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The DIEP flap procedure vs implants which option is ideal for me

The DIEP flap procedure vs implants which option is ideal for me

Choosing a breast reconstruction procedure after a mastectomy can be a difficult decision. Both breast implants and flap reconstruction procedures can produce excellent cosmetic results, but both also have their strengths and weaknesses. It’s important to thoroughly research and understand each procedure before making a decision on something which will have such a lasting impact on your body and physical health. In this section, we’ll discuss the differences between breast implants and DIEP flap reconstruction, two of the most popular forms of breast reconstruction surgery for post-mastectomy patients. We’ll also take a look at which procedure is most suitable for which candidates, and answer some of the most commonly asked questions about breast reconstructive surgery.

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Find out what occurs during this popular procedure and the pros and drawbacks of having breast implant surgery.

Read how DIEP flap surgery differs from implant surgery, and the pros and cons associated with this procedure.

Find out how to determine which option of breast reconstruction would be better for you, depending on your body type and preferences.

Frequently asked questions on choosing an option of breast reconstruction.

What is implant surgery?

Implant surgery is the most common procedure for reconstructing breast tissue after a mastectomy. A breast implant is a prosthesis used to change the size, shape, and contour of a person’s breast. Several different types of breast implants are suitable for use after mastectomies, including saline implants and silicone implants. There are a number of reasons why women might opt for implants. The recovery from surgery is usually much quicker in the case of implants than it is for flap surgery, and implant surgery creates no additional scars on the patient’s body except for those on the breasts.

Implants can be a good choice for patients without excess fatty tissue who don’t require radiation treatment. However, there are drawbacks to implant surgery. Many patients do not like the idea of foreign tissue being implanted into their breasts, and breast implants outcomes tend to deteriorate over time and are not permanent, which means further surgeries are inevitable for many. Breast implants can also rupture over time or occasionally following a strong impact, and there is a risk of capsular contracture or hardening of the breast. Additionally, breast implants stay the same size regardless of what happens to a woman’s body, which means significant weight gain or loss can create an asymmetry. Implant surgery can hurt and usually leaves patients feeling sore for a week or two after the procedure. However, the recovery time is shorter than for flap procedures, and most patients will be fully recovered within six to eight weeks.

You can read more about breast implant surgery here.

What is DIEP flap surgery?

Flap reconstruction makes use of a woman’s own tissues – including skin, fat, and sometimes muscle (MS-TRAM)- to reconstruct the breast. DIEP flap surgery is a new and improved version of the TRAM flap procedure and involves using fat from a woman’s tummy area (sometimes giving the benefits of a tummy tuck at the same time). It’s a more technically difficult procedure and therefore only offered by very qualified and experienced surgeons.

You can find out more about DIEP flap surgery here.

One of the biggest advantages of DIEP flap surgery is the natural appearance and feel of the breast post-surgery when compared to implants, which can often feel cool to the touch. DIEP flap surgery is also natural, using only a woman’s own tissues. After DIEP flap surgery, your reconstructed breast will appear more like a natural breast. One of the drawbacks of DIEP flap surgery is that a scar will be left on the tummy at the site where the tissue was taken. There is also a higher rate of complications, including wound infections, blood clots and pneumonia, following flap surgery than following breast implants, and the recovery time is a little longer. As is the case with breast implants, DIEP reconstruction can cause pain and soreness following the procedure, although in this case in two sites rather than one. Patients will be up and walking three to four days after surgery, but full recovery can take up to three months.

Find out more about whether DIEP flap surgery is ideal for you in our guide Is DIEP flap surgery suitable for me?

How do I know which option is the most suitable for me?

Which option is most suitable for you will depend on both your priorities and your body type. In general, breast implants are a good choice for slimmer women who do not have enough belly fat for DIEP flap breast reconstruction and who don’t need to undergo radiation treatment or women who want to avoid incisions elsewhere in the body. DIEP flaps are a better choice for women who prioritise reconstructed breasts with a natural feel which will grow and change with their bodies. It is also more ideal for women who would rather avoid the use of foreign objects in their reconstructed breast. DIEP flap is also the best choice for patients keen to have sensory nerve reconstruction during the procedure.

Stephen McCulley is a specialist in the treatment of breast cancer and breast reconstruction, having achieved national and international recognition in this field. He is one of the few Consultants in the country that can offer both the cancer surgery and the full spectrum of breast reconstruction options. To get in touch, you can email Stephen McCulley at, or alternatively you can ring the surgery on 0115 962 4535.

Choosing a breast reconstruction procedure: FAQs

Are implants an option after DIEP flap surgery?

It’s very uncommon for most women to choose implants after DIEP flap surgery as the results of the latter procedure are often preferred. However, implants can be used sometimes to enlarge a DIEP flap result.

Can I be reconstructed at the same time as my mastectomy?

Yes, whether you choose to opt for breast implants or DIEP flap surgery, you can have this done at the same time as your mastectomy.

Why don’t more surgeons perform the DIEP and GAP flap procedures?

DIEP and GAP flap procedures are very tricky. The hardest part of the procedure is the anastomosis phase, which must be performed by an experienced Plastic surgeon qualified in microsurgery.

How long after chemotherapy or radiation therapy do I need to wait before reconstruction?

In many centres, doctors will recommend that women wait until radiation therapy is complete to undergo reconstruction. This is because radiation can cause post-surgery issues, including delayed healing and scarring, as well as lowering the success rate of the operation. However, it is feasible to perform reconstruction and particularly DIEP flap before radiotherapy. Stephen McCulley is an advocate of this.

Does anyone ever have a flap procedure on one breast and an implant on the other?

It’s possible, but the results of the two procedures are so different that this is inadvisable. The breast that has undergone a flap procedure will grow and develop with your body over time, while the breast with an implant will stay largely the same, which can lead to asymmetry in time.

How many procedures are involved in each type of reconstruction?

Both kinds of reconstruction can be completed in one single procedure, or two if the mastectomy and reconstruction are completed on separate occasions.

What are the possible complications of each type of breast reconstruction?

Both procedures come with risks. Common and rare implant reconstruction complications include implant displacement; symmastia, when implants join together in one pocket of tissue. Other possible complications are capsular contracture, when the tissue around the implant becomes hard and sore; implant rupture if the implant is impacted; and infection. Some possible complications of DIEP flap procedure include tissue breakdown or necrosis; lumps in the reconstructed breast; a hernia at the donor site; and infection.

Can you take out implants and have DIEP flap surgery?

Yes, it’s very common. Both the implants and any associated capsular contracture can be removed and replaced with natural fatty tissue. Nipple reconstruction can usually be successfully preserved, too.

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