Pushing the DIEP Envelope: Where are we Now?

The deep inferior epigastric perforator (DIEP) flap in breast reconstruction has been an evolution in providing an ideal autologous reconstruction while minimizing donor site morbidity. Innovations have continued to optimize the DIEP flap in multiple facets. Alternative flap designs, vasculature modifications, and conjoined and stacked flaps have improved the ability to increase flap volume and perfusion. Advancements in anatomic understanding of the abdomen have resulted in decreases in donor site morbidity and improved abdominal outcomes. Patient satisfaction regarding aesthetics has been enhanced through careful consideration of mastectomy techniques and recipient site modifications in addition to improved quality of life outcomes through sensory innervation. The study reviews the evolution and current state of abdominally-based breast reconstruction in its goal of optimizing aesthetic, patient-reported and quality-of-life outcomes while minimizing complications.