If you’ve heard you’re “too thin” for DIEP flap breast reconstruction, don’t give up hope—your body type may not disqualify you after all. Many thin patients are still excellent candidates for this advanced, natural tissue reconstruction technique. 

“We often hear from patients who’ve been told elsewhere they don’t have enough tissue for a DIEP flap. But BMI alone doesn’t tell the whole story,” says Dr. Minas Chrysopoulo, a board-certified plastic surgeon at PRMA. “We’ve helped many lean individuals achieve great results using personalized surgical strategies.” 

Can You Be Too Thin For DIEP Flap Breast Reconstruction? 

It’s a common misconception that DIEP flap surgery is only possible for patients with extra abdominal tissue. DIEP flap eligibility depends more on your fat distribution, body shape, and reconstructive goals.

At PRMA, our surgeons frequently perform DIEP flap breast reconstruction for thin patients, including those considering bilateral reconstruction. Even if your body type is lean, your abdominal tissue can often be used to create natural-looking results, especially with advanced surgical techniques like flap stacking and fat grafting.

What is the Ideal BMI Range for DIEP Flap?

There’s no one-size-fits-all BMI for flap reconstruction.

“At PRMA, we’ve successfully performed DIEP flap reconstruction for patients with BMIs of 20 and even lower,” says Dr. Chrysopoulo. “In cases where we’re reconstructing one breast, we can often use all the available tissue from the lower abdomen and reshape or layer it to achieve the desired volume and contour.”

Fat grafting in breast reconstruction offers a powerful solution in bilateral cases or when additional volume is needed. This process uses liposuction to collect fat from another area (such as the thighs or flanks), purify it, and re-inject it into the reconstructed breast to fine-tune shape and contour.

Factors Affecting Candidacy for DIEP Flap Surgery

Your eligibility for DIEP flap surgery depends on several individualized factors, including:

• Distribution and quality of lower abdominal fat
• Previous abdominal surgeries or scarring
• Whether reconstruction is unilateral or bilateral
• Your desired breast size and volume
• Overall health and surgical risk profile

During your consultation, your surgeon will assess these elements to help you determine the safest and most effective path forward.

Alternative Breast Reconstruction Techniques for Thin Patients

If DIEP flap volume alone isn’t enough, particularly for breast reconstruction after mastectomy on both sides, additional options can help achieve your desired results.

These include:

• Placing a small implant beneath the DIEP flap for added projection
• Using multiple flaps to reconstruct each breast
• Combining the DIEP flap with another flap (like the TUG flap from the inner thigh), resulting in two flaps per breast

“There’s no one ‘perfect’ approach to breast reconstruction. It’s really about tailoring the solution to the individual. For thinner patients, combining techniques can provide the best blend of natural shape and long-term durability,” explains Dr. Chrysopoulo.

Success Stories: DIEP Flap in Thin Patients

Think DIEP flap isn’t for you? Here’s one patient’s story that may help you see otherwise.

“I’m around 5’7″ and 140 pounds, with a pretty athletic build. I don’t carry much fat in my midsection—just some extra skin, thanks to having twins! I’d been told that DIEP flap surgery wouldn’t be an option for me, so I initially went with implants because that’s what I thought most people did.”

But two years in, she still didn’t feel comfortable.

“I dealt with chronic issues and just didn’t feel connected to the look of augmentation. It didn’t feel like me. When I started exploring my options, PRMA was the first place to confidently tell me I was a candidate for DIEP, and they were honest with me. They said I’d likely be smaller, and that it might take up to three surgeries to reach my final result. But I appreciated the transparency and trusted them completely.”

She chose Dr. Chrysopoulo as her surgeon and never looked back.

“I had the implants removed and moved forward with the DIEP flap very successfully. I was a little worried my cup size would look too small, but it looks great. I’m thrilled with my results and have zero regrets.”

This patient’s story proves that BMI alone doesn’t determine your candidacy—and that the right team makes all the difference.

Have Questions About Your Reconstruction Options? Get Expert Advice

If you’ve been told you’re not a candidate for DIEP flap surgery due to your BMI or body type, we encourage you to get a second opinion. The surgeons at PRMA specialize in complex and custom flap-based reconstructions and are passionate about helping every patient explore their full range of options.

You can start today with a free virtual consultation. Fill out the form here to connect with our team.