DIEP (Deep Inferior Epigastric Perforator) Flap Breast Reconstruction

The DIEP flap procedure is the most advanced form of breast reconstruction surgery available today. It is the preferred reconstructive technique performed in our practice. The surgery uses the patient's own abdominal tissue to reconstruct a natural, soft breast after mastectomy without sacrificing any abdominal muscle.

The DIEP flap is similar to the muscle-sparing free TRAM Flap except that all the abdominal muscle is preserved. Only abdominal skin and fat are removed. The blood vessels ("perforators") required to keep the 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.

After the skin, tissues and perforators (collectively known as the "flap") have been dissected, the tissue is transplanted and connected to the patient's chest using microsurgery. The surgeons then shape the tissue to create the new breast. As all abdominal muscle is preserved patients experience less pain after the surgery, enjoy a faster recovery and maintain their abdominal strength long-term.

Sometimes all the lower abdominal tissue is needed to reconstruct one breast. Occasionally this cannot be performed as a single flap (eg due to a previous midline abdominal scar). This requires the tissue to be transplanted as 2 separate flaps which are then reconnected at the chest site using microsurgery. This technique is known as the stacked DIEP flap procedure.

Many women who undergo this operation enjoy the added benefit of a flatter abdomen with results that mimic a “tummy tuck” procedure. The risk of abdominal complications such as bulging and hernia is also very small, much smaller than with the TRAM method of breast reconstruction.

The DIEP flap is the most common method of breast reconstruction performed by our surgeons. There are many doctors in the United States performing reconstructive breast surgery, however only about 40 US plastic surgeons routinely perform the DIEP procedure due to the technical difficulty of the surgery.

Most reconstructive breast surgery practices perform only 10-20 microsurgical reconstructions each year. To date, our surgeons have performed over 2500 microsurgical breast procedures and typically perform over 450 DIEP flap surgeries each year. Our success rate is over 99%. We are in-network for most major US insurance carriers and do not balance bill.

Unlike many practices, we use two microsurgeons on every DIEP flap 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 Plastic Surgery 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 have treated patients from all over the US as well as from several countries across the world and have built tremendous reputations for breast reconstruction excellence:

"For me, arriving at the decision to do a DIEP flap reconstruction was simple. The key was finding the perfect surgeon for the task. Being from New York, I was concentrating at first on the surgeons in my area, until I learned that it was the PRMA group who performed the majority of this type of reconstruction in the US; almost 1 per day during a calendar year. I knew that this was the group I wanted to perform my second mastectomy, remove my silicone implant and do a bilateral DIEP flap reconstruction; someone who sees this and does this every day.....I always say, “You can make it work.” Thanks to all of you at PRMA for helping me make it work. I am forever grateful." Sue Meringolo, New York, NY.

To learn more about DIEP breast reconstruction please visit our frequently asked questions page.

Please visit our Gallery to view DIEP flap before and after photos.

If you are considering reconstructive breast surgery and would like to schedule a consultation with one of our surgeons please contact our office today.