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The DIEP Flap Procedure

The gold standard of breast reconstruction, the DIEP flap is the most advanced reconstructive procedure available today.

The DIEP flap is the most common tissue flap procedure due to its natural looking result. In the DIEP procedure, a flap of tissue containing fat and skin is removed from the lower abdomen and used to form a new breast.

Unlike TRAM flap surgery, DIEP flap surgery preserves the abdominal muscles. Because the new breast is made entirely of living abdominal tissue, which is similar to breast tissue in appearance and texture, the new breast looks and feels soft, warm, and natural. After surgery, many women enjoy having a flatter abdomen, similar to the effects of a “tummy tuck.”


In most cases, the DIEP surgery can be done on the same day as the mastectomy (immediate reconstruction). If you’ve already had a mastectomy, the DIEP can be at a later date (delayed reconstruction). During the procedure, a flap—a piece of tissue containing skin, fat and blood vessels—is removed from the lower abdomen, below the belly button, and transplanted to the chest.

The DIEP procedure is named after the blood vessels that nourish the fat and skin of the lower abdomen, the deep inferior epigastric perforator vessels, which travel through the abdominal muscles. Very small incisions are made through the muscle to access these vessels, which are reconnected to the new blood supply in the chest. Sometimes it’s necessary to remove a small piece of cartilage from the chest to access the vessel. Using microsurgery, the plastic surgeon connects the tiny blood vessels in the chest to the vessels in the flap. The flap is then shaped to create the new breast.

After Surgery

Because the abdominal muscles are completely preserved in DIEP flap surgery, patients retain more of their core strength, feel less pain, and recover more quickly than with the TRAM flap procedure. There’s less need to insert synthetic mesh to support the abdominal wall, as is done in the TRAM procedure, and the risk of postoperative problems, such as hernias, is reduced.

The incision for the DIEP flap surgery is horizontal and runs from hip bone to hip bone in the lower abdomen, about a third of the way between the top of your pubic hair and your belly button.  The scar may be higher than a tummy tuck (abdominoplasty) scar, but it often sits under the bikini line. Although the DIEP flap scar is long, it typically fades over time.

Contraindications and Alternatives

If you’ve had prior abdominal surgery, you may not be a candidate for a DIEP flap. Your doctor can evaluate this during your consultation. If your abdomen can’t be used as the donor site, alternative sites, such as your thighs, buttocks or back, may be considered. Or, an implant may be used instead of fat.

Women who have little abdominal fat may be candidates for a stacked flap procedure, a hybrid flap-implant procedure, or a flap from another donor site.

Stacked Flap

Hybrid Flap

Recovery Time

The usual hospital stay for a DIEP flap is 1-3 days. Recovery time for a DIEP flap is typically 6-8 weeks. The risk of an abdominal hernia is small—less than with a TRAM flap—but no heavy lifting may be done for 6-12 weeks after surgery. It can take up to a year for your tissue to completely heal.

Additional Procedures

The new breast is living tissue and becomes part of you, while implant reconstruction will require replacement of the implant at some point in the future. DIEP flap reconstruction can often benefit from minor touch-up outpatient procedures a few months after healing. Nipple reconstruction may also be done at this time if desired.

Things to Consider

  • You’ll have little to no sensation in the nipples and breast, and less sensation in the area around the abdominal incision, after the DIEP procedure.
  • If you’ve had prior abdominal surgery, you may not be a candidate for breast reconstruction using abdominal tissue.
  • Abdominal tissue can be used for both unilateral (one breast) or bilateral (both breasts) reconstruction, depending on the amount of tissue available.
  • Tissue can be taken from the abdomen for breast reconstruction only once. If you need reconstruction of the other breast at a later time, you’ll need to use tissue from an alternate donor site or have implant reconstruction. If you’re considering a single-side mastectomy with breast reconstruction, you might want to consider having the other breast prophylactically removed and reconstructed as well.
  • The scar that is left on the abdomen will be higher than with a traditional tummy tuck.
  • No heavy lifting may be done for 6-12 weeks after surgery.

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