The donor site: tummy scar, bulge and hernia risk

In a DIEP flap, and in the older TRAM flap, the surgeon takes skin and fat from the lower tummy to rebuild the breast. The place the tissue comes from is called the donor site. Once the tissue is lifted away, the remaining tummy skin is pulled down and stitched, rather like a tummy tuck. This leaves a long scar that runs low across the abdomen from one hip to the other, usually below the underwear line. The belly button is brought out through a new small opening, so there is a scar around it too. Most people find the tummy flatter than before, and many are pleased with that part of the result. There are, however, some problems that can happen at the donor site. The tummy often feels tight for several weeks, and you may need to walk slightly bent forward at first. Fluid can collect under the skin, small areas of the wound can be slow to heal, and the skin below the belly button often stays numb. A smaller number of people later notice a bulge, or develop a hernia, where the tummy wall is weaker than before. The chance of a bulge or hernia depends mostly on how much muscle and its covering layer were disturbed. A DIEP flap aims to leave the muscle in place, so this risk is usually lower than after a TRAM flap. Knowing what is normal, and which signs need a check, can make recovery far less worrying.

The scar is long but low

It usually sits across the lower tummy, where clothing covers it.

Tightness is expected at first

It eases gradually over the weeks after surgery as the tissues relax.

A bulge or hernia is less common

It is more likely when muscle is taken, as in a TRAM flap.

Surgeons explain the benefits of using your own tissue, and it is equally fair to know the trade-offs.

You gain a second wound

A flap means healing in two places at once, the breast and the tummy, and the tummy wound is often the more uncomfortable one in the first weeks.

The scar is permanent

It fades and flattens over a year or more, but it will not disappear, and it may sit slightly higher than a cosmetic tummy tuck scar.

What this page cannot tell you

It cannot tell you your own chance of a hernia or wound problem. That depends on your health, weight, previous tummy surgery and the exact technique, which your surgeon can assess.

Some swelling, bruising and tightness are expected. Contact your surgical team promptly if you notice any of the following, rather than waiting for your next appointment.

Signs of infection

Spreading redness, heat, increasing pain, pus or a bad smell from the wound, or a fever with chills.

A wound that opens

Any part of the scar that splits, looks dark or black at the edges, or keeps oozing fluid.

A new or growing swelling

A soft lump that keeps filling up, or a bulge that appears weeks or months later and gets bigger when you strain.

Sudden severe pain

A hard, painful, tender bulge that cannot be pushed back, especially with vomiting, needs urgent medical care because it can mean a trapped hernia.