Is DIEP Flap Surgery the Same as a Tummy Tuck

DIEP flap breast reconstruction uses a patient’s lower abdominal tissue to recreate a warm, soft, natural breast following a mastectomy. It is often said the abdominal skin and fat used during DIEP flap surgery is removed in a way that is “similar to a Tummy Tuck,” but what does that really mean? Ideally, the final scar looks the same but in reality, the two procedures are very different in several important ways. To help distinguish the two procedures we have provided an overview of the similarities and differences below.

How the Procedures are Similar

• Incision Pattern: The surgical incision made to the lower abdomen is quite similar for both DIEP flap surgery and a Tummy Tuck. Both procedures remove a football-shaped area of skin and fat.
• Tissue Removed: Both procedures remove skin and fat from the lower abdomen and preserve the abdominal muscles. However, the DIEP flap is a more invasive procedure: the blood vessels (“perforators”) that keep the DIEP flap skin and fat alive travel just beneath or within the abdominal muscle. An incision is made in the abdominal muscle to access these blood vessels. The prepared tissue is then disconnected from the body and transplanted to the chest using microsurgery. The surgeons then shape the tissue to create the new breast. In contrast, the tissue removed during a Tummy Tuck is simply thrown away as medical waste.
• Final Abdominal Results/Scar Placement: Ideally, the final abdominal results are similar after both procedures. All patients generally benefit from a flatter abdomen and an improved abdominal contour. Both procedures create a final scar that runs across the lower abdomen from hip to hip which is commonly hidden under a swimsuit or underwear. Some DIEP flap patients can end up with a higher than ideal abdominal scar due to their anatomy and/or tissue distribution.

How the Procedures are Different

• Abdominal Wall Tightening: During a Tummy Tuck procedure, surgeons use sutures internally to tighten the abdominal muscles. This helps create a smooth and firm final abdominal result.  PRMA surgeons also perform abdominal wall tightening during DIEP flap surgery, however, it is generally not as extensive as would be performed during a cosmetic Tummy Tuck procedure – if muscle tightening is too aggressive after a diep flap procedure, it can potentially increase the risk of complications like lower abdominal bulging.
• Surgeon Training: DIEP flap surgery requires the expertise of highly trained microsurgeons. This is due to the extensive care and technique required to properly harvest the necessary blood vessels and sensory nerves needed to successfully transplant the abdominal tissue to the chest wall for breast reconstruction. Although seeking a highly trained and board-certified plastic surgeon is important for a Tummy Tuck procedure, no special care to harvest blood vessels or sensory nerves is necessary.
• Insurance Coverage: Thanks to The Women’s Health and Cancer Rights Act (WHCRA), it is a federal mandate for insurance providers to cover breast reconstruction surgery (including DIEP flap surgery) if a patient has had a mastectomy. A Tummy Tuck on the other hand is considered a “cosmetic surgery” and is not covered by insurance.

Author: Dr. Minas Chrysopoulo and Courtney Floyd

It is often said the abdominal skin and fat used during DIEP flap surgery is removed in a way that is “similar to a Tummy Tuck,” but what does that really mean? Ideally, the final scar looks the same but in reality, the two procedures are very different in several important ways. 

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