DIEP, SIEA and TRAM Flap for Breast Reconstruction

Using a woman’s own abdominal tissue to create a new breast following mastectomy is the gold standard in breast reconstruction. The abdomen provides skin and soft tissue that is soft, warm and mobile, very much like the original breast.

Experts in DIEP Flap and SIEA Flap Breast Reconstruction

At Froedtert & the Medical College of Wisconsin, our team of plastic surgeons is committed to providing women with every established alternative currently available in breast reconstruction. It is our practice philosophy that by combining artistry, sound surgical science and teamwork, we can provide the best possible outcome and most satisfying experience for our patients.

Dr. John Hijjawi image

John Hijjawi, MD and John LoGiudice, MD board-certified plastic surgeons at Froedtert & the Medical College of Wisconsin, are among a relatively few number of surgeons in the United States who perform DIEP Flap and SIEA Flap breast reconstruction surgery routinely.

In addition to Plastic and Reconstructive Surgery residency training, they have both completed fellowships in microvascular surgery. Dr. Hijjawi has also completed a microvascular breast reconstruction fellowship with Dr. Phillip Blondeel, one of the techniques originators, in Gent, Belgium.


The DIEP Flap, or Deep Inferior Epigastric Perforator Flap, represents the evolution of the TRAM technique and the current state of the art in breast reconstruction. The DIEP Flap is a microsurgical technique that involves precisely separating the skin, soft tissue and tiny blood vessels, or perforators, from the abdomen without removing any of the abdominal muscles.

The blood vessels are matched to supplying vessels at the mastectomy site, and a new breast is formed. Three months later, a new nipple is reconstructed, and finally tattooing of the nipple completes the reconstruction. Leaving the abdominal muscles intact results in less post-operative pain, a shorter hospital stay and a quicker recovery.

The tissue taken to create a new breast using the DIEP Flap is virtually the same as that taken for a cosmetic tummy tuck or abdominoplasty. In fact, the narrow incision at the bikini line used for the DIEP Flap is identical to that made for a tummy tuck.


The SIEA Flap, or Superficial Inferior Epigastric Artery Flap, is similar to the DIEP Flap technique in that it uses skin and fatty tissue from the abdomen to replace the skin and soft tissue removed in a mastectomy.

The SIEA, however, relies on a distinctive blood supply and requires less tissue removal from the abdomen. The SIEA Flap depends on the tiny vessels of the superficial vascular system in the fatty layer just below the skin of abdomen. About 20 percent of women have these types of superficial arteries. Women who do not have adequate superficial blood vessels are not candidates for this procedure. The decision about which procedure to use — DIEP Flap or SIEA Flap — is made during surgery. Because less tissue is removed, the abdomen generally heals faster than with the DIEP Flap procedure.

As with the DIEP Flap procedure, the SIEA Flap preserves the abdominal muscle and leaves a thin scar and a flat belly, similar to a tummy tuck. Three months after surgery, a new nipple is reconstructed, and finally tattooing of the nipple completes the reconstruction.


Plastic surgeons have used the TRAM Flap, or Transverse Rectus Abdominis Myocutaneous Flap, for more than 20 years, transferring extra tissue from the abdomen to the breast, sometimes taking one entire rectus abdominis muscle with the flap, and sometimes taking only a part of the muscle.

Candidates for DIEP and SIEA Flap Breast Reconstruction


Most commonly the DIEP Flap and SIEA Flap are used in breast reconstruction immediately following mastectomy for breast cancer. Increasingly, women who did not have breast reconstruction following a mastectomy are pursuing delayed breast reconstruction, or reconstruction years after their mastectomy.

While a mastectomy on only one breast is more common, bilateral mastectomies (removal of both breasts) are performed in many women. Often, as in the case of women with the BRCA gene mutation, prophylactic mastectomy (surgically removing the breasts before any sign of cancer) is performed bilaterally. These patients make ideal candidates for DIEP Flap or SIEA Flap breast reconstruction. 

Breast Implant Problems

Women with problems related to breast implants also occasionally seek out breast reconstruction with their body’s own tissue. These are often patients who have had breast implants placed for breast reconstruction following breast cancer treatment, or sometimes women having some problem with implants placed for cosmetic breast augmentation.

Congenital Breast Abnormalities

Congenital breast abnormalities, such as those encountered by patients with Poland’s Syndrome, are also problems that can be treated with the DIEP Flap or SIEA Flap.  Often a breast implant is placed during the late teenage years followed by removal of the implant and more definitive reconstruction with the patient’s own tissue years later.


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