“Too Thin” For A DIEP Flap?

By: Dr. Minas Chrysopoulo


Can you be too thin for DIEP flap breast reconstruction? 

I've spoken to several ladies recently who have had the same misconception about DIEP flap surgery. They were scared they were "too skinny", especially if they were considering bilateral reconstruction (both breasts). The truth of the matter is that you don't need to be overweight to be a candidate for DIEP flap surgery. What matters is the distribution of the fat that you do have and your desired results.

I can say that at PRMA we have successfully performed DIEP flap reconstructions on women with BMI's of 20 and even less. For reconstruction of one breast, all the available lower abdominal tissue can be used and either folded or "stacked". 

In instances where both breasts need to be reconstructed and the breasts are too small after the initial reconstruction, autologous fat grafting can be used to enhance the results. This involves liposuction of fat from another part of the body, purifying this fat, and then re-injecting it into the reconstructed breast for additional volume and to correct any contour defects from the mastectomy. 

Additional options for achieving more volume, especially for bilateral reconstructions include placing a small implant under the DIEP flap or using multiple flaps to reconstruct each breast. If there is an obvious significant discrepancy between the desired results and amount of abdominal tissue available, each DIEP flap can be combined with another type of flap from another part of the body (eg TUG flap) to reconstruct each breast, in other words a total of 4 flaps for 2 breasts.

If you'd like to know for sure whether you're a candidate for the DIEP flap or any other type of perforator flap breast reconstruction, you are welcome to fill out our free virtual consultation form here

Can you be too thin for DIEP flap breast reconstruction?

Learn More About DIEP Flap Breast Reconstruction


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  • Tracy Hewit

    I have had two lots of implants both have capsulated as a result of CANCER, it is obvious my body is rejecting them, I have been told by TWO surgeons here in UK I am too slim for the Diep and the TUG, one surgeon claimed I have enough for the TUG, one surgeon out of UK has said I can have the diep I am worried I could end up with a small bump, as stated my body keeps rejecting implants, any ideas PLEASE

  • PRMA Plastic Surgery

    Thanks for reaching out Tracy! So sorry to hear you are experiencing complications with the implants! First, it is wonderful to know you are seeking more than one opinion. It is ideal to hear all of your options and then choose what is best for you. It is difficult for us to say which direction you should go without consulting with you first. We have had patients come to us who were originally told they were “too thin” for the DIEP flap, but we were able to perform the procedure successfully. It is important to discuss the realistic post-operative expectations with both doctors (or even a third) to get a better understanding of what your breast size may be after surgery. If you desire more breast volume post surgery, additional fat grafting can be performed. Again, it is important to discuss realistic expectations with your surgeon and decide what is right for you.

    • Marcie

      I have a question if after the diep flap is done and your not happy with volume how long after can a implant or fat graphing be done

      • PRMA

        Great question Marcie!  Typically we recommend waiting at least 3 months before adding an implant or performing fat grafting to increase volume. We want to give the new flap plenty of time to heal and settle and swelling to go down before adding more volume.  Hope this helps!

PRMA Plastic Surgery