Microsurgery is an innovative technique that borrows tissue from one area of the body for reconstruction. The tissue removed is called the “Flap.”  The Flap consists of skin, soft tissue and small blood vessels that supply the area. Further refinements in microsurgery now allow us to provide flaps without removing muscle. These flaps are called perforator flaps and they are changing the way we perform breast reconstruction. We can now provide skin and soft tissue removed from the lower abdomen and buttock to supply the breast with soft living tissue.  We use a microscope to attach the small blood vessels of the perforator flap to supplying vessels at the mastectomy site using a microscope.


DIEP stands for deep inferior epigastric perforator flap, this is the name of the small blood vessels that supply nutrition to the lower abdomen. An incision along the lower abdomen is made in a similar location to the incision made with a caesarean section. However, the incision is longer from hip to hip. The skin from below the belly button to pubic bone, soft tissue, and small feeding blood vessels are removed. These tiny blood vessels are matched to vessels at the mastectomy site and they are sutured together under a microscope.

The DIEP differs from the TRAM flap by not sacrificing the underlying abdominal muscles. The small perforating blood vessels are carefully freed from the muscle while allowing the muscle to remain intact. The flap is then shaped into a new breast mound. This completes the first stage of breast reconstruction.


GAP stands for gluteal artery perforator flap. GAP flaps are an option for women who do not have enough abdominal tissue to donate for breast reconstruction. The SGAP flap uses the upper buttock for breast reconstruction. The SGAP scar lies in the upper buttock. The IGAP flap uses the lower buttock for breast reconstruction. The IGAP scar lies within the lower buttock crease. MUSC Health Plastic surgeons will choose the right flap for each patient depending on the anatomy of the blood supply to that area.