What Is Rib-Sparing DIEP? Here’s What You Should Know.

The Breast Cancer Podcast

Rib-sparing DIEP flap refers to a technique used during Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction surgery where the surgeon preserves the rib and surrounding muscle when accessing the blood vessels that supply the flap.
Quick Breakdown:
• DIEP Flap Reconstruction:
• Uses skin and fat from the lower abdomen to create a new breast after mastectomy.
• Preserves the abdominal muscles (unlike TRAM flap).
• Requires connection of the flap’s blood vessels (deep inferior epigastric vessels) to chest vessels, usually the internal mammary vessels (IMVs).
• Traditional DIEP:
• Often involves removal of a portion of rib cartilage (typically the 2nd or 3rd rib) to reach the internal mammary vessels for microsurgical connection.
• This can lead to post-op pain, risk of chest wall weakness, or delayed healing.
• Rib-Sparing Technique:
• Avoids rib removal by carefully dissecting around the rib or using intercostal spaces.
• Benefits:
• Less post-op pain.
• Preserved chest wall integrity.
• Potentially quicker recovery.
• More cosmetic outcome (less chance of chest wall contour deformity).
Clinical Note:
• Rib-sparing is technically more challenging and requires a skilled microsurgeon.
• Not all patients are candidates; it depends on anatomy, vessel quality, and other surgical considerations.

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