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DIEP Flap Reconstruction

Breast reconstruction using your own tissue without the use of implants is called autologous (referring to your own tissue) flap surgery. An autologous flap procedure uses a combination of skin, fat, and/or muscle that is moved from areas such as your abdomen, upper back, upper hip, or buttocks to the chest where it is shaped into a new breast. Not every woman is a candidate for this type of breast reconstruction, and it is best to discuss the pros and cons of these procedures with your surgeon.

DIEP (deep inferior epigastric perforators) flap surgery is a cutting-edge breast reconstruction procedure that uses a flap of complete tissue - blood vessels (perforators), skin and fat - from a woman’s lower abdomen as donor tissue. The flap is then transferred to the chest where the surgeon, aided by a microscope, will attach the donor tissue blood vessels to the chest blood vessels and reconstruct the breast. This delicate procedure provides significant benefits, such as a slimmer appearance, a natural-looking breast, maintained core strength and a quick recovery.

DIEP flap breast reconstruction surgery is relatively new to the world of plastic surgery, and few health care facilities have the expertise necessary to perform the surgery safely. Yet due to its significant benefits, DIEP is quickly becoming known as the state-of-the-art choice for breast cancer patients. That’s why Brigham and Women’s Hospital (BWH), as one of the select few hospitals nationwide that offers DIEP flap surgery, is committed to educating patients about the procedure and offering its benefits to more and more women.

DIEP flap procedure is similar to the traditional TRAM (transverse rectus abdominus muscle) flap procedure. The TRAM procedure is preferable in some cases, but for other patients, there are unique advantages to choosing the DIEP procedure.

Both procedures harvest abdominal tissue, thereby giving the patient the benefit of a slimmer appearance. However, there is a difference in how each procedure treats the rectus abdominus (“six pack”) muscle when removing the abdominal tissue. The DIEP procedure keeps the muscle in place on the abdomen so that it may continue to perform its intended functions. By maintaining the viability of the abdominal muscle, the DIEP procedure helps to preserve abdominal strength, lessen the likelihood of a hernia and shorten recovery time.

After the DIEP flap has been taken from the abdomen, the dissected blood vessels from the belly tissue are then connected to the patient's chest blood vessels. Studies have shown that this aspect of the DIEP procedure, which requires a long period of delicate microsurgery, can lead to a better blood supply for the transplanted tissue, and thus, less fat necrosis (tissue damage). In the TRAM procedure, the harvested flap’s blood vessels are not severed, thereby maintaining the tissue’s connection to the original (belly tissue) blood supply.

Once the vessels have been attached, the surgeon works on shaping the breast. By only using the body’s own tissue, a very natural shape can be attained. Visit our patient before-and-after photos page to see the results of DIEP flap surgery at BWH.

Summary of benefits of DIEP flap reconstruction:

  • Minimizes loss of muscle function
  • Minimizes risk of abdominal hernia
  • Less post-operative pain
  • Quicker recovery
  • Flatter abdomen
  • Natural appearance

More Information

If you have further questions or would like to schedule a breast reconstruction consult, please contact us.

Breast Reconstruction Words To Know

  • Areola: Pigmented skin surrounding the nipple.
  • Breast augmentation: Also known as augmentation mammaplasty; breast enlargement by surgery.
  • Breast lift: Also known as mastopexy; surgery to lift the breasts.
  • Breast reduction: Reduction of breast size and breast lift by surgery.
  • Capsular contracture: A complication of breast implant surgery which occurs when scar tissue that normally forms around the implant tightens and squeezes the implant and becomes firm.
  • DIEP flap: Deep Inferior Epigastric perforator flap which takes tissue from the abdomen.
  • Donor site: An area of your body where the surgeon harvests skin, muscle and fat to reconstruct your breast – commonly located in less exposed areas of the body such as the back, abdomen or buttocks.
  • Flap techniques: Surgical techniques used to reposition your own skin, muscle and fat to reconstruct or cover your breast.
  • General anesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.
  • Grafting: A surgical technique to recreate your nipple and areola.
  • Intravenous sedation: Sedatives administered by injection into a vein to help you relax.
  • Latissimus dorsi flap technique: A surgical technique that uses muscle, fat and skin tunneled under the skin and tissue of a woman’s back to the reconstructed breast and remains attached to its donor site, leaving blood supply intact.
  • Local anesthesia: A drug injected directly to the site of an incision during an operation to relieve pain.
  • Mastectomy: The removal of the whole breast, typically to rid the body of cancer.
  • SGAP flap: Superior Gluteal Artery perforator flap which takes tissue from the buttock.
  • Tissue expansion: A surgical technique to stretch your own healthy tissue and create new skin to provide coverage for a breast implant.
  • TRAM flap: Also known as transverse rectus abdominus myocutaneous flap, a surgical technique that uses muscle, fat and skin from your own abdomen to reconstruct the breast.
  • Transaxillary incision: An incision made in the underarm area.


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