The initial part of this dissection is done with high power loupe magnification. The final stages of blood vessel preparation are done under the operating microscope. These blood vessels range from 1.6 to 3.0 mm in diameter. They are extremely delicate and are handled like wet tissue paper. The other half of the surgery involves the dissection and isolation of the DIEP flap.
Dissection is begun laterally and continued medially until the first perforators are identified.
As few as one and as many as five suitable perforators are chosen for the transfer. The grizzle or fascia around the base of these perforating blood vessels is cut. With the aid of loupe magnification and occasionally the operating microscope the perforating blood vessels are traced through the rectus muscle down to the common deep inferior epigastric vessels. With this dissection, the flap is isolated on only its vascular pedicle. The pedicle is now divided and the flap is placed on the chest.