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What is DIEP Flap Surgery & is it Suitable for Me?

What is DIEP Flap Surgery & is it Suitable for Me?

If you have undergone or are due to undergo a mastectomy, you face a difficult and extremely personal choice when it comes to reconstruction.

DIEP flap breast reconstruction is a popular option as it delivers natural results, utilising the patient’s own tissue from the abdomen, without being too invasive. No muscle tissue is taken from the abdomen, which means fewer complications, lower risk, and faster healing times.

In this guide, we will take you through all you need to know about DIEP flap surgery and answer some frequently asked questions.

Click on a link to jump to that section:

Read about the DIEP flap breast reconstruction and the benefits of choosing this option.

Find out how long DIEP flap surgery takes and what to expect during the procedure.

A guide to the potential risks involved with DIEP flap surgery.

Find out more about the recovery process after having DIEP flap surgery, including what to expect and how long you can expect to recover.

Find out if you are an ideal patient for DIEP flap breast reconstruction.

What is DIEP flap surgery?

A DIEP (Deep Inferior Epigastric Perforator) flap, is a piece of tissue – of just skin and fat – that is taken from the abdomen, which is then used to reconstruct the breast mound following a mastectomy.

As no muscle tissue is taken from the abdomen, the DEIP flap surgery enables patients to retain more strength in their abdomen. Other benefits include:

Reduced Risk of Hernia

With the muscle integrity of the abdomen intact, there is a reduced risk of an organ pushing through weak muscle, causing a hernia.

Shorter Recovery Time

As no abdominal muscle is removed, patients often experience less post-operative pain and shorter recovery time than other flap procedures.

Uses Your Own Tissue

The breast reconstruction will look more natural as it is made using your own tissue, as opposed to implants.

What to expect when having DIEP flap surgery

DIEP flap surgery is a major procedure that’s performed under general anaesthetic and takes anywhere between 3 – 9 hours depending on whether it is being carried out with a mastectomy or if one or both breasts are being reconstructed. Stephen McCulley usually takes 3-4 hours to perform this surgery.

Your surgeon will start by making an incision along your bikini line, and a flap of skin, fat, and blood vessels will be removed from your lower abdomen. This flap of tissue will be used to create a natural breast shape. For this to be achieved, the blood supply of the flap will be connected to the tiny blood vessels behind the chest wall or under the armpit, using a microscope.

The incisions of your new breast(s) and abdomen will be closed with stitches, and you’ll be moved to the recovery room where your vitals will be monitored. A hospital stay of two to five days is usually required before discharge.

What are the risks involved with DIEP flap surgery?

As with all operations, DIEP flap surgery comes with the risk of bleeding, infection, and the side effects of anaesthesia. Other complications associated with DIEP flap surgery include:

Tissue Rejection

1-2 of every 100 people who undergo the DIEP flap procedure will develop tissue necrosis (source), which is death of the tissue due to blood supply issues, which can result in failure of the entire flap. If this occurs, your Plastic surgeon will remove the dead tissue, and another form of reconstruction can be attempted again in 6-12 months.


If the fat in the breast tissue isn’t getting a sufficient blood supply, necrosis occurs replacing the fat with firm scar tissue, which feels like a lump. They are usually not noticeable until 6-8 months post-surgery and can be uncomfortable, so if they don’t go away on their own and is painful, it’s advised they be surgically removed, although this can be done with Liposuction.

Fluid Buildup

There may be a buildup of excess fluid or blood in the breast, which may require draining.


There will be scarring around your breasts and belly button area. The abdominal scar is likely to be hidden by your bikini line; however, keloid tissue or overgrown scar tissue may develop in some cases.

Blood Supply Issues

Around 1 in 10 DIEP surgery patients will have problems with sufficient blood supply in the first few days after the procedure. This requires immediate surgical intervention.

Loss of Sensation

Some women do recover some sensation in the breast after DIEP surgery, but many do not.

Hernia at Donor Site

With any abdominal surgery there is a risk of hernia, but it’s low in DIEP flap surgery, as no muscle tissue is harvested, unlike in TRAM flap reconstruction.

If you are considering DIEP flap surgery, it is therefore important to have the procedure performed by an experienced plastic surgeon with extensive training in microsurgery and breast reconstruction surgery.

Is DIEP Flap surgery suitable for me?

DIEP flap surgery is an extremely popular breast reconstruction option as it produces natural results and doesn’t take any muscle tissue. However, it’s not suitable for everyone, but it is a good option for you if:

– You have sufficient spare tissue around the abdomen, which has a good blood supply.

– You’re within the suitable weight range as those that are too thin or significantly overweight may not be eligible.

– You have no serious health issues or complications.

– You haven’t already had certain abdominal surgeries, including a colostomy or tummy tuck.

– You want a natural reconstructed breast, which is difficult to achieve with breast implants.

You can read about the different options for breast reconstruction here.

How long does it take to recover from DIEP flap surgery?

Following the procedure and your discharge from the hospital, your doctor will give you instructions to care for your dressings, stitches, and any surgical drains. Plus, you will also be advised on what you can do to aid your recovery, such as any physiotherapy exercises and massage techniques to increase skin suppleness in the scar tissue.

You must take time to heal, leaving between 6 to 8 weeks before you resume normal activities, lifting heavy objects, and strenuous exercises. It can take up to a year for the tissues to completely heal and for scars to fade. You may decide to have further procedures in the future, such as reconstructing a nipple or reshaping the flap.

Stephen McCulley is a specialist in the treatment of breast cancer and breast reconstruction, receiving recognition worldwide in this field. He set up his private practice in Nottingham in 2002, where he works with an exceptional team of anaesthetists specialist nurses, and secretarial support, for a reassuring treatment journey.

Stephen believes in an honest approach to consultation, offering realistic expectations to his DIEP Flap patients. If you want to find out more about DIEP Flap surgery or book yourself in for a consultation, you can contact Stephen McCulley’s private practice by emailing You can also call the clinic on 0115 962 4535.


How will I feel after breast reconstruction?

You’re likely to feel tired and sore for a few weeks following DIEP flap reconstruction surgery, but your doctor will prescribe medication to manage discomfort. In the few days after surgery, you may have drainage tubes in place at the surgical site to remove excess fluids, which can feel uncomfortable.

Is DIEP surgery safe?

As with any surgery, there are risks of infection and bleeding, but other potential risks are rare. Experienced surgeons – like Stephen McCulley – have a 99% success rate with DIEP flap surgery.

How soon can I drive after DIEP flap surgery?

Doctors advise that you do not drive for 6 to 8 weeks following your surgery. Before you start driving again, you should check with your surgeon that it is safe to do so and check you’re covered by your insurance provider.

What body changes should I expect after the surgery?

You will experience some swelling and bruising in the surgical sites following the DIEP flap procedure, which can take up to 8 weeks to go away. Patience is important, as it may take for as long as a year from the tissues to heal fully, for the breasts to settle, and for the scars to fade. Your scars will never go away completely, but the abdomen scar will be hidden on your bikini line.

How long is the hospital stay after DIEP surgery?

Usually, the hospital stay is only between 2 and 5 days.

How painful is DIEP flap surgery?

The pain from DIEP surgery is often significantly less than people may think. As with all abdominal surgery, you will find it painful to sit, but as no muscle tissue is harvested, the pain should be easing significantly within a few weeks. Your doctor can advise and prescribe medication to manage the pain if required.

How long after chemotherapy can DIEP flap reconstruction be done?

It’s recommended that you wait for four to six weeks after the completion of chemotherapy treatment to allow the body time to heal.

You can read more about DIEP flap procedure here.