The transverse rectus abdominis myocutaneous (TRAM) flap has become the gold standard for autologous breast reconstruction in the last decade. The deep inferior epigastric perforator (DIEP) flap is a refinement of the conventional myocutaneous flap, which is based on anatomic studies of the abdominal wall. These authors have performed a transparent morphologic study of the abdominothoracic wall, in order to visualize the vessel architecture and relationships. The methodology of specimen processing, the anatomic findings, and modifications of surgical incisions are illustrated and discussed.