A deep inferior epigastric artery perforator (DIEP) flap surgery is used to reconstruct your breast using your tissue after a mastectomy, which is usually performed as part of breast cancer treatment. Your surgeon may perform this procedure even during a mastectomy.

To restore the natural look of your breast, they may use natural tissue taken from another part of your body (autologous reconstruction) or breast implants.

There are two types of autologous breast reconstruction surgery. They are known as the DIEP and TRAM flaps. The TRAM flap reconstructs a new breast from muscle, skin, and fat from your lower abdomen. DIEP flap is a newer, more advanced method that employs skin, fat, and blood vessels from your belly. Unlike a TRAM flap, the DIEP flap retains the abdominal muscles and allows you to keep your abdominal strength and muscle function. This also results in a less painful and speedier recovery.

Here's what you need to know about how the reconstruction works, its benefits and hazards, and what to expect if you choose a DIEP flap.

1. Who is a DIEP flap reconstruction candidate?
Someone with ample abdominal tissue, who isn’t obese and doesn’t smoke, is a great candidate for a DIEP flap. You may not be a candidate for a DIEP flap reconstruction if you have had previous abdominal surgery.

These factors can increase your chances of problems following a DIEP reconstruction. If you are not a candidate for DIEP reconstruction, you and your doctor can discuss viable options.

2. When should I consider having a DIEP flap reconstruction?
If you are a DIEP flap candidate, you may have reconstructive breast surgery at the same time as your mastectomy or months to years afterward.

Women are increasingly choosing rapid breast reconstruction surgery. In some circumstances, a tissue expander will be required to provide room for the new tissue. A tissue expander is a medical procedure or device placed to expand the surrounding tissue, preparing the area for additional operations. It will be gradually enlarged to stretch the muscles and breast skin and make way for the reconstructive tissue.

If tissue expanders are required before reconstructive surgery, the rebuilding process will be postponed. During the mastectomy, your surgeon will insert the tissue expander.

The time of DIEP flap breast reconstruction will also be influenced by chemotherapy and radiation. DIEP reconstruction will take four to six weeks following chemotherapy and six to twelve months after radiation.

3. What happens during the DIEP flap procedure?
General anesthesia is always used during DIEP flap surgery. To begin, your surgeon will make an incision across your lower abdomen. Then, a flap of skin, fat, and blood arteries from your abdomen will be unfastened and removed.

The excised flap will be transferred to your chest to form a breast mound. If you just have one breast reconstructed, the surgeon will strive to match the size and contour of your other breast as nearly as possible. The flap's blood supply will then be connected to the tiny blood veins behind the breastbone or under the arm. In some circumstances, a breast lift or reduction on the opposite breast will be beneficial to  ensure breast symmetry.

After shaping the tissue into a new breast and connecting it to the blood supply, your surgeon will use stitches to close the wounds. The procedure might take up to 8 to 12 hours. 

4. What are the advantages of DIEP flap reconstruction?
Preserves muscular integrity
Other breast reconstruction treatments, such as the TRAM flap that remove muscle tissue from your abdomen increase your risk of abdominal bulges and hernia. A hernia occurs when an organ pushes through a weak spot in the muscle or tissue that is meant to keep it in place.

DIEP flap surgery, on the other hand, does not frequently include muscle. This could mean a quicker recovery period and less pain following surgery. You will not lose abdominal strength or muscular integrity because the abdominal muscles are not used. You also have a considerably decreased chance of acquiring a hernia.

Natural-looking
Because it is constructed from your tissue, your restored breast will appear more natural. You also won't have to be concerned about the hazards associated with artificial implants.

5. What are the complications after DIEP flap surgery?
All surgeries have the risk of infection, bleeding, and anesthetic adverse effects. Breast reconstruction is no different. If you are thinking of having this procedure, make sure you choose a surgeon who has considerable training and experience in microsurgery.

The most common complications after DIEP flap surgery are: 
- breast fat lumps
- fluid or blood accumulating in the new breast
- loss of sensation
- blood supply issues 
- tissue rejection
- scars

6. What happens after the DIEP flap procedure?
After this procedure, you will likely need to stay in the hospital for a few days. You'll have some tubes in your chest to drain fluids, and your doctor will remove them once the amount of fluid in your body has decreased to an appropriate level, which should be within a week or two. You should be ready to resume routine activities within six to twelve weeks.

Over time after DIEP flap surgery, your natural breast may droop in ways that your reconstructed breast does not. Thus, you might want to fix the asymmetrical contour of your breasts. If this troubles you, talk to your doctor about it. 

7. How to decide if you should have a breast reconstruction
Whether or not to have breast reconstruction after a mastectomy is a highly personal decision. And a number of factors will influence which operation is best for you:
- personal preference
- other medical problems
- your weight and amount of abdominal tissue or fat
- previous abdominal surgeries
- your general health

Before making any decisions, examine the pros and cons of all surgical and nonsurgical treatments with your medical team.