The Donut DIEP Flap: A Novel Scarless Technique

Deep inferior epigastric perforator (DIEP) flap surgery is a common technique for breast reconstruction. However, the long and noticeable abdominal scar is one of its greatest disadvantages. Here, the authors suggest a minimal scarring DIEP flap harvest with a novel abdominal design. The key to this method is to preserve more skin tissue with a circular design centered around the navel. Three circular incisions are made: (1) the smallest circle represents an incision around the umbilicus; (2) the middle circle with a radius of less than 3.5 cm indicates another skin incision because the donut-like skin paddle between the small and middle circles is included in the flap; and (3) the largest circle with a radius of greater than 10 cm represents the extent of flap dissection that was performed diagonally from the skin toward the Scarpa fascia. Pedicle dissection proceeds with the conventional method. For closure, a purse-string suture is performed with the umbilicus at its center, leaving only a single small circular scar around the umbilicus as the final scar. Closure of the donor-site is possible with the patient in a supine or slightly flexed position because of less skin excision.