“Too Thin” For A DIEP Flap?

By: Dr. Minas Chrysopoulo

June 04, 2010

I've spoken to several ladies recently who have had the same misconception about DIEP flap surgery. They were scared they were "too skinny". 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.

Unfortunately that can't always be determined over the phone. Sometimes it can't even be determined by emailing pictures. I can say that we have successfully performed DIEP flap reconstructions on women with BMI's of 20 and even less.

In instances where the reconstruction ends up too small, many women are candidates for autologous fat grafting. 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.

The fat that is injected can become reabsorbed or form little pea-sized areas of hardening (fat necrosis), especially if the fat grafting is not performed in a meticulous way. There were fears for a while that the injected fat could cause calcification on a mammogram that could look like or even mask a new breast cancer. Several studies have since proven that fat grafting is safe though some plastic surgeons are still reluctant to perform the procedure because of these previous fears. Even though fat grafting may not be 100 % predictable, it has served our patients very well.

In appropriate candidates, it's also possible to place an implant under the DIEP flap in women who needed more volume.

If you'd like to know for sure whether you're a candidate for a DIEP flap please visit with an experienced DIEP surgeon. It's the only way to really be sure.

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