Related Experiment Video
Updated: Feb 20, 2026
An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps
Published on: December 5, 2025
Evidence-Based Clinical Practice Guideline: Autologous Breast Reconstruction with DIEP or Pedicled TRAM Abdominal
Bernard T Lee1,2, Jayant P Agarwal1,2, Jeffrey A Ascherman1,2
1Boston, Mass.; Salt Lake City, Utah; New York, N.Y.; Arlington Heights, Ill.; Durham, N.C.; Chicago, Ill.; Phoenix, Ariz.; Tulsa, Okla.; Jacksonville, Fla.; Beverly Hills, Calif.; Southbury, Conn.; Baltimore, Md.; and Hamilton, Ontario, Canada.
Abstract:
The American Society of Plastic Surgeons commissioned a multistakeholder Work Group to develop recommendations for autologous breast reconstruction with abdominal flaps. A systematic literature review was performed and a stringent appraisal process was used to rate the quality of relevant scientific research. The Work Group assigned to draft this guideline was unable to find evidence of superiority of one technique over the other (deep inferior epigastric perforator versus pedicled transverse rectus abdominis musculocutaneous flap) in autologous tissue reconstruction of the breast after mastectomy. Presently, based on the evidence reported here, the Work Group recommends that surgeons contemplating breast reconstruction on their next patient consider the following: the patient's preferences and risk factors, the setting in which the surgeon works (academic versus community practice), resources available, the evidence shown in this guideline, and, equally important, the surgeon's technical expertise. Although theoretical superiority of one technique may exist, this remains to be reported in the literature, and future methodologically robust studies are needed.
Insights
For autologous breast reconstruction, current evidence does not favor deep inferior epigastric perforator (DIEP) or pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps. Surgeon expertise and patient factors should guide technique selection.
Area of Science:
- Plastic Surgery
- Surgical Oncology
- Reconstructive Medicine
Background:
- Autologous breast reconstruction utilizes abdominal flaps to restore breast volume post-mastectomy.
- Two primary techniques, deep inferior epigastric perforator (DIEP) and pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps, are commonly employed.
- A need exists for evidence-based guidelines to inform the selection of these reconstructive methods.
Purpose of the Study:
- To develop evidence-based recommendations for autologous breast reconstruction using abdominal flaps.
- To compare the efficacy and outcomes of DIEP versus pedicled TRAM flaps in breast reconstruction.
Main Methods:
- A multistakeholder Work Group was convened by the American Society of Plastic Surgeons.
- A systematic literature review was conducted to evaluate the quality of scientific research.
- Evidence appraisal was performed to assess the comparative effectiveness of different flap techniques.
Main Results:
- The systematic review found no conclusive evidence demonstrating the superiority of DIEP flaps over pedicled TRAM flaps, or vice versa.
- The quality of existing research was insufficient to definitively rank one technique above the other for autologous breast reconstruction.
Conclusions:
- Current evidence does not support a preference for DIEP or pedicled TRAM flaps in autologous breast reconstruction.
- Surgeons should consider patient preferences, risk factors, practice setting, available resources, and technical expertise when selecting a flap technique.
- Further high-quality research is necessary to establish definitive evidence regarding the comparative outcomes of these reconstructive methods.
