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What is DIEP Flap Breast Reconstruction?

DIEP flap (Deep Inferior Epigastric Artery Perforator) reconstruction surgery is an ideal option for breast reconstruction because it can produce very natural results using your own tissue. Skin, tissue, fat, and blood vessels are taken from the abdomen and shaped into a breast mound that best fits the shape and size you desire. Unlike other breast reconstruction procedures, DIEP flap does not require implants and does not require removing muscle from the donor site.

Dr. Ergun Kocak, Dr. Pankaj Tiwari and Dr. Santosh Kale are considered the top board-certified plastic surgeons in Ohio. They have over 20 years of combined microsurgery experience and perform more than 250 successful breast reconstructions each year.

Insurance Coverage and Cost

DIEP flap reconstruction in Columbus, Ohio, is covered by all health insurance providers under the Women’s Health and Cancer Rights Act of 1998.

This typically includes all associated pre-op appointments and aftercare. Contact us to learn more about the overall process and next steps.

Who is an Ideal Candidate for Flap Surgery?

Most patients are suitable candidates for DIEP flap breast reconstruction. Previous abdominal surgeries, such as a hysterectomy and C-section, are typically not an issue. However, some operations, including tummy tuck and hernia repair with mesh, can be limiting.

Other factors, such as smoking and excessive body weight, may pose challenges but are not considered absolute contraindications to surgery. For patients who do not have an adequate amount of tissue on the lower abdomen, other perforator-based flaps (such as the GAP, TUG, or PAP flap) or breast implants are alternative options.

DIEP Flap Reconstruction vs. Other Techniques

The DIEP flap procedure is only one of several reconstructive options. Here are some key differences to help you decide which technique is appropriate for you.

DIEP Flap vs. Other Flap Techniques

Compared to other flap methods, reconstructed breasts made from a DIEP flap end up feeling and looking more natural due to the presence of fat and absence of muscle in the replacement of breast tissue.

DIEP Flap vs. Implant Technique

Saline or silicone breast implants are an option for women who do not have much body fat present in the abdomen. They are also the preferred breast reconstruction method if you wish to have immediate reconstruction but still require follow-up cancer treatments such as chemotherapy.

DIEP Flap vs. TRAM Flap

While DIEP flap uses only skin and fat from the lower abdomen, TRAM flap uses skin, fat, and abdominal muscle with either a pedicle flap, which leaves some muscle attached, or a free flap, which fully cuts and detaches the muscle. While a pedicle flap is typically a quicker operation than a DIEP flap, DIEP flap reconstruction surgery is generally preferred because it spares muscle.

DIEP Flap vs. Gluteal Artery Perforator Flap (GAP Flaps)

While DIEP flap surgery offers many benefits, it may not be ideal for patients who have inadequate fat and tissue in the abdominal area or have had certain types of abdominal surgery. In this case, GAP flaps, which take tissue from the buttocks area, may be a better choice.

DIEP Flap vs. Profunda Artery Perforator Free Flap (PAP Flaps)

PAP flaps use tissue from the upper thighs. This area will generally yield smaller flaps, preventing its widespread use and making DIEP flaps a preferred alternative.

DIEP Flap vs. Transverse Upper Gracilis Flaps (TUG Flaps)

The TUG flap uses skin, fat, and a small portion of muscle from the upper inner thigh. It can be difficult to get a large flap from this area and may lead to issues with wound healing due to its proximity near the groin crease. Conversely, the DIEP flap spares the muscle and causes less pain.

What to Expect With DIEP Flap Reconstruction Surgery

Here’s what patients undergoing DIEP flap breast reconstruction can expect:

  • DIEP flap reconstructions are performed under general anesthesia and take around 6-8 hours to complete.
  • First, skin and fat tissue with active blood vessels are taken from the abdomen.
  • The blood vessels are often contained in a pedicle and are reattached to blood vessels on the chest with the help of microsurgery to enable natural blood flow.
  • Once blood flow is restored to the flap, it is reshaped accordingly and attached with dissolvable sutures around its perimeter.
  • Nipple and areola reconstruction follows as requested.
  • The surgeon will then close the donor area, tightening the abdominal skin and then closing the incision with dissolvable sutures.

DIEP Flap Recovery Timeline

Here’s what you can expect with DIEP flap recovery week by week:

Immediately After DIEP Flap

You will wake up with a surgical bra and a compression garment on your midsection. Drains will be placed to remove fluid buildup. DIEP flap reconstruction requires a 3-4 day stay in the hospital, and you may return home once cleared by your doctor.

First Week After DIEP Flap

 You may experience a moderate level of pain, swelling, and bruising. Walking is encouraged to promote blood flow. Avoid long showers until the end of the first week.

2-3 Weeks After DIEP Flap 

Pain and discomfort will begin to improve. You can start light activities but should avoid lifting arms overhead. You may resume driving and work.

4-6 Weeks After DIEP Flap

Swelling and bruising continue to go down. You may return to work if it is not physically demanding. More strenuous physical activities such as the gym or heavy lifting may continue after 4-6 weeks, or when you are allowed to by your physician.

2-3 Months After DIEP Flap

You need to wear your compression garments until swelling and bruising go down to a manageable level, usually after 6-8 weeks. Sensation may start returning to the breast.

It can take up to a full year for your breasts to completely settle into their final shape and position.


If you follow your post-op instructions, your scars will fade into thin white lines over 6-8 weeks, easily hidden beneath your underwear. You will find a new sense of balance and confidence thanks to your reconstructed chest, as well as a thinner and slimmer midsection due to the removal of fat and skin.

Frequently Asked Questions

1. Is DIEP Flap the same as Tummy Tuck?

No. However, the DIEP flap is usually taken from the same areas a tummy tuck would also affect, resulting in a smaller and firmer midsection in addition to reconstructed breasts.

2. What if breast cancer returns after I had undergone breast reconstruction surgery?

Your surgeon will recommend that the flap be removed and reattached at a later time, so that you may undergo chemotherapy to remove any traces of cancer.

According to research, however, DIEP flap procedures are not linked to a higher cancer recurrence rate compared to mastectomy alone.

3. Can breast reconstruction restore sensation to the breasts?

DIEP flap reconstruction can, but the procedure is highly technical and intensive to perform.

*The information available on this page was created to educate our patients. It is not an alternative for a formal consultation with a board-certified plastic and reconstructive surgeon. Individual results vary per patient. For more information, we strongly recommend scheduling a consultation with our doctors.