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DIEP Flap Breast Reconstruction

What is DIEP Flap Surgery?

DIEP flap breast reconstruction uses a woman’s own skin and fat—usually from the lower abdomen—to create a soft, natural-looking breast after mastectomy. Unlike older methods, this procedure leaves the abdominal muscles completely intact, which can support a smoother recovery and better long-term strength.

DIEP flap is an implant-free option that uses advanced microsurgery to reconnect tiny blood vessels, allowing the transferred tissue to thrive in its new location.

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Key Information

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Our flap success rate is over 99%
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Most patients are eligible for sensation restoration through nerve reconstruction
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DIEP is the most advanced form of breast reconstruction available today
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Offers the added benefit of a flatter abdomen (similar to a tummy tuck)
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PRMA performs approximately 1,000 DIEP flap procedures annually
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Very low risk of abdominal complications like bulging or hernia
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Uses the patient’s own lower abdominal skin and fat—no implants
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Lymphedema surgery (lymph node transfer) can be performed during the same procedure
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Preserves all abdominal muscles (unlike the older TRAM flap)
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Every surgery is performed by two board-certified microsurgeons
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Understanding Your Options

PRMA offers two advanced approaches to DIEP flap reconstruction: the standard DIEP flap and the High-Definition DIEP® flap. Both procedures use your own tissue and preserve your abdominal muscles, but they differ in the level of surgical refinement and aesthetic enhancement. Here’s what you need to know:

Standard DIEP Flap

The standard DIEP flap uses skin and fat from the lower abdomen to create a soft, natural breast after mastectomy—without implants and without sacrificing muscle. It’s a highly advanced, muscle-sparing procedure that prioritizes long-term safety and function. Most patients also qualify for sensory nerve reconstruction at the same time to help restore feeling in the breast.
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High Definition DIEP® Flap

High Definition DIEP® builds on the same foundational technique but takes aesthetic results a step further. This approach uses additional surgical refinement to enhance breast shape, improve symmetry, and create more defined cleavage. It’s ideal for patients who want the most natural-looking outcome with a higher level of contouring and detail. Only available at PRMA, High Def DIEP® is performed by surgeons with specialized microsurgical expertise.
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What to Expect During Surgery

DIEP flap breast reconstruction typically takes 4 to 6 hours, depending on whether one or both breasts are being reconstructed and if you're also having a mastectomy. During the procedure, your surgeon will remove a section of skin and fat from your lower abdomen—without taking any muscle—to create the new breast(s). Using microsurgical techniques, they will carefully reconnect tiny blood vessels from the abdominal tissue to those in the chest, ensuring healthy blood flow in the new breast mound.

For patients choosing High Def DIEP®, your surgeon will take additional steps to enhance breast shape, contour, and symmetry—especially along the cleavage area—for a more natural-looking result. 

Once the reconstruction is complete, your abdominal incision will be closed in a way that also tightens the area, much like a tummy tuck. Surgical drains will be placed at the chest and abdomen to help manage fluid during early healing.

After surgery, you’ll wake up in a private recovery room where nurses closely monitor your new breast tissue and overall vitals. A small Doppler ultrasound device may be used to check blood flow in the flap. Pain is managed using Enhanced Recovery After Surgery (ERAS) protocols, and most patients are up and walking—with help—the same day or by the next morning.

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Before & After

See real results from women who’ve trusted PRMA with their reconstruction journey.
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Procedure: Bilateral Mastectomy with Immediate High Definition DIEP Flap Breast Reconstruction
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Procedure: Bilateral Mastectomy with Immediate High Definition DIEP Flap Breast Reconstruction
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Procedure: Bilateral Mastectomy with Immediate High Definition DIEP Flap Breast Reconstruction
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Procedure: Bilateral Mastectomy with Immediate High Definition DIEP Flap Breast Reconstruction
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Recovery Timeline

  • Week 1:
    Most patients stay in the hospital for 2–3 days after surgery. You'll begin walking with assistance and managing drains and incision care. Mild swelling and fatigue are common, but pain is controlled with ERAS protocols. You’ll be encouraged to rest, hydrate, and limit activity to gentle walking around your home.
  • Week 2:
    By now, you’re likely feeling more mobile. Drains may be removed, and you'll begin transitioning off prescription pain meds. Many patients can manage light household tasks and shower independently. You’ll continue wearing your surgical bra and compression garment, and follow-up visits help monitor healing.
  • Week 3:
    Energy improves, and most patients start driving short distances again—if no longer on narcotics. Many return to desk jobs with modified duties. Bruising and swelling continue to subside. Nerve regeneration may begin, which can feel like tingling, itching, or sensitivity in the chest area.
  • Week 4-5:
    Walking longer distances is encouraged. Surgical scars begin to fade, and swelling is significantly reduced. Patients pursuing sensation restoration with TruSense® may start noticing early sensory responses.
  • Week 6:
    You should be ready to return to work (if not physically demanding). You can also continue to increase your activity based on your comfort level and surgeon’s recommendations.
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The Nation’s Destination for
Sensation Restoration

PRMA has transformed breast reconstruction with their revolutionary TruSense® procedure, a proprietary technique that restores breast sensation in qualified patients—giving back not just form, but feeling.
About TruSense®

Am I a Candidate for DIEP Flap?

If you’ve had a mastectomy or are planning one, and you’re seeking a long-term, natural alternative to implants, you may be a strong candidate for DIEP flap breast reconstruction. This procedure uses your own tissue to rebuild the breast and can often include sensation restoration at the same time. 

Ideal candidates typically meet the following criteria:

  • Have enough tissue in the lower abdomen to recreate the breast
  • Prefer to avoid or remove implants
  • Are seeking natural results that look and feel like their own body
  • Are in good general health and able to tolerate a longer surgery
  • May have had complications with previous reconstructions or implants
  • Are interested in restoring breast sensation through nerve reconstruction (if eligible)
  • Are not currently smokers (or are willing to quit prior to surgery)
  • Do not have medical conditions that impair healing (e.g., uncontrolled diabetes)
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Find Your Surgeon

PRMA’s board-certified, fellowship-trained microsurgeons perform over 1,000 DIEP flap procedures every year, making us one of the most experienced breast reconstruction centers in the world. Every surgery is performed by two microsurgeons, enhancing safety, precision, and outcomes—with a flap success rate of over 99%. With more than 15,000 reconstructions performed to date, our team delivers world-class expertise you can trust.
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Dr. Minas Chrysopoulo
Championing Advanced Breast Reconstruction Access Nationwide
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Dr. Gary Arishita
Dedicated to Restoring Confidence Through Expert Reconstruction
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Dr. Oscar Ochoa
Board-Certified Plastic Surgeon & Fellow of the American College of Surgeons (FACS)
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Dr. Gary Arishita
Dedicated to Restoring Confidence Through Expert Reconstruction
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Dr. Oscar Ochoa
Board-Certified Plastic Surgeon & Fellow of the American College of Surgeons (FACS)

Will Insurance Cover DIEP Flap?

By federal law, insurance companies are required to cover breast reconstruction after mastectomy, including DIEP flap procedures. At PRMA, we’re in-network with most major insurance providers and do not balance bill, making high-quality reconstruction accessible and affordable for patients nationwide. Our billing team will work with you directly to verify coverage and explain any out-of-pocket costs, so you can focus on healing—not paperwork.

For more information, visit [Insurance FAQs] in the patient resource center.

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Preparing for Surgery

Whether you live in Texas or are traveling from across the country—or even internationally—our team helps coordinate every detail, from travel and lodging to pre-op planning. We’re here to make your experience as smooth and stress-free as possible.

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Preparing for Surgery
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Frequently Asked Questions

Will I need to stay in the hospital?
Most patients stay in the hospital for about 2 to 3 days, during which time you'll receive support for drain care, mobility, and wound management. Before heading home, your care team will walk you through a personalized recovery plan and ensure you feel confident about what to expect in the coming weeks.
How closely will the reconstructed breast match my opposite healthy breast?
There will be aesthetic differences between your natural breast and your reconstructed breast, particularly at first. However, patients should not worry about this initially. Almost always, more than one surgery is required for the most cosmetic results. Revision surgery will be performed a few months after the initial reconstruction to ensure that your breasts are as aesthetically pleasing and matching as possible. If required, nipple-areola tattooing is performed as an additional step in the office under local anesthesia to complete the reconstruction. Please also remember that most women are not 100% symmetric to begin with, even if they have never had any breast surgery.
Do you have Residents or Fellows?
Some centers have surgeons-in-training known as “residents” or “fellows” who may be helping with your surgery or even performing part of it. This may or may not be something you are comfortable with, considering the complexity of the surgery. We do not have residents or fellows at PRMA.
Will my reconstructed breasts have any feeling?
Patients undergoing mastectomy must understand they may lose all feeling, regardless of whether they choose to have breast reconstruction or not. This is because the mastectomy cuts most of the nerves that provide feeling. DIEP flap patients may be candidates for an additional procedure called a “micro neurorrhaphy,” performed at the same time as their flap breast reconstruction. This repairs the nerves cut by the mastectomy and significantly improves the return of feeling to the reconstructed breast. Micro neurorrhaphy is performed by joining two nerves using microsurgery and, therefore, requires specialized training. While very few centers worldwide offer this additional procedure, PRMA has been successfully performing sensory nerve reconstruction since the late 1990s.
How often do you plan to perform a DIEP flap but convert the procedure to a free TRAM flap during the surgery?
We do not routinely convert DIEP flap procedures to free TRAM flaps. Our surgeons are highly experienced in performing DIEP flaps and will discuss any potential need for conversion with you prior to surgery, ensuring you are fully informed.
How long will I need to stay in San Antonio if I’m traveling from out of town?
Out-of-town patients will usually need to stay in San Antonio for a little over a week, including the hospital stay. However, the best plan is developed on a patient-by-patient basis.
What accommodation options are available if I’m traveling from out of town?
Our office is conveniently located near several hotels with easy access to the Medical Center and discounted rates for our patients and their families. We have also partnered with the American Cancer Society and are able to offer reduced/free hotel stays for out-of-town patients. We will be pleased to help you make any arrangements you need.

Look and Feel Like You Again.

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