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One of the most common questions patients ask when considering DIEP flap surgery is: Where will my abdominal scar be?
While every patient’s anatomy is unique, PRMA San Antonio surgeons carefully plan each procedure with both function and aesthetics in mind. Whenever possible, the goal is to create a low, discreet abdominal scar that can be easily hidden beneath underwear or swimwear.
Understanding how scar placement works and what factors influence it can help set realistic expectations and ease concerns before surgery.
Where Is the Abdominal Scar After DIEP Flap Surgery?
DIEP flap breast reconstruction is an advanced procedure that uses a patient’s own lower abdominal skin and fat, without removing muscle, to rebuild a natural-looking, warm, and soft breast after mastectomy.
During breast reconstruction with abdominal tissue, the surgeon removes lower abdominal skin and fat using a football-shaped incision located between the belly button and the upper pubic hairline.
After the DIEP flap tissue is transferred to reconstruct the breast, the remaining upper abdominal skin is gently pulled downward to close the incision, similar to what occurs during a cosmetic tummy tuck.
In ideal situations, the abdominal scar after DIEP flap surgery closely resembles a traditional tummy tuck scar:
- It typically extends from hip to hip
- It sits low on the abdomen
- It is usually positioned so it can be hidden beneath underwear or most bikinis
However, scar placement varies from patient to patient. Several anatomical factors influence the final DIEP flap scar location.
What Factors Influence DIEP Flap Scar Placement?
1. Amount of Abdominal Tissue
Patients with more available lower abdominal tissue can often achieve a lower scar position. Thinner patients may have a slightly higher scar depending on how their tissue is distributed.
2. Location of Abdominal Tissue
Where a patient naturally carries abdominal fullness plays an important role. Patients who carry tissue lower on the abdomen generally have lower-setting scars after surgery.
3. Perforator Location
DIEP flap surgery relies on carefully selected perforator blood vessels that supply the transferred tissue. Occasionally, the best perforator is located higher in the abdomen, which may require a higher incision and ultimately influence scar placement.
4. Belly Button (Umbilicus) Position
The position of the belly button helps determine where the upper incision is made. Patients with a higher-positioned belly button may have a slightly higher scar. However, strong skin elasticity can allow surgeons to pull tissue downward and still achieve a lower final scar.
5. Skin Elasticity from Previous Pregnancies
Previous pregnancies often increase abdominal skin elasticity. More elastic skin allows surgeons to stretch the upper abdominal tissue further during closure, which can help create a lower, more discreet scar.
In every case, our surgeons make every effort to keep the scar as low as possible.
Can DIEP Flap Scars Be Revised or Improved?
Many patients are surprised to learn that scar appearance can continue to improve during the second stage of reconstruction.
This revision stage typically occurs several months after the initial surgery and focuses on optimizing symmetry and cosmetic results.
“The second stage of DIEP flap reconstruction allows us to refine the results after the body has healed,” explains Tyler Merceron, MD, a renowned microsurgeon at PRMA. “At this phase, we can often improve scar appearance, adjust contour, and make small refinements that help patients feel even more comfortable and confident with their outcome.”
Depending on individual needs, surgeons may:
- Refine or smooth scar contours
- Improve overall scar appearance
- Adjust or slightly lower the abdominal scar when possible
- Perform additional contouring for a more natural abdominal result
What Patients Can Expect from DIEP Scar Healing
Like all surgical scars, DIEP flap scars evolve gradually over time.
In the early weeks after surgery, the incision may appear firm, raised, or pink. This is a normal part of healing. Over the following 12-18 months, scars typically soften and flatten, fade in color, and become less noticeable as they mature.
Proper post-op DIEP care, including following activity guidelines and scar care recommendations, plays an important role in healing.
DIEP Flap at PRMA: Low Scars, Natural Results, Exceptional Care
At PRMA, our surgeons carefully plan every DIEP flap surgery with attention to both reconstructive success and aesthetic detail, aiming for low, discreet abdominal scars and natural-looking results.
Through advanced microsurgical expertise, thoughtful surgical planning, and personalized follow-up care, PRMA helps patients achieve beautiful, lasting outcomes after breast reconstruction. Reach out to schedule a consultation.
