Common DIEP Flap Breast Reconstruction Misconceptions

By: Courtney Floyd


What are common DIEP flap breast reconstruction misconceptions?

What are common DIEP flap breast reconstruction misconceptions? | PRMA Plastic Surgery

I cannot tell you how many times I have heard the words, “I wish I had gone with DIEP flap breast reconstruction the first time.”

There are many misconceptions that lead patients to believe the DIEP flap is too risky or painful. Some women choose to go with implant reconstruction believing the journey will be easier. However, many of these patients will go on to experience common implant related complications (such as pain, capsular contracture, rippling, cold feeling breasts, etc.) and will require multiple revision surgeries. As you may gather from my opening quote, many women who experience these complications go on to have their implants removed and undergo DIEP flap reconstruction. We see this regularly at PRMA.

Although the DIEP flap may not be the best option for all patients, we believe it is important to dispel common misconceptions so women can make an informed decision for their breast reconstruction journey.

Misconception #1 - DIEP Flap is more painful compared to implant reconstruction.

Many patients believe DIEP flap breast reconstruction is more painful compared to implant surgery. While every patient experience is different, studies show patients report more pain following sub-pectoral tissue expander/implant surgery compared to DIEP flap. The DIEP flap reduces muscle trauma and preserves all patient abdominal and chest muscles. Most implant-based reconstruction procedures involve placing an implant under the chest muscle. This requires releasing and lifting the muscle off the chest wall to create a pocket for the implant which is painful and adds to patient recovery. For patients needing tissue expanders, the overlying breast tissue will be stretched over a period of time causing discomfort. At PRMA, our patients experience minimal pain after DIEP flap surgery thanks to our ERAS Protocol. In fact, most patients are able to control their post-operative discomfort without the use of narcotics!

Misconception #2 - DIEP flap has a higher complication rate compared to other reconstruction methods.

Any surgery carries a risk of complications. In the hands of experienced surgeons, DIEP flap breast reconstruction is safe. At PRMA, our DIEP flap success rate is over 99%. I feel it is important to note here that when radiation therapy is a part of cancer treatment, about 1 in 3 implant reconstructions fail. The DIEP flap provides a safe and natural alternative.

Misconception #3 - You will need to stay in the hospital for a long period of time after DIEP flap surgery.

Again, thanks to the implementation of our ERAS protocol, patients are recovering faster after DIEP flap surgery. Patients can expect to be up and walking the day after surgery and back at home after 2-3 days. There is no extended stay period in the hospital following DIEP flap surgery.

Misconception #4 - Any Plastic Surgeon can perform the DIEP flap successfully.

This is a DANGEROUS misconception! Most plastic surgeons do not perform advanced perforator flap procedures like the DIEP flap on a routine basis (if at all). Experience matters for a successful outcome! Seek out a board-certified plastic surgeon who performs at least 100 DIEP flaps a year with a very high success rate. At PRMA, we perform over 700 perforator flap procedures a year with a success rate of over 99%! Because of the small number of surgeons routinely performing this procedure, many women may have to travel for surgery. Although travel may seem overwhelming, it’s worth it!  

Find information on travel assistance programs here!

Learn More About DIEP Flap Breast Reconstruction


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  • Betty

    Trying to find what city and state you’re located in and if you take Medicare and Medicaid I spoke with my insurance the Medicare and I have Blue Cross complete Michigan and they said as I can go out of state as long as Medicare covers at the Blue Cross Medicaid will cover it as well I just need to know if you take that

    • PRMA

      Thanks so much for reaching out Betty!  We are located in San Antonio, Texas.  We do accept some forms of out of state insurances.  Our billing department will need to verify your coverage and eligibility to see if we are in-network.  You can reach our billing department at 800-692-5565

  • LBishop

    You write: The DIEP flap reduces muscle trauma and preserves all patient abdominal and chest muscles. It was my understanding that the DIEP flap procedure still involves inserting the new tissue under the chest muscles, not on top. Can you please clarify?

    • PRMA

      Great question!  The tissue taken from the lower abdomen is transplanted to the chest. It is placed on top of the chest muscles, not under.  Most commonly, implants are placed under the chest muscles.  Hope this answers your question!

  • Susan

    I underwent tissue expander reconstruction 7 years ago following a nipple sparing mastectomy. Can this be converted to DIEP? If so, what happens to the stretched out muscle if the flap goes on top of the muscle?

    • PRMA

      Hello Susan! Great question!  Prior tissue expander or implant reconstruction can be converted to DIEP flap. During the procedure the surgeons remove the implant and make corrections to the chest wall before connecting the flap.

PRMA Plastic Surgery