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DIEP flap reconstruction explained
A DIEP flap rebuilds the breast using skin and fat from your lower tummy while leaving the tummy muscle in place. This page explains how the operation works, what it offers compared with implants, what recovery looks like, and the honest limits and risks to discuss with your surgical team.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is a DIEP flap reconstruction, and how does it work?
- What a DIEP flap offers, and what it asks of you
- DIEP flap compared with implant reconstruction
- The vocabulary, in plain language
- Honest realities about DIEP flaps
- What happens during the operation
- Recovering from a DIEP flap
- What people assume about DIEP flaps
- Common questions about DIEP flap reconstruction
The short answer
What is a DIEP flap reconstruction, and how does it work?
A DIEP flap is a way of rebuilding a breast using skin and fat taken from your lower tummy, the same area that is removed in a tummy tuck. DIEP stands for deep inferior epigastric perforator, which is the name of the small blood vessels that run through the tummy muscle to feed this tissue. The surgeon lifts the skin and fat together with these vessels, carefully separating them from the muscle so the muscle itself stays in place. The tissue is then moved up to the chest, and the tiny artery and vein are joined to blood vessels in the chest using a microscope. This joining step is called microsurgery, and it is what keeps the new breast alive. Because no muscle is taken, a DIEP flap is known as a muscle-sparing flap, and many women keep better tummy strength than with older methods. The result is a breast made of your own living tissue, which usually feels soft and warm, and changes with your weight as the rest of your body does. It can be done at the same time as a mastectomy or months or years later. The trade-offs are a longer operation, a scar across the lower tummy, a longer recovery than implant surgery, and a small risk that the blood supply fails. Not everyone has enough tummy tissue or suitable vessels, and smoking, some health conditions and previous tummy surgery can affect whether it is a safe choice for you.
It uses your own tissue
Skin and fat from the lower tummy are shaped into a new breast.
The muscle is left behind
Only the small feeding vessels are threaded out through the muscle.
It is a big operation
Surgery and recovery take longer than with implant reconstruction.
This page gives general information only. Your surgical team will advise on your own situation.Weighing it up
What a DIEP flap offers, and what it asks of you
A DIEP flap has real strengths, but it is not the right fit for every woman.
A natural feel
Living fat feels soft and moves more like a natural breast. It ages with you, and it gains or loses size when your weight changes.
Usually no implant to replace
Once healed, the flap does not wear out the way an implant can, so later replacement operations are usually not needed.
Small touch-up procedures are still common.A tummy scar and recovery
You will have a long, low scar from hip to hip and a tighter tummy. Both the chest and the tummy need time to heal.
Specialist skills needed
Microsurgery needs a trained reconstructive team, an operating theatre set up for it and nurses who know how to watch a flap closely.
Things that may rule it out
- Too little tummy fat
- Heavy smoking
- Some earlier tummy operations
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DIEP flap compared with implant reconstruction
Question
DIEP flap
Where the new breast comes from
Your own lower tummy skin and fat, rather than a silicone or saline implant
Length of surgery
Several hours longer than implant surgery, often most of a day
Hospital stay
Usually a few days, with close flap checks at first
Recovery at home
Often around six to eight weeks before most normal activity
Coping with radiotherapy
Own tissue generally tolerates radiotherapy better than an implant
Words you may hear
The vocabulary, in plain language
- Flap
- A piece of tissue moved from one part of the body to another with its blood supply.
- Perforator
- A small blood vessel that passes through a muscle to feed the skin and fat above it.
- Microsurgery
- Joining very small blood vessels under a microscope with stitches finer than a hair.
- Free flap
- A flap that is fully detached and then reconnected to new vessels in the chest.
- Donor site
- The place the tissue is taken from, here the lower tummy.
- Muscle-sparing
- A technique that leaves the tummy muscle in place instead of removing part of it.
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Being straight with you
Honest realities about DIEP flaps
A DIEP flap can give a lovely, lasting result, but it helps to know its limits before you decide.
The flap can fail
Most flaps survive, but a small number lose their blood supply, usually in the first few days. A further operation may be needed, and sometimes the flap cannot be saved.
More than one operation is common
Many women have later procedures to adjust shape, add fat, match the other breast or rebuild a nipple.
Feeling is usually reduced
The new breast is often numb at first. Some feeling may return slowly, but it rarely becomes normal.
Availability varies
Not every hospital offers microsurgery, so you may need to travel or wait.
What this page cannot tell you
It cannot tell you whether your body, cancer treatment plan and health make a DIEP flap suitable. Only a reconstructive surgeon who examines you can judge that.
On the day
What happens during the operation
Before surgery, many teams arrange a scan of your tummy blood vessels so the surgeon can choose the best perforators in advance. On the day you have a general anaesthetic and sleep throughout. Often two surgical teams work together, one on the chest and one on the tummy, to save time.
Preparing the chest
If the reconstruction is immediate, the breast surgeon first removes the breast tissue. The reconstructive surgeon then finds suitable blood vessels in the chest, usually the internal mammary vessels behind a rib cartilage near the breastbone.
Lifting the tummy tissue
An oval of lower tummy skin and fat is lifted along with its perforator vessels, which are traced through a small opening in the muscle and freed without cutting the muscle away.
Joining and shaping
Under the microscope, the artery and vein are joined to the chest vessels. The flap is then shaped into a breast, and the tummy is closed much like a tummy tuck, with your belly button brought out through a new opening.
Afterwards
Recovering from a DIEP flap
Recovery happens in stages, and everyone moves at a slightly different pace. Your team will give you clear guidance for each stage.
The first few days
Nurses check the colour, warmth and blood flow of the flap very often, especially in the first day or two. You will have drains, and you will be kept warm and well hydrated to help blood flow.
Going home
You will walk slightly bent forward at first because the tummy feels tight. Avoid lifting, pushing or pulling anything heavy, and follow the advice on wearing a support garment.
The weeks that follow
Most women slowly return to everyday tasks over several weeks. Driving, desk work and gentle exercise usually come back before heavy housework or lifting children.
Commonly believed
What people assume about DIEP flaps
A DIEP flap is just a cosmetic tummy tuck.
It is major reconstructive surgery with microsurgery, not a cosmetic procedure.
A rebuilt breast hides cancer coming back.
Reconstruction does not usually stop doctors checking for or finding a recurrence.
It feels exactly like the old breast.
It feels soft and natural, but sensation is usually reduced.
Any woman can have it, whatever her build.
You need enough tummy tissue, so very slim women may not be suitable.
Questions we are asked
Common questions about DIEP flap reconstruction
Am I too thin for a DIEP flap?
You need enough lower tummy fat to build a breast of the size you want. Women who are very slim, or who want a larger breast than their tummy can provide, may not be suitable. Your surgeon may suggest a different donor area, such as the thigh or buttock, or a combination with fat grafting.
Can I have a DIEP flap if I need radiotherapy?
Often yes. Own-tissue flaps generally cope with radiotherapy better than implants. Some teams prefer to wait until radiotherapy is finished before building the flap, so it is not affected by the treatment. Your breast surgeon, oncologist and reconstructive surgeon will plan the timing together.
Will I have a flat tummy afterwards?
The tummy is usually flatter and tighter, a bit like after a tummy tuck, but it will not necessarily be perfectly flat. You will have a long scar low across the tummy. Some women notice a bulge or weakness later, and your surgeon can explain how likely that is for you.
Can I get pregnant after a DIEP flap?
Pregnancy is possible, but it stretches the repaired tummy and may affect its shape. Some surgeons suggest waiting until you have finished having children before a tummy flap. If future pregnancy matters to you, raise it early so your team can discuss other options.
Does smoking matter?
Yes, a great deal. Smoking narrows small blood vessels and raises the risk of flap failure, wound breakdown and poor healing. Most surgeons ask you to stop all tobacco, including chewing tobacco, several weeks before and after surgery. Ask your team for help to stop.
Can both breasts be rebuilt with a DIEP flap?
Yes. The tummy tissue can be divided into two halves, one for each side. The operation takes longer and each breast may be a little smaller. If you are having both breasts removed, your surgeon will check whether you have enough tissue for two flaps.
How will my new breast be checked for cancer later?
You will still have regular follow-up. Doctors examine the reconstructed breast and chest wall, and scans are arranged if something new is felt. Tell your team about any lump, but remember that firm areas of fat can form in a flap and are often harmless.
How soon can I go back to work?
It depends on your job. Many women with desk jobs return after about six to eight weeks. Work that involves lifting, bending or heavy physical effort usually needs longer. Your surgeon will guide you, and a gradual return with lighter duties often helps.
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Sources
- American Cancer Society — Breast reconstruction using your own tissue
- Breast Cancer Now — Breast reconstruction
- Cancer Research UK — Breast reconstruction
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