DIEP Flap Reconstruction

DIEP flap breast reconstruction involves using skin and fat from your lower abdomen to recreate the breast following a mastectomy.

This technique uses the tissue along with its blood supply, which runs through the abdominal muscles and originates from the pelvis. Occasionally, a small portion of abdominal muscle may need to be included to ensure the tissue has a good blood supply - this is referred to as a muscle-sparing TRAM flap, and the need for this is determined by your individual anatomy. The operation typically takes between six and eight hours under general anaesthetic, and you can expect to stay in hospital for two to three nights afterwards.

Recovery takes time, and while most of the healing happens in the first six weeks, it can take around three months before you feel fully back to your usual activities. Scars, both internal and external, continue to mature over the following 18 to 24 months, and gradual improvements in the appearance and feel of the reconstructed breast are expected during that time.

Following the surgery, you will have a horizontal scar across your lower abdomen, usually stretching from hip to hip, and another scar around your belly button. On the breast itself, the scar pattern will vary depending on your previous surgery, and a patch of skin from your tummy will be used to replace the skin removed during the mastectomy. In rare cases, an additional scar across the shoulder may be necessary if other donor sites are not suitable.

Frequently Asked Questions

1How can I prepare for surgery?
This procedure is one not undertaken lightly and in order to reduce the risks of complications and optimise the outcome I recommend my patients have a BMI of 30 or less and are physically fit prior to surgery. Physical exercise such as pilates is helpful before surgery to strengthen your core which will aid a faster recovery.
2What about breast screening?
After a DIEP flap you will not have breast surveillance or screening on the reconstructed breast. The tissue here is from your tummy and it is not helpful to perform mammograms. If you have any lumpiness in the time after your reconstruction please talk to me about it and we may arrange a scan to check the tissue. If you find a lump some time after your surgery i.e. more than 3 months after surgery, I would recommend you see a breast surgeon and this can be arranged by calling your GP or Breast Care Nurse for an urgent review, or by letting me know.
3Where will my scars be?
This will be decided when you come to the clinic. You will be advised which placement is most appropriate for your goals. Implant registry – all implants are now recorded on a national database called the Breast and Cosmetic Implant Registry (BCIR). This is managed by NHS Digital and entry of your information onto the database is mandatory to allow you to be traced in the event of an issue with your type of implant in the future. For information on the Registry please click here.
4What are the risks of surgery?
These will be discussed in the clinic. Please note a specific cup size cannot be guaranteed but you can express a preference. In order to reduce your risk you can make sure you eat healthily, are a healthy weight, and stop smoking.
5Can this be done at the same time as a mastectomy?
Yes, this surgery can be performed at the same time as a mastectomy. It is called an immediate breast reconstruction. I will liaise with your breast surgeon, and we will perform the surgery together. We will discuss whether you are a candidate to keep your nipple areola complex (this depends on the type and position of your breast cancer) and breast skin and whether the breast size should be altered.
6What is the post-operative recovery?
Your wounds will usually be healed in 2 weeks. Occasionally areas can take up to 6 weeks to heal. You will need to wear your post-surgical bra day and night for 6 weeks.
7How long does a flap last?
Once your reconstruction has settled (after about 6 months) there will be small changes only. An advantage of using your own tissue to reconstruct the breast is that it will change with you over time although it will behave differently to your native breast. It does not require further surgery or exchange like an implant would, it does not pose any risk to you, and as you change weight it will change with you.
8Is this the right operation for me?
This may be the right operation for you if:
  • You want an increase in the size of your breasts
  • You have no objection to having silicone
  • You accept the long-term risks associated with breast implants such as rupture and BIA-ALCL
  • You understand that removing the implants in the future will result in residual loose skin
Not sure about breast augmentation? Consider Fat Transfer.
  • Surgical time – 6-8 hours
  • Anaesthetic type – General anaesthetic
  • Time off work – 1-2 weeks office work, 2-6 weeks manual work
  • Hospital stay – 2-3 nights
  • Shower – 72 hours after being discharged
  • Reasonably mobile – 2 days
  • Sleeping position – back or side
  • Exercise including gym – 6 weeks
  • Bras – front fastening post-op bra for 6 weeks day and night
  • Sexual activity – after 1-2 weeks when comfortable
  • Full recovery – 18 months 
  • Driving – 1-2 weeks
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