What does DIEP mean?
Deep inferior epigastric perforator.
These are the blood vessels that supply the lower abdominal skin and fat used to rebuild the breast.
Reconstructive surgery · Breast reconstruction
DIEP Flap Reconstruction
DIEP flap reconstruction rebuilds a breast using lower abdominal skin and fat while preserving the abdominal muscles.
Does it use an implant?
Usually, your own tissue provides the breast volume.
Some plans combine tissue with an implant, but that is not required for a standard DIEP flap.
Is it right for everyone?
Suitability depends on your health, abdominal tissue and blood vessels.
A microsurgical consultation helps establish whether DIEP reconstruction fits your anatomy and treatment plan.
01 · Overview
Understanding DIEP flap reconstruction
During DIEP reconstruction, a surgeon moves skin and fat from the lower abdomen to the chest. Using microsurgery, they connect the flap's small blood vessels to vessels in the chest so the transferred tissue has its own blood supply. [1]
Unlike a TRAM flap, a DIEP flap does not transfer abdominal muscle. However, the surgeon still works through the abdominal wall to free the blood vessels, so muscle preservation does not eliminate the possibility of weakness, a bulge or a hernia. This operation is also different from a cosmetic tummy tuck. [1]
Reconstruction may happen during mastectomy or months or years later. Radiation, other cancer treatments, previous abdominal surgery and your health can influence the plan. DIEP reconstruction creates breast shape; it does not treat cancer or restore a breast exactly as it was. [2]
- Tissue source
- Lower abdominal skin and fat
- Muscle approach
- Abdominal muscle is preserved
- Care setting
- Hospital surgery with inpatient monitoring
- Timing
- At mastectomy or at a later date
Can both breasts be reconstructed?
Sometimes the abdominal tissue can be divided to reconstruct both breasts. The amount of tissue and the blood vessel anatomy help determine the achievable size and whether this is a reasonable option.
Will I need blood vessel imaging?
Your surgeon may order imaging to map the abdominal blood vessels. Previous surgery and your medical history help determine what testing is useful.
02 · Concerns & Goals
What you may want to discuss
Reconstruction is a personal choice. Your cancer treatment, daily life and feelings about your body all belong in the conversation.
Breast shape after mastectomy
You may want a breast mound that helps clothing fit or feels more like part of your body. Discuss the size and shape that are possible with your available tissue.
Avoiding or replacing implants
You may prefer reconstruction using your own tissue or want to discuss replacing an existing implant reconstruction. Prior surgery and radiation can affect the options.
Abdominal strength and scars
Preserving muscle may be important to you, but the abdomen still needs time to heal. Ask about the long lower abdominal scar, belly button changes and risks of weakness.
More surgery during cancer care
A lengthy operation and recovery may feel like a lot to take on. Delayed reconstruction or choosing no reconstruction are valid options to discuss.
03 · Options
How the approaches differ
These are planning choices within DIEP reconstruction, not interchangeable recommendations. A microsurgeon can explain which are appropriate for you.
Immediate DIEP reconstruction
Reconstruction takes place during the same operation as mastectomy.
How it worksThe breast surgeon and reconstructive surgeon coordinate tissue removal and flap transfer.
May suitPeople whose health and cancer treatment plan support reconstruction at mastectomy.
Main tradeoffThe combined operation is lengthy, and later radiation may affect the reconstructed breast.
Delayed DIEP reconstruction
Reconstruction takes place after mastectomy and initial healing or cancer treatment.
How it worksAbdominal tissue is transferred during a separate operation.
May suitPeople who need more time, have completed treatment or were not ready for immediate reconstruction.
Main tradeoffIt requires another major operation and a period without a reconstructed breast.
One-sided DIEP reconstruction
A flap rebuilds one breast.
How it worksThe surgeon shapes the abdominal tissue to create a breast mound and considers balance with the other breast.
May suitPeople needing reconstruction on one side with suitable abdominal tissue and vessels.
Main tradeoffMatching the other breast may require additional shaping or surgery on that breast.
Two-sided DIEP reconstruction
Abdominal tissue is used to rebuild both breasts.
How it worksThe tissue is divided into separate flaps, each with its own microsurgical blood vessel connections.
May suitPeople needing reconstruction on both sides who have enough suitable tissue.
Main tradeoffThe available tissue must serve both breasts, which may limit breast size and increase surgical complexity.
Timing and one-sided or two-sided reconstruction are separate decisions. Radiation plans and the amount of usable abdominal tissue can change the recommended approach. [1] [2].
What if I have had abdominal surgery?
A previous cesarean delivery or other abdominal operation does not always rule out DIEP reconstruction. Scars and changes to blood vessels matter. A prior tummy tuck may substantially limit or prevent its use.
Could the surgical plan change?
Yes. If the blood vessels or tissue are unsuitable, a different flap or another reconstruction method may be needed. Ask what backup options you would authorize before surgery.
04 · Results
What may improve and what may remain
A breast mound made from your tissue
The aim is a breast shape that fits your body and preferences.
- Size depends partly on how much abdominal tissue can be safely transferred.
- Perfect symmetry is not expected.
- The reconstructed breast can change with weight changes and aging.
Shape and sensation are different outcomes
A reconstructed breast will not feel exactly like the original breast.
- Numbness or altered sensation can persist in the breast and abdomen.
- Some sensation may return, but normal sensation is not assured.
- Nipple reconstruction or tattooing may be discussed later if the nipple was removed.
Refinement may be part of the plan
The first operation may not be the final stage.
- Swelling and tissue settling affect the early appearance.
- Later procedures may address contour, scars or breast balance.
- Discuss how possible revisions fit with cancer treatment and your priorities.
Reconstruction does not replace cancer follow-up. Your breast care team will explain the examinations and imaging appropriate for your remaining breast tissue and treatment history. [2]
05 · Recovery
Planning your recovery
Recovery at a glance
- Stay after surgery
- Determined by Your Surgeon
- Initial recovery at home
- Varies by Individual
- Return to desk work
- Varies by Procedure and Work Activity
- Light daily activities
- Based on Individual Recovery
- Strenuous exercise
- Based on Surgeon Clearance
Returning to work does not mean fully healed. Follow your surgeon’s instructions; strenuous activity requires clearance.
Recovery involves both the chest and abdomen. Your surgical team should provide a plan tailored to your flap, wound healing, health and home support.
Step 1 · Surgery and early monitoring
Treatment day
The operation uses general anesthesia. Afterward, staff closely check the flap's blood supply and manage pain, drains and circulation precautions.
Step 2 · The first several days
Hospital recovery
The team continues flap checks and helps you begin moving safely. Discharge depends on the flap, your mobility, pain control and ability to manage care at home.
Step 3 · The following weeks
Healing at home
Fatigue, swelling and abdominal tightness can limit daily tasks. Follow your own instructions for drains, dressings, posture and activity, and attend planned checks.
Step 4 · Over subsequent weeks and months
Building back activity
Your surgeon gradually clears more demanding activity as healing allows. Scars and breast shape continue to change after you feel ready for work or routine tasks.
Planning everyday activities
ActivityGeneral planning contextWhat affects the plan
WorkPlanning context: Several weeks away may be needed; physically demanding work often requires longer. [1]What affects it: Fatigue, lifting demands, complications and whether one or both breasts were reconstructed.
DrivingPlanning context: Wait for clearance and until you can maneuver and react safely without sedating medicines.What affects it: Chest and abdominal discomfort, arm movement and seat belt tolerance.
Lifting and exercisePlanning context: Heavy lifting and abdominal exercise need specific clearance. [1]What affects it: Abdominal wall healing, wounds and the type of activity you want to resume.
Walking and daily tasksPlanning context: The team usually helps you start gentle movement in the hospital and increase it gradually. [2]What affects it: Balance, stamina, drains and any movement restrictions.
Returning to work is not the same as complete healing. Follow your surgical team's instructions rather than another person's recovery timeline.
Before your procedure
- Discuss reconstruction timing with both your cancer care team and microsurgeon.
- Review prior abdominal operations, radiation and any history of blood clots.
- Share all medicines, supplements, allergies and nicotine use; ask what changes are needed.
- Complete the examinations and blood vessel imaging your team recommends.
- Arrange transportation and help with meals, household tasks, children or dependents.
- Ask for written guidance on hospital stay, drains, activity limits and urgent contact numbers.
Will I go home with drains?
You may have drains in the breast area and abdomen. Your team will teach you how to care for them and decide when removal is appropriate based on healing and drainage.
How can I protect numb skin?
Reduced sensation can make injuries harder to notice. Ask your team how to protect and check the skin, and avoid applying heating pads or ice packs unless they specifically direct you to do so.
06 · Safety
Risks and what your clinician assesses
Early soreness, bruising, swelling, fatigue, abdominal tightness and numbness are common. Symptoms should be reviewed if they worsen, change suddenly or do not follow the pattern your team described.
Blood supply problems or flap loss
A clot or other circulation problem can threaten the transferred tissue. Urgent surgery may be needed, and some or all of the flap can be lost.
Bleeding or fluid collections
Blood or fluid can collect in the breast or abdomen and may require drainage or another procedure.
Infection or delayed wound healing
Incisions can become infected, open or heal slowly. Skin or fat may not survive fully, sometimes requiring wound care or surgery.
Abdominal weakness, bulge or hernia
These problems remain possible even though abdominal muscle is preserved. Further treatment or repair may be needed.
Lasting changes in comfort or appearance
Scars, numbness, persistent pain, asymmetry or firm areas from fat necrosis may occur. Additional procedures may not resolve every concern.
Anesthesia and blood clot complications
Major surgery carries risks including anesthesia reactions and clots in the legs or lungs. Your team assesses these risks and plans preventive measures.
Discuss these risks and your individual health history with your surgeon. [1]
What your clinician assesses
- Available abdominal tissue, blood vessel anatomy and previous scars
- Heart and lung health, diabetes and factors affecting wound healing
- Nicotine exposure, medication use and personal or family clotting history
- Cancer treatment timing, radiation history and ability to manage recovery
07 · Costs
What makes up the Total Procedure & Care Cost
Compare written estimates for the same planned scope: one or both breasts, timing, hospital care and any expected later stages. Ask your insurer and surgical team about coverage and your likely share.
Surgeon
Surgical care
Surgeon services for flap transfer, microsurgery and breast shaping.
Ask your surgeonAsk which surgeons and stages are included and whether revisions or procedures on the other breast are separate.
Facility
Anesthesia and facility
Anesthesia, operating room services and the hospital stay.
Ask your surgeonConfirm network status and how a longer stay or an unplanned operation would be billed.
Supplies
Supplies and follow-up
Potential charges for medicines, dressings, garments, appointments and rehabilitation.
Ask your surgeonAsk what is included, what requires separate payment and how complications are handled.
TRC
Patient Services
Any separately offered care-coordination or administrative support.
Ask TRCAsk whether there is a fee, what it includes, whether it is optional and whether insurance covers it.
Your written estimate should explain the services included, any separate charges, and payment terms.
08 · Questions
Common questions
Is DIEP reconstruction a tummy tuck?
No. It removes lower abdominal tissue to reconstruct a breast and requires microsurgical blood vessel connections. The abdominal contour changes, but the purpose and risks differ from a cosmetic tummy tuck.
Can I have DIEP reconstruction after radiation?
It may be an option. Radiation affects tissue quality and treatment timing, so your reconstructive surgeon and cancer team should plan together.
Will my nipple be reconstructed too?
That depends on whether your nipple can be safely preserved during mastectomy. If it is removed, later nipple reconstruction, tattooing or leaving the breast without a nipple are options.
Do I have to choose reconstruction?
No. You can discuss an external prosthesis, aesthetic flat closure or delaying a decision. The choice should reflect your health, values and preferences.
0 consultation questions in your plan
View in My TRC workspaceMy Aesthetic Plan
Prepare for your consultation
Bring these to help your consultation:
- Confirm the planned timing, side or sides, and agreed backup options.
- Get a personalized recovery plan and round-the-clock urgent contact instructions.
- Review the written estimate, insurance requirements and possible later stages.
View My Aesthetic Plan
Choices stay in this visit until saving to your account completes. Nothing is sent to a clinician.
Sources
- [1]Cleveland Clinic: DIEP Flap SurgeryDIEP anatomy and microsurgical transfer, muscle preservation, candidacy, hospital monitoring, recovery restrictions, flap loss, abdominal complications and warning signs.
- [2]Mayo Clinic: Breast reconstruction with flap surgeryImmediate and delayed reconstruction, radiation considerations, flap and implant alternatives, recovery, sensation limitations, additional shaping procedures and continued cancer follow-up.
Photographs are illustrative scenes, not patients, staff, facilities or outcomes. This information does not replace a personal assessment by your treating clinician.