Just as muscle sparing free TRAM flaps have evolved to spare more and more rectus abdominus muscle, the deep inferior epigastric perforator (DIEP) flap is the culmination of this evolution. The DIEP flap represents a new class of "perforator flaps" which means that the entire rectus abdominus muscle is spared. This is the most technically challenging of the TRAM-flaps as the blood vessels ("perforators") are dissected completely free of the muscle. This is completely opposite of the pedicle-TRAM. Whereas the pedicle-TRAM sacrifices the entire rectus abdominus muscle, the DIEP sacrifices none. As a result, the abdominal morbidity is the least and the abdominal integrity is the best with the DIEP.