DIEP Breast Reconstruction

What is DIEP Breast Reconstruction Surgery?

DIEP breast reconstruction (deep inferior epigastric perforator flap) is an advanced microsurgical technique that is used to rebuild the breast lost to mastectomy. Excess living fat from below the belly button is transplanted to the chest to give back volume and shape. This approach to breast reconstruction is gentler than and preferred over older breast reconstruction techniques known as TRAM and Latissimus flaps.

Our Center has been performing pioneering work with the DIEP procedure since 2003.

The APEX FlapSM procedure is our latest refinement and provides another level of sophistication to the options available to women facing mastectomy. While there are several choices when it comes to reconstructive breast surgery, DIEP breast reconstruction and the APEX FlapSM represent the most advanced surgical technology available in breast reconstruction. For women who are very thin, there are additional options, including the Stacked FLAPSM, BODY LIFT Flap®, SGAP Flap, and Hybrid Breast Reconstruction procedures. This collection of techniques provides a set of natural tissue reconstructive options for all body types.

When is DIEP Breast Reconstruction Surgery Used?

DIEP breast reconstruction is used to recreate a soft breast made entirely of living fat. In almost every case, the DIEP procedure can be done on the same day as mastectomy, which is known as “immediate reconstruction.” For women with a previous mastectomy, the DIEP may be performed at a separate time after a mastectomy. This is known as “delayed reconstruction.” Almost all women are candidates for immediate reconstruction, so speaking with your team prior to mastectomy about reconstruction is important. Occasionally, a “bridging implant” reconstruction is used before DIEP breast reconstruction to allow women with a more advanced disease requiring radiation treatment to benefit from skin sparing or nipple sparing mastectomy as well.

What are the Benefits of DIEP Breast Reconstruction Surgery?

There are several benefits of the DIEP breast reconstructive technique. Rebuilding the breast with soft, warm, living fat is permanent and doesn’t require maintenance or repeat surgery over time. For women who’ve undergone a mastectomy in the past, the DIEP procedure allows for the avoidance of tissue expanders.

Women who undergo the DIEP breast reconstruction also benefit from an improved abdominal shape, much like a “tummy tuck.” Using fat from unwanted areas of excess produces a flatter, tighter abdomen as a nice compliment to the newly reconstructed breast.

What are the benefits of DIEP vs. TRAM Flap breast reconstruction?

An important benefit of the DIEP over the TRAM Flap and other outdated procedures is that the muscle of the abdominal wall is protected and core strength is preserved. This allows avoidance of artificial mesh placement into the abdomen as well as preventing hernia and long-term abdominal weakness. To guarantee quality in the care that is used to avoid cutting the muscle, our Center developed the APEX FlapSM procedure that is used when more blood flow is needed to support the new fat. The ordinary DIEP can require muscle cutting to improve blood flow in the tissue in some situations. The surgeons at The Center For Restorative Breast Surgery shift to the APEX FlapSM in this situation to prevent muscle damage and improve the quality of the operation. This assures the maximum opportunity for a successful procedure, with preserved strength and long-term softness in the new breast. It is NEVER necessary to convert to a TRAM procedure for any reason.

We believe so firmly in this quality measure that digital imaging is used to document the perfect preservation of the muscle wall in the tummy during our procedures. This standard of care elevation is unique to The Center for Restorative Breast Surgery and gives reassurance to our patients that extreme care has been applied to the details of their procedure to provide for their long-term well-being.

What are the Risks of DIEP Breast Reconstruction Surgery?

As with any surgery, the risks of surgery can be minimized by carefully following your pre-surgical instructions. If you have other medical problems or factors that increase your risk, we will work with you to educate you on proper preparation and arrange your clinical care regimen to maximize your safety and proper recovery.

What should I expect prior to my DIEP Breast Reconstruction surgery?

In most cases, you will be seen in our office 1-2 days prior to your surgery. At that time, we will go over the planned procedure, review consents, answer any questions you may have, and apply any surgical planning markings as may be required.

What should I expect on the day of my DIEP Breast Reconstruction surgery?

When you arrive at the hospital, you will be escorted to the preoperative area where you will change into a gown and be given foot coverings. The nurse or anesthesiologist will start an IV so that fluids and necessary medications may be given to you. Family members will be allowed to visit with you in the preoperative area once you are prepared for surgery.

After your surgery is complete, you will awaken in the recovery room under warm blankets with a dedicated nursing attendant at your side. You will be carefully monitored and kept comfortable. You will then be transferred to a private inpatient room that is prepared to allow you to rest and recover under the supervision of your attending physician and nurses. One adult caregiver may stay with you overnight during your hospitalization. A fold-out Murphy bed has been integrated into your room for their individualized comfort.

Your procedure will be performed in a state-of-the-art operating suite that is part of a fully accredited hospital that has been recognized by the American College of Surgeons for Excellence in care quality. Highly trained professionals using the most modern equipment and techniques will attend to you. In addition to your surgeons, the surgical team includes anesthesiologists, operating room technicians, nurses, and physician assistants.

What should I expect during my recovery from DIEP Breast Reconstruction Surgery?

You will experience some changes that are quite common after surgery and may include:


Some mild swelling and bruising is to be expected after surgery and will gradually subside in a few weeks.


Some soreness is normal after surgery but we will provide medications to maximize your comfort and help speed your recovery. Intermittent muscle spasms and feelings of tightness are normal and will subside as your swelling resolves.


Scar lines tend to improve in appearance for up to a year and are usually faded by 12-18 months.


Some numbness in the skin is normal after surgery. Occasionally the recovery of sensory nerves can result in tingling, itching, or mild electrical sensations that come and go. These sensations will resolve over time and are usually accompanied by some return of feeling in the skin.

DIEP Breast Reconstruction Recovery Time

You may resume your normal activities as recommended by your surgeon. In most cases, avoidance of strenuous activity is recommended for 4-6 weeks. As a general rule, most patients can drive between 2-3 weeks after surgery if you are no longer using pain medication and your doctor has cleared you. You should maintain range of motion and gentle stretching is recommended for the shoulders beginning in the early weeks after your procedure. Your clinic team can provide specific instruction for a post-mastectomy range of motion exercises as applicable. Patients are generally released to return to full activities and work schedule between 4-6 weeks after surgery. Your clinic team will provide any necessary documentation for your employer.

Your Return Home

If you are traveling from out of state or internationally for care with us, your caregiver will need to be with you throughout your stay post-discharge and on the same flight home to assist you in the airport. Your caregiver’s education will be provided by our nursing staff during your time with us and our team is available to you and your assistant 24 hours/day should any questions arise after you are released from the hospital. Your arrangements for assistance after surgery should include an estimated week to ten days of availability from your caregiver.

We Are Here For You

Be reassured that you are being attended to by some of the most highly skilled and dedicated healthcare providers in the world. Do your best to relax knowing that we are going to take excellent care of you from the moment you enter our facility. Do not hesitate to ask for any special needs you may have.