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This chapter presents an overview of the deep inferior epigastric perforator (DIEP) flap in breast reconstruction. The vascular basis of the DIEP flap and surgical technique are described in detail. Planning, preoperative investigations, and how to select the ideal perforator are discussed. Tips to avoid complications are also presented.

A complete understanding of vascular anatomy is now integral to planning most, if not all, vascularized flaps in plastic surgery. Recent advances in preoperative imaging have provided an unheralded ability to investigate the vascular anatomy of planned donor and recipient sites for plastic surgical reconstruction, and as such, have been associated with a significant decrease in operative morbidity, operative time, and surgeon stress. This chapter provides a comprehensive review of the most recent advances in preoperative planning investigations for plastic surgery in the thorax and abdomen and autologous breast reconstruction.