"2019","journal-title":"J Reconstr Microsurg"},{"issue":"06","key":"ref29","first-page":"484","article-title":"Breast reconstruction following conservative mastectomies: Predictors of complications and outcomes","volume":"4","author":"S H Voineskos","year":"2015","journal-title":"Gland Surg"},{"issue":"01","key":"ref30","first-page":"41","article-title":"Satisfaction and quality of life after DIEP-flap breast reconstruction","volume":"68","author":"S Niddam","year":"2023","journal-title":"Ann Chir Plast Esthet"},{"issue":"11","key":"ref31","doi-asserted-by":"crossref","first-page":"3278","DOI":"10.3390\/jcm13113278","article-title":"Three-dimensional printing in breast reconstruction: Current and promising applications","volume":"13","author":"H F Mayer","year":"2024","journal-title":"J Clin Med"},{"issue":"06","key":"ref32","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1097\/PRS.0000000000011863","article-title":"Intraoperative surgical guidance for DIEP flap harvest using augmented reality","volume":"155","author":"P M Edgcumbe","year":"2025","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref33","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.cps.2022.10.003","article-title":"Modern approaches to breast neurotization","volume":"50","author":"R C O'Neill","year":"2023","journal-title":"Clin Plast Surg"},{"issue":"05","key":"ref34","doi-asserted-by":"crossref","first-page":"3235","DOI":"10.1097\/JS9.0000000000002331","article-title":"Breast neurotization along with breast reconstruction after nipple sparing mastectomy enhances quality of life and reduces denervation symptoms in patient-reported outcome: A prospective cohort study","volume":"111","author":"S Shyu","year":"2025","journal-title":"Int J Surg"},{"issue":"02","key":"ref35","doi-asserted-by":"crossref","first-page":"znae005","DOI":"10.1093\/bjs\/znae005","article-title":"Elongation of intercostal nerve cutaneous branches for breast and nipple neurotization during breast reconstruction after mastectomy for breast cancer: Case-control study","volume":"111","author":"T N Chang","year":"2024","journal-title":"Br J Surg"},{"issue":"01","key":"ref36","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1186\/s12885-021-08256-y","article-title":"Reconstructive outcome analysis of the impact of neoadjuvant chemotherapy on immediate breast reconstruction: A retrospective cross-sectional study","volume":"21","author":"J R Yang","year":"2021","journal-title":"BMC Cancer"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.jpra.2023.09.001","article-title":"Surgical and patient-reported outcomes in an Asian female population with or without adjuvant radiotherapy after immediate free perforator flap breast reconstruction: A retrospective review","volume":"38","author":"W C Hsieh","year":"2023","journal-title":"JPRAS Open"},{"issue":"01","key":"ref38","doi-asserted-by":"crossref","first-page":"e31046","DOI":"10.1002\/micr.31046","article-title":"Small flaps in microsurgical breast reconstruction: Selection between the profunda artery perforator and small deep inferior epigastric artery perforator flaps and associated outcomes and complications","volume":"44","author":"S Y Chan","year":"2024","journal-title":"Microsurgery"},{"issue":"02","key":"ref39","doi-asserted-by":"crossref","first-page":"e70039","DOI":"10.1002\/micr.70039","article-title":"Coherences of cesarean sectioning scars and other abdominal scars and venous augmentation using SIEV in free DIEP flaps for breast reconstruction","volume":"45","author":"I E Tinhofer","year":"2025","journal-title":"Microsurgery"},{"issue":"07","key":"ref40","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1055\/a-2238-8399","article-title":"DIEP donor site satisfaction between patients with and without history of pregnancy","volume":"40","author":"D C Cheong","year":"2024","journal-title":"J Reconstr Microsurg"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1055\/a-2717-4502","article-title":"Complications and donor site morbidity in harvesting the intercostal main nerve as a graft for breast neurotization in microsurgical breast reconstruction","author":"Y H Lee","year":"2025","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref42","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1245\/s10434-024-16672-0","article-title":"Long-term follow-up of surgical outcomes and oncological results of nipple-sparing mastectomy with immediate reconstruction through a single axillary incision with different approach methods","volume":"32","author":"R Y Gau","year":"2025","journal-title":"Ann Surg Oncol"},{"issue":"05","key":"ref43","doi-asserted-by":"crossref","first-page":"109622","DOI":"10.1016\/j.ejso.2025.109622","article-title":"Comparative analysis of oncological and surgical outcomes of robotic versus conventional mastectomy for breast cancer","volume":"51","author":"W L Kuo","year":"2025","journal-title":"Eur J Surg Oncol"},{"issue":"01","key":"ref44","doi-asserted-by":"crossref","first-page":"29","DOI":"10.5999\/aps.2021.00843","article-title":"Transcutaneous medial fixation sutures for free flap inset after robot-assisted nipple-sparing mastectomy","volume":"49","author":"B S Kim","year":"2022","journal-title":"Arch Plast Surg"},{"key":"ref45","doi-asserted-by":"crossref","first-page":"106143","DOI":"10.1016\/j.ijsu.2021.106143","article-title":"Robotic-assisted nipple-sparing mastectomy followed by immediate microsurgical free flap reconstruction: Feasibility and aesthetic results - Case series","volume":"95","author":"J J Huang","year":"2021","journal-title":"Int J Surg"}],"container-title":["Seminars in Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2794-0652.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T22:36:30Z","timestamp":1777070190000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2794-0652"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":45,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2026,4,24]]},"published-print":{"date-parts":[[2026,2]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2794-0652","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1535-2188","1536-0067"],"issn-type":[{"value":"1535-2188","type":"print"},{"value":"1536-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}