DIEP Flap Breast Reconstruction (Deep Inferior Epigastric Perforator Flap)

The DIEP flap is the most advanced form of breast reconstruction available today. It is the preferred technique performed at PRMA.

The DIEP procedure uses the patient's own abdominal skin and fat to reconstruct a natural, warm, soft breast after mastectomy. Unlike the TRAM flap, the DIEP flap preserves all the abdominal muscles. Only abdominal skin and fat are removed similar to a "tummy tuck". Saving the abdominal muscles means patients experience less pain, enjoy a faster recovery, maintain their core strength long-term, and have a lower risk of complications. Dr Chrysopoulo discusses the differences between these two procedures in our DIEP flap video here.

The skin and fat below the belly button feels very similar to breast tissue. It is the perfect choice to replace the breast tissue removed by the mastectomy. The blood vessels ("perforators") that keep this skin and fat alive lie just beneath or within the abdominal muscle. A small incision is made in the abdominal muscle to access these vessels.

The prepared tissue ("flap") is then disconnected from the body and transplanted to the chest using microsurgery. The surgeons then shape the tissue to create the new breast.

Most patients are also candidates for sensory nerve reconstruction. This reconstructs the nerves that supply feeling and allows for improved long term sensation in the reconstructed breast.

Patients that have arm lymphedema as a result of previous breast cancer surgery may also be candidates for Vascularized Lymph Node Transfer in combination with the DIEP flap procedure. This involves the transplantation of healthy lymph nodes from the groin to the underarm area (axilla) to replace the lymph nodes removed or damaged by previous axillary surgery. The procedure helps restore lymphatic drainage of the arm and can significantly improve lymphedema.



Women also enjoy the added benefit of a flatter abdomen with results that mimic a “tummy tuck”. The risk of abdominal complications such as bulging and hernia is also very small, much smaller than with the TRAM flap.

Sometimes all the lower abdominal tissue is needed to reconstruct one breast. Occasionally this cannot be performed as a single flap. For example, the patient may have a previous midline abdominal scar or may be too thin. In these cases, the lower abdominal tissue can be transplanted as 2 separate flaps which are then reconnected on the chest using microsurgery to create one breast. This technique is known as the stacked DIEP flap procedure.

There are many reconstructive breast surgeons in the United States, however very few perform the DIEP procedure routinely due to the technical difficulty of the surgery. To date, our surgeons have performed thousands of microsurgical breast procedures and typically perform over 500 DIEP flap surgeries each year. Our success rate is over 99%. We are in-network for most US insurance carriers and do not balance bill.

A team of two microsurgeons performs every procedure. This ensures you benefit from the expertise of two specially trained surgeons and also significantly decreases the length of the surgery and anesthesia time.

PRMA is the only center in San Antonio, Texas and one of only a handful of centers worldwide to provide breast reconstruction on such a large scale. Our surgeons treat patients from across Texas and across the US, as well as international patients, and have built tremendous reputations for breast reconstruction excellence:

"For me, arriving at the decision to do a DIEP flap reconstruction was simple. Being from New York, I was concentrating at first on surgeons in my area, until I learned that it was PRMA that performed the majority of this type of reconstruction in the US... I knew this was the group I wanted to perform my reconstruction; someone who sees this and does this every day....." Sue M, New York, NY.

Watch our DIEP flap video to hear more patient experiences.

To learn if you are a DIEP flap candidate or to schedule a consultation, please contact us here or call us on (800) 692-5565.

DIEP flap photos (before and after pictures)

DIEP flap FAQs

DIEP flap insurance-related FAQs