In clinical terms, a major surgery is any procedure that involves significant alteration of normal anatomy, typically requires general anesthesia, and often takes place in an operating room setting. These surgeries are more complex, may involve a longer recovery, and demand a higher level of surgical expertise.
DIEP flap breast reconstruction meets these clinical criteria. It involves microsurgically transferring skin and fat from the lower abdomen to recreate the breast after mastectomy without using implants. It also involves reconnecting tiny blood vessels under a microscope to ensure the transferred tissue survives. The procedure is technically advanced, requires specialized training, and typically lasts several hours.
However, it’s important to understand that “major” doesn’t have to mean “more dangerous.” At PRMA, every DIEP flap is performed by two highly-skilled San Antonio microsurgeons working together, reducing surgical time, minimizing risk, and improving outcomes. Our dual-surgeon approach, combined with over 30 years of experience and enhanced recovery protocols, means patients receive the highest level of safety and care.
DIEP flap surgery is considered a muscle-sparing, advanced form of breast reconstruction. It involves transplanting skin and fat from the lower abdomen to recreate the breast after mastectomy, without removing any abdominal muscle.
To perform the procedure, surgeons make a horizontal, football-shaped incision from hip to hip, usually positioned low on the abdomen (similar to a tummy tuck). Through this incision, they carefully harvest the tissue needed for the new breast, along with the tiny blood vessels that supply it.
Unlike older techniques like the TRAM flap, the DIEP flap preserves the abdominal muscles entirely. That’s a major advantage. By sparing the muscle, DIEP patients typically enjoy:
| Feature | DIEP Flap | TRAM Flap |
|---|---|---|
| Muscle used | None (muscle-sparing) | Uses part or all of the rectus muscle |
| Abdominal strength impact | minimal | Moderate to significant |
| Risk of hernia/bulge | Lower | Higher |
| Recovery time | Shorter | Longer |
| Aesthetic outcome | Natural look and feel | Natural, but higher complication risk |
DIEP flap breast reconstruction is not a procedure that just any plastic surgeon can perform. It’s a highly specialized microsurgical operation that requires advanced training, precision, and years of experience.
What makes DIEP surgery so unique is the need to dissect and reconnect tiny blood vessels—sometimes just 1–2 millimeters wide—under a microscope. These vessels supply the transplanted abdominal tissue with blood flow, and the success of the reconstruction depends on the surgeon’s ability to connect them flawlessly. In many cases, PRMA surgeons also perform nerve reconnection techniques to help restore breast sensation through our proprietary TruSense® innovation.
Every DIEP flap procedure performed at PRMA is completed by two specialized microsurgeons working together, ensuring optimal precision, safety, and efficiency. Our team has over 100 years of combined microsurgical experience and has performed more than 15,000 flap reconstructions, making PRMA one of the most experienced centers in the world.
This level of expertise is one of the many reasons patients from across the U.S. trust PRMA to handle even the most complex reconstruction cases.
The length of a DIEP flap surgery can vary depending on several key factors:
Thanks to this collaborative model and decades of experience, most DIEP flap surgeries at PRMA take approximately 4 to 6 hours—often significantly less than at other centers using only one surgeon.
Yes, DIEP flap reconstruction is considered a major surgery, but it’s also a major investment in your long-term health, comfort, and confidence.
Unlike implant-based reconstruction, DIEP uses your own tissue to recreate the breast, resulting in a softer, more natural look and feel with none of the risks tied to implants, like rupture, capsular contracture, or the need for future replacements. It’s a one-time procedure with lifelong results.
Because no abdominal muscles are removed, patients maintain their core strength and experience fewer long-term complications than with older techniques such as the TRAM flap. It’s a powerful combination: better aesthetics, preserved strength, and long-term peace of mind.
Understandably, the idea of a "major surgery" can sound intimidating, but when performed by experienced microsurgeons, DIEP flap reconstruction is a very safe and proven procedure.
PRMA has performed over 15,000 flap-based reconstructions with consistently excellent outcomes. Our use of a dual-surgeon approach helps reduce time under anesthesia, lower complication risk, and improve precision at every step. In fact, studies and our own patient data show very low rates of major complications, especially when compared to national averages.
Every patient undergoes thorough pre-operative screening, and surgical plans are tailored to each individual’s anatomy, medical history, and goals. From your initial consultation to long-term follow-up, our team ensures your journey is safe, personalized, and supported every step of the way.
DIEP flap reconstruction may be a major surgery—but in the right hands, it’s a safe, life-changing option that prioritizes long-term health, natural results, and restored confidence. If you're considering your next step after breast cancer surgery, we’re here to guide you.
Schedule your free virtual consultation to learn more about DIEP and other natural tissue reconstruction options with PRMA’s expert microsurgeons.