Microsurgical breast reconstruction · UK
DIEP flap breast reconstruction, the gold-standard autologous option.
A rebuilt breast made from your own lower-abdominal skin and fat — no implant, no muscle sacrificed, a natural feel that ages with you, and an abdominal contour sculpted along the way.
Why patients choose us
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Fellowship-trained microsurgical team
A named plastic surgeon with a dedicated microsurgical breast reconstruction practice — not a general plastics list with the occasional flap.
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CTA planning before you book a date
A pre-operative CT angiogram maps the perforators — the internal roadmap that turns a long, technical operation into a planned one.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Key facts
What DIEP actually involves, at a glance.
The essentials — donor site, operative length, hospital stay, monitoring and recovery — before you go deeper.
In short
Your own tissue, no implant, muscle preserved — a 6–8 hour microsurgical operation with a 4–6 week recovery.
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Autologous (uses your own tissue) — no implant
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Donor site: lower abdomen (skin and fat only, muscle preserved)
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Surgery length: typically 6–8 hours
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Microsurgical anastomosis to the internal mammary vessels
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24 hours of flap monitoring on ITU / HDU
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Hospital stay 4–6 days; recovery 4–6 weeks
The problem
The right team, the right plan, the right timing.
DIEP is one of the most technical operations in plastic surgery. Volume, planning and post-op monitoring are what separate a good result from a flap in trouble.
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Unsure if DIEP is right for you?
Implant, latissimus, PAP/SGAP/IGAP or no reconstruction may fit better. We say so before you commit.
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Worried about the abdomen?
Because muscle is preserved, the risk of abdominal weakness or hernia is much lower than with the older TRAM flap.
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Want the operation done properly?
A fellowship-trained microsurgical team, pre-op CTA planning, and ITU-level flap monitoring for the first 24 hours.
The journey
CTA to tattoo — what happens, in order.
From perforator mapping through microsurgery and ITU monitoring to nipple reconstruction — the full pathway, planned as one.
Phase 1 · Before surgery
MDT, CTA and prehab
Phase 2 · In hospital
Theatre, ITU and step-down
Phase 3 · After
Recovery, nipple and tattoo
- 01
Before
Consultation and MDT review
A full history, examination and honest discussion of the options — DIEP, implant, latissimus, PAP/SGAP/IGAP or no reconstruction. Immediate vs delayed is decided with the breast MDT.
- 02
Before
CTA perforator mapping
A dedicated CT angiogram of the abdominal wall maps the deep inferior epigastric perforators. The surgeon uses it to pick the best pedicle and plan flap design.
- 03
Before
Pre-assessment and prehab
Bloods, ECG, anaesthetic review, VTE risk stratification and stop-smoking support. Weight, diabetes control and fitness matter for flap survival.
- 04
In hospital
The operation
6–8 hours in theatre. The flap is raised, the abdomen closed like an abdominoplasty, and the flap anastomosed to the internal mammary vessels under the microscope.
- 05
In hospital
ITU flap monitoring
The first 24 hours on ITU or HDU — the flap is checked hourly for colour, warmth, capillary refill and Doppler signal. Early salvage is what protects the flap.
- 06
After
Step-down and discharge
Onto the ward for another 3–5 days. Drains stay in while output settles. Discharged when mobile, eating, and the flap is stable.
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After
Recovery, nipple and tattoo
4–6 weeks off work and no heavy lifting. Nipple reconstruction at ~3 months if wanted, followed by areolar tattooing.
Typical hospital stay: 4–6 days. Full recovery: 4–6 weeks. Nipple reconstruction at ~3 months.
When it helps
When DIEP is the right reconstruction.
The situations where DIEP earns its reputation — plus the one post-op red flag that means straight back to theatre.
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Immediate reconstruction at mastectomy
Done at the same operation as the mastectomy — one anaesthetic, best skin envelope, best cosmetic result for the right patient.
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Delayed reconstruction
Months or years after mastectomy — a proper option even after radiotherapy, where implants often fail.
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Failed implant reconstruction
Capsular contracture, implant exposure, chronic pain or a poor cosmetic outcome — DIEP is the standard rescue.
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Radiation-damaged tissue
Radiotherapy stiffens skin and makes implants unreliable. Bringing in your own well-vascularised tissue is the durable answer.
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Wanting to avoid an implant
For patients who do not want a foreign body — no implant exchange, no rupture risk, no capsule.
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Bilateral reconstruction
Both sides at once from one abdominal donor — commonly considered for bilateral mastectomy or risk-reducing surgery.
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Contralateral symmetrising surgery
A reduction, mastopexy or augmentation to the other breast can be planned alongside to match the reconstructed side.
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Red flag: flap concern after surgery
A cool, dusky or mottled flap in the first 24–72 hours is an emergency — return to theatre urgently to salvage the anastomosis.
Reconstruction options
DIEP is not the only option.
Every honest reconstruction conversation covers implant, latissimus, alternative perforator flaps and the option of no reconstruction at all.
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DIEP flap
Deep inferior epigastric perforator free flap. Skin and fat from the lower abdomen, muscle preserved. Gold-standard autologous option.
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Implant-based (silicone / saline)
A silicone or saline implant, sometimes over an expander. Quicker, shorter recovery, but with lifetime implant risks and often poor after radiotherapy.
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Tissue expander then implant
A two-stage implant reconstruction — an expander stretches the skin envelope, then swapped for a definitive implant.
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Latissimus dorsi flap ± implant
Muscle and skin from the upper back, often combined with a small implant. Reliable, but sacrifices back muscle.
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TRAM flap
An older abdominal flap that takes rectus muscle. Largely superseded by DIEP because of abdominal weakness and hernia risk.
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PAP / SGAP / IGAP flap
Thigh (PAP) or buttock (SGAP/IGAP) perforator flaps — for patients without an adequate abdominal donor.
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Nipple and areola reconstruction
A second-stage local flap plus medical tattooing, usually 3–6 months after the DIEP.
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No reconstruction (aesthetic flat closure)
A planned, tidy flat closure is a valid choice. Not a lesser option — just a different one.
Our vetted UK network
A small panel of microsurgical teams, we picked them.
Consultant plastic surgeons who do DIEP flaps as a core part of their practice — with the CTA, ITU cover and MDT that the operation needs.
Selection criteria
How we choose every microsurgical team in our network.
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Fellowship-trained microsurgical breast reconstruction surgeons
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Routine access to pre-operative CT angiography for perforator mapping
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Dedicated ITU / HDU flap monitoring protocol for the first 24 hours
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Working within a breast MDT — oncoplastic, oncology and reconstructive together
Risks, recovery and red flags
Real risks, honestly named.
DIEP is a safe, well-established operation in the right hands — but it is major surgery. The things worth planning for are flap monitoring, the abdominal donor site, VTE prevention, and the likely need for a stage 2 tidy-up.
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Flap loss (1–5%)
Partial or total flap failure from thrombosis of the anastomosis. Rare in high-volume units, and often salvageable if caught early.
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Fat necrosis
Firm lumps in the reconstructed breast from poorly perfused fat. Common, usually settles, occasionally needs excision.
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Abdominal bulge or hernia
Much lower than TRAM because muscle is preserved, but not zero — a weakness or bulge in the lower abdomen can still occur.
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Donor-site seroma or wound issues
Fluid collections and delayed abdominal wound healing, particularly at the umbilicus and low transverse scar.
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VTE (DVT / PE)
A long operation plus pelvic dissection raises clot risk. Chemical prophylaxis, calf pumps and early mobilisation are standard.
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Cardiac and anaesthetic event
Any 6–8 hour operation carries cardiac, respiratory and anaesthetic risk — pre-optimisation matters.
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Delayed wound healing
Smoking, diabetes, obesity and prior radiotherapy all slow healing at both the chest and abdominal sites.
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Need for stage 2 revision
A tidy-up under LA or GA is common at 3–6 months — lipofilling, scar revision, dog-ear correction, nipple reconstruction.
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Lymphoedema
Arm swelling relates to the axillary surgery, not the DIEP itself, but is worth planning for.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever team performs the DIEP, the note the surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication and reconstruction type
Why the reconstruction was done — immediate or delayed, unilateral or bilateral — and that a DIEP was chosen over the alternatives.
- 02 Technique
Flap design and anastomosis
Which perforators were used, whether one or two per side, and that the flap was anastomosed to the internal mammary vessels under the microscope.
- 03 Findings
Flap viability and donor closure
Intra-operative flap perfusion, the abdominal closure (like an abdominoplasty, with umbilical repositioning) and any intra-op concerns.
- 04 Impression
Recovery, review and next stages
Read this first: ITU monitoring plan, expected hospital stay, drains, activity restrictions, and when nipple reconstruction and tattooing are planned.
Recognised by major UK insurers
Cover for DIEP flap reconstruction is standard on most policies when done after mastectomy for cancer — we confirm cover before booking.
Frequently asked
Everything we get asked about DIEP.
Straight answers on what DIEP is, how long it takes, the real risks, and when to pick it over an implant.
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What is a DIEP flap breast reconstruction?
A DIEP flap uses skin and fat from your lower abdomen to rebuild a breast after mastectomy. It is a microsurgical free-tissue transfer — the tissue is disconnected, moved to the chest and its blood vessels reconnected to the internal mammary vessels under a microscope. No abdominal muscle is taken.
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Why is DIEP considered the gold-standard autologous reconstruction?
Because it gives a natural feel and long-term result using your own tissue, tolerates radiotherapy well, and — unlike the older TRAM flap — preserves the rectus abdominis muscle. It also sculpts the abdomen like an abdominoplasty as a by-product.
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How long does DIEP surgery take, and how long is the hospital stay?
The operation typically runs 6–8 hours (longer for bilateral). You then spend around 24 hours on ITU or HDU for flap monitoring, followed by 3–5 days on the ward — total stay is usually 4–6 days.
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What are the main risks of DIEP flap reconstruction?
The most important are partial or total flap loss (1–5%), fat necrosis, abdominal weakness or hernia (much lower than TRAM), donor-site seroma, delayed wound healing, VTE and cardiac events. Rarely, a return to theatre is needed within 72 hours to salvage the anastomosis.
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DIEP versus an implant — how do I choose?
Implants are quicker with a shorter recovery, but they are foreign bodies with lifetime risks (rupture, contracture, exposure) and often fail after radiotherapy. DIEP is a bigger operation but uses your own tissue, ages with you, and is durable after radiation. The right choice depends on anatomy, oncology plan and preference.
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Can I have a DIEP if my abdomen is not suitable?
Yes — the alternatives are PAP (inner thigh), SGAP or IGAP (buttock) perforator flaps, or a latissimus dorsi flap ± implant. Very thin patients, previous abdominoplasty and some abdominal scars can rule out DIEP.
Sources & guidelines
- British Association of Aesthetic Plastic Surgeons (BAAPS).
- British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) — Breast reconstruction.
- Association of Breast Surgery (ABS) — Oncoplastic breast reconstruction guidance.
- National Institute for Health and Care Excellence. Breast reconstruction (NG101 / CG164).
- American Society of Plastic Surgeons — DIEP flap procedure information.
Published 2026-07-30. Last reviewed 2026-07-30. Next review due 2027-07-30. Reviewed by the Pulse Atlas Editorial Board.
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All tests & procedures
Every test and procedure we arrange.
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