DIEP Flap Breast Reconstruction in Washington, DC
DIEP flap reconstruction rebuilds a breast after mastectomy using your own skin and fat from the lower abdomen, without taking the abdominal muscle. The tissue is moved to the chest and its blood vessels are reconnected under a microscope, so the new breast is living tissue that looks and feels natural. It can be done at the same time as a mastectomy or later.
“Most women who come to talk about a DIEP flap have already been through a great deal. My first job is to slow things down, explain every option, and help her choose the one that fits her body and her life, not the one that sounds most advanced.”
— Dr. Samir S. Rao, board-certified plastic surgeon at Center for Plastic Surgery
Below is how the procedure works, who it suits, what recovery is really like, and how it compares with the other reconstruction options at Center for Plastic Surgery. You can also see real patients' results in our DIEP flap photo gallery.
In This Article
What Is a DIEP Flap?
DIEP stands for deep inferior epigastric perforator, the small blood vessels in the lower abdomen that keep the transferred tissue alive. Our DIEP flap page describes it as "an autologous breast reconstruction technique utilizing the patient's own tissue while sparing the muscle."
The surgeon makes an incision from hip to hip, lifts the skin, fat and blood vessels from the lower abdomen, moves that tissue to the chest to shape the new breast, and then reconnects its blood vessels using microsurgery. Because the abdominal muscles stay in place, there is less risk of weakened abdominal muscles than with techniques that move muscle. Closing the abdomen also flattens it, similar to a tummy tuck.
It is a long operation. Breastcancer.org puts it at "four to six hours or more," and it is followed by a hospital stay.
“The microsurgery is what makes a DIEP flap possible. We're moving living tissue, so the blood supply we reconnect in the chest is what keeps the new breast healthy for the long term.”
Who Is a Good Candidate?
The main requirement is enough lower-belly tissue to build a breast of the size you want. A DIEP flap may suit you if you:
Want to avoid implants: the new breast is made entirely of your own tissue.
Have enough abdominal tissue: the belly is the donor site, so there has to be enough skin and fat to work with.
Haven't had certain abdominal surgeries: our DIEP page notes that women who have had a previous procedure such as a tummy tuck are not candidates. Some other abdominal surgeries can also rule it out. Many people can still have a DIEP flap after a C-section, according to Cleveland Clinic.
Don't smoke, or can stop: smoking "increases the risk of serious surgical complications, including flap failure" (Breastcancer.org).
Are healthy enough for a long operation: heart or lung conditions can be a reason to choose a shorter procedure.
One more point matters for planning: a DIEP flap can only be done once. If more reconstruction is needed later, tissue has to come from another part of the body.
“If a woman doesn't have enough tissue on her abdomen, or she's had surgery there before, that isn't the end of the conversation. We have other places to borrow tissue from, and implants are still a very good option for many women.”
DIEP Flap vs. Other Reconstruction Options
Center for Plastic Surgery offers both reconstruction with your own tissue and implant-based reconstruction. The main difference between the flap techniques is where the tissue comes from:
| Tissue comes from | Muscle used? | Often suits | |
|---|---|---|---|
| DIEP flap | Lower abdomen | No | Enough belly tissue, no prior tummy tuck |
| SIEA flap | Lower abdomen (different, superficial vessels) | No | Same as DIEP, when the vessels are large enough |
| MS TRAM flap | Lower abdomen | A small amount | Enough belly tissue |
| TUG/DUG flap | Inner thigh | Small part of a thigh muscle | Not enough belly tissue; small to medium breasts |
| Latissimus flap | Upper back | Yes | Not enough belly tissue, or a second reconstruction |
| TDAP flap | Upper back | No | Adding volume after radiation or an earlier reconstruction |
| Implants | Saline or silicone implant, often after a tissue expander | No | Most women, except after failed implant reconstruction or prior chest radiation |
The trade-off is broadly this. Reconstruction with your own tissue is a bigger operation with a longer first recovery, and it leaves a scar where the tissue was taken. Implant reconstruction is a shorter operation, but an implant is a device that may need attention later. Breastcancer.org also notes "a higher overall risk of complications with DIEP flap surgery than implant reconstruction."
“There isn't one best reconstruction. A DIEP flap can give a very natural result, but it's a bigger operation. For some women, a quicker recovery matters more, and that's a completely reasonable choice.”
Should Reconstruction Happen at the Time of Mastectomy?
It can, but it doesn't have to. Our DIEP page notes that it "can be performed on the same day as a mastectomy, or at a later time." The American Society of Plastic Surgeons says reconstruction "can either begin at the time of mastectomy or be delayed until a later date," and that it "often involves multiple procedures performed in stages."
The timing usually depends on your cancer treatment plan, especially whether radiation is expected, and on what you're ready for.
“Some women want to wake up from their mastectomy with a breast. Others need to finish treatment first and come back when they're ready. Both are good choices, and we plan around the cancer team's timeline.”
How Painful Is DIEP Flap Recovery?
Expect swelling, bruising and soreness in both the breast and the abdomen, which our DIEP page describes as a normal part of recovery. Discomfort is managed with medication and eases over the first weeks. A typical recovery looks like this:
In the hospital: a stay of a few days while the team checks the new breast closely. Your surgeon may prescribe a blood thinner for 5 to 10 days to help prevent clots (Breastcancer.org).
Weeks 1–3 at home: rest, follow your post-op instructions closely, and avoid heavy lifting. Drains in the chest and abdomen are usually removed two to four weeks after surgery (Breastcancer.org).
Weeks 4–6: daily activity returns gradually. Our DIEP page asks patients to avoid strenuous exercise for four to six weeks.
6–8 weeks: most initial recovery is complete. Recovery "can take from 6 to 8 weeks," according to Breastcancer.org.
Up to a year: tissue keeps settling, and it "can take as long as a year or more for your tissue to completely heal and for your scars to fade."
Everyone heals differently, so stick with your surgeon's timeline.
“I tell patients to plan for real help at home for the first couple of weeks. The ones who let other people carry things, drive and cook usually feel better sooner.”
What Are the Risks?
A DIEP flap is major surgery, and it carries real risks. Complications aren't common, but they include:
Fat necrosis: areas where part of the fat doesn't get enough blood and becomes a firm lump of scar tissue.
Flap loss: rarely, the reconnected blood vessels fail and some or all of the transferred tissue doesn't survive. Cleveland Clinic reports success rates "between 96% and 99%."
Hernia or bulging at the abdominal donor site.
Numbness and changes in sensation in the chest and abdomen. Some feeling may return over time.
Scars: a horizontal scar from hip to hip, plus scars on the breast.
More surgery: many women have later procedures to refine the shape or reconstruct the nipple and areola.
“Every operation has risks, and I want patients to hear them plainly before they decide. We choose this procedure together, knowing both the benefits and the trade-offs.”
What Do the Results Look Like?
A DIEP flap creates a breast made of soft, living tissue. Our DIEP page says "the breast should look similar to the natural breast and any visible scarring should continue to fade with time." Patients can also talk with their surgeon about recreating the nipple and areola once they have fully healed. See nipple and areola reconstruction.
The best way to understand the results is to look at them. Our DIEP flap gallery shows real CPS patients, and our breast reconstruction gallery includes other techniques. You can also hear women describe their experience in their own words on our patient stories page.
“The early result isn't the final result. The breast softens and settles for months, and scars keep fading. I'd rather patients judge it at a year than at a few weeks.”
Frequently Asked Questions
Is a DIEP flap a major surgery?
Yes. It typically takes several hours, involves microsurgery, and is followed by a hospital stay of a few days. Initial recovery usually takes six to eight weeks. It is a bigger operation than implant reconstruction, which is why your health, your timing and your priorities all factor into the decision at your consultation.
Is a DIEP flap better than implants?
Neither is better for everyone. A DIEP flap uses your own tissue and avoids an implant, but it is a longer operation with a longer first recovery and a donor-site scar. Implant reconstruction is shorter, but the implant is a device that may need attention later. Your surgeon can help you compare the two for your body and treatment plan.
Can I have a DIEP flap after a tummy tuck?
Usually not. A tummy tuck removes the lower abdominal tissue a DIEP flap would use, and our DIEP page notes that women who have had one are not candidates. Tissue from the thigh or back, or implant reconstruction, may be options instead.
Will my reconstructed breast have feeling?
It may have some. Numbness in the chest and abdomen is normal after surgery, and some sensation can return over time, but it usually isn't the same as before. Ask your surgeon what to expect in your case.
Will insurance cover DIEP flap reconstruction?
A federal law, the Women's Health and Cancer Rights Act of 1998, requires certain health plans that pay for a mastectomy to also cover breast reconstruction (Breastcancer.org). Coverage still depends on your specific plan, so confirm the details with your insurer.
DIEP Flap Breast Reconstruction in Washington, DC
If you're facing a mastectomy, or you've had one and are thinking about reconstruction now, a DIEP flap may be worth discussing. Dr. Samir S. Rao and our board-certified plastic surgeons can examine your tissue, talk through your treatment timeline, and explain whether a DIEP flap, another flap, implants, or a combination is the best fit.
Center for Plastic Surgery welcomes patients from Washington, DC, Chevy Chase, Bethesda, Arlington, Fairfax, and surrounding areas, with offices in Chevy Chase, Maryland and Tysons Corner, Virginia.
Chevy Chase: (301) 652-7700 Tysons Corner: (703) 560-2850
For information on cost and financing, visit our pricing page.
About the Author
October 8, 2026