What is DIEP flap surgery?

DIEP flap surgery is a breast reconstruction procedure used to restore your breast after a mastectomy. This surgery uses tissue, fat and blood vessels from your abdomen, allowing your surgeon to recreate a breast that looks and feels more natural than other breast reconstruction options.

The surgery gets its name from the deep inferior epigastric perforator (DIEP), an artery in the abdomen. It uses tissues from the abdomen but preserves the abdominal muscles, and most women have the added benefit of a flatter stomach after surgery.

DIEP flap surgery patient enjoying time inside with her dog

Am I a good candidate for DIEP flap reconstruction surgery?

If you need a mastectomy or surgery to remove part of your breast, called a lumpectomy, you have several options for breast reconstruction following your procedure. You may choose DIEP flap surgery if you want a more natural-looking breast and are healthy enough for the procedure.  

This procedure could be a good fit if you:

  • Have enough lower abdominal tissue to use in reconstruction
  • Are in generally good health and are a non-smoker
  • Want to avoid breast implants and ongoing implant monitoring
  • Are willing to have a slightly longer recovery to get the long-term results you want

Who shouldn't have a DIEP flap surgery?

DIEP flap surgery may not be right for everyone, especially if your surgeon can’t get all the tissue needed from your abdominal area to perform the procedure. Sometimes, other breast reconstruction options, including a different type of flap reconstruction or implant reconstruction, could better match your needs.

You may not be able to have DIEP flap surgery if you:

  • Have a medical condition that makes surgery unsafe
  • Have had certain other abdominal surgeries—such as colostomy or abdominal wall reconstruction
  • Don’t have enough fat or tissue in your abdomen, for example, if you’ve previously had a tummy tuck or liposuction procedure
  • Have abdominal blood vessels that aren’t able to be used for reconstruction
  • Have already had a flap surgery to reconstruct the other breast, as the abdominal tissues used are only enough for one breast
  • Are a current smoker

How to prepare for DIEP flap surgery

You’ll feel more prepared for DIEP flap surgery if you start the conversation about your breast reconstruction options before your mastectomy procedure. That way, your entire care team, including the plastic surgeon who will perform your DIEP flap surgery, can work together to decide the best timing for both procedures and make sure you know what to expect throughout the entire process.  

Your plastic surgeon will go over the pros and cons of DIEP flap surgery, answer your questions about recovery and give you specific instructions to follow in the days before your procedure.

Some steps you may take before DIEP flap surgery include:

  • Understanding your insurance coverage
  • Planning for support as you recover at home
  • Discussing any follow-up care or additional procedures
  • Stopping certain medications as instructed by your doctor
  • Getting help quitting smoking

The DIEP flap procedure

DIEP flap is performed by plastic surgeons with experience in microsurgery. This type of surgery uses special instruments and a microscope to transfer tiny blood vessels from your abdomen and reconnect them in your new breast. This type of surgery is more complex than other reconstruction options, so it requires a team with specialized training that is not found at every hospital.

The DIEP flap procedure uses blood vessels, skin, fat and tissues from your abdomen. But your surgeon may have to take blood vessels from more than one place. Because it doesn’t use any muscle tissue, it preserves the strength and function of your abdominal muscles.

Before the procedure

Your surgeon will give you details on when to stop specific medications or stop eating and drinking leading up to your DIEP flap procedure. When you arrive on the day of your surgery, you’ll go to the pre-op area. Here, you’ll change into a gown, get an intravenous (IV) drip, and talk with your surgeon and anesthesiologist before going into surgery.

DIEP flap recovery

After DIEP flap surgery, it typically takes six to eight weeks to start to feel like yourself again. Most people will have a follow-up visit with their surgeon about a week or two after surgery to make sure they are healing well. Because this type of surgery includes two incisions, you may need more time to recover than other procedures that only need one incision, like a mastectomy.

To help you heal, you may wear support garments around your belly or chest during your first few weeks of recovery. It’s also important to follow your care team’s instructions about easing back into exercise, work and other activities in the coming weeks.

It’s common to have some discomfort during your initial recovery. At first, it may be hard to change positions, such as going between standing and sitting or getting in and out of bed. You may have pain, tenderness or numbness around the incisions in your abdomen and your reconstructed breast. Your abdomen, new breast and the areas around it may also be swollen or feel tight. These symptoms get better with time.

DIEP flap surgery patient enjoying time outside with her daughter

What are the benefits of DIEP flap reconstruction?

Compared to other breast reconstruction options, DIEP flap surgery offers several possible benefits for women looking to restore the look and feel of their breasts after a mastectomy. In general, this procedure has a high success rate and satisfaction from those who choose it. 

Some benefits of DIEP flap reconstruction include:

  • Offers a more natural reconstructed breast by using your own tissue
  • Preserves the muscles in the abdomen
  • Provides a flatter belly by removing excess fat and tissue
  • May give some feeling and sensation in the new breast
  • Doesn’t require long-term monitoring or adjustments like breast implants
  • Can be performed at the same time as a mastectomy

Possible risks of DIEP flap reconstruction

DIEP flap surgeries have a high success rate, and serious side effects are rare. But DIEP flap reconstruction is complex, so like any procedure, it comes with some risks. Your doctor can answer any questions about risks so that you can make the right choice for you.

Some risks of DIEP flap reconstruction include:

  • Infection or problems with your incisions healing after surgery
  • Scar tissue—your new breast may form a hard area of scar tissue that feels like a lump
  • Abdominal hernia—where a weak area of the abdominal muscles allows part of your intestines to bulge out
  • Vessel and tissue failure—where your new breast tissue doesn’t get enough blood, causing the tissues to die

Frequently asked questions