Autologous Reconstruction

DIEP Flap Breast Reconstruction

The DIEP flap rebuilds the breast with skin and fat from the lower abdomen while preserving the abdominal muscles. It is one of the most widely used microsurgical techniques in modern breast reconstruction.

Medically reviewed by Dr. Fatih KılıçUpdated 6 November 20263 min read

What does DIEP mean?

DIEP stands for Deep Inferior Epigastric Perforator — the small blood vessels that travel through the abdominal muscle to nourish the skin and fat of the lower abdomen. These vessels are carefully separated from the muscle, so the muscle itself stays in place.

Donor areas for own-tissue reconstructionFront view showing the common donor areas: lower abdomen for DIEP, upper back for latissimus dorsi, inner thigh for TUG or PAP, and buttock for GAP flaps. ABDOMEN — DIEP / MS-TRAM BACK — LATISSIMUS DORSI THIGH — TUG / PAP · BUTTOCK — GAP BREAST RECONSTRUCTED WITH OWN TISSUE
  1. Abdomen — diep / ms-tram
  2. Back — latissimus dorsi
  3. Thigh — tug / pap · buttock — gap
  4. Breast reconstructed with own tissue
Figure 1The lower abdomen is the most common donor area for own-tissue breast reconstruction.

How the operation is performed

  1. An ellipse of skin and fat is raised from the lower abdomen, similar to a tummy tuck.
  2. The perforator vessels are dissected free, preserving the rectus muscle and its nerves.
  3. The tissue is transferred to the chest and its vessels are connected — usually to the internal mammary vessels — under the operating microscope.
  4. The flap is shaped into a breast, and the abdomen is closed with a low horizontal scar.

Imaging of the abdominal vessels (CT angiography) is commonly performed before surgery to plan the perforators.

DIEP flap breast reconstructionSkin and fat from the lower abdomen are transferred with their perforator blood vessels to the chest and connected to the internal mammary vessels. MICROSURGICAL CONNECTION INTERNAL MAMMARY VESSELS ABDOMINAL FLAP (SKIN & FAT) PERFORATOR VESSELS NEW BREAST
  1. Microsurgical connection
  2. Internal mammary vessels
  3. Abdominal flap (skin & fat)
  4. Perforator vessels
  5. New breast
Figure 2DIEP flap: lower-abdominal skin and fat are moved with their perforator vessels and connected to the internal mammary vessels.

Who may be suitable

  • Women with sufficient lower-abdominal tissue
  • Patients who have had, or will have, radiotherapy to the chest
  • Those who prefer to avoid implants, or have had implant problems
  • Non-smokers (or those willing to stop well before and after surgery)

Previous abdominal operations do not automatically rule out a DIEP flap; they are reviewed individually.

How radiotherapy affects reconstructionIrradiated skin becomes thinner, tighter and less elastic; bringing in healthy tissue with its own blood supply often heals more reliably. TIGHT, IRRADIATED SKIN HEALTHY FLAP TISSUE Implant under irradiated skinOwn tissue after radiotherapy
  1. Tight, irradiated skin
  2. Healthy flap tissue
Figure 3The DIEP flap is frequently chosen after radiotherapy because it brings healthy, well-vascularised tissue.
A patient and doctor talking during a consultation
Every plan begins with an unhurried conversation about your history and goals.

Recovery timeline

PeriodWhat to expect
Days 1–3Close flap monitoring in hospital; walking begins early with support
Days 4–5Discharge from hospital in most cases
Weeks 1–2Wound checks in Istanbul; drains removed; fit-to-fly assessment
Weeks 4–6Return to most daily activities and desk work
Months 3–6Shape settles; refinements and symmetry procedures can be planned
  1. 01TechniqueMicrosurgical free flap
  2. 02Donor areaLower abdomen
  3. 03Hospital stay3–5 nights
  4. 04Stay in IstanbulAbout 14 days
Figure 4DIEP flap recovery at a glance.
A nurse checking on a patient recovering in hospital
Close monitoring and support while you recover in hospital.

Risks

As with all major surgery, risks include bleeding, infection and blood clots. Specific to free flaps is the small risk of the vessel connection failing, which may require a return to theatre. Partial fat necrosis (firm areas within the flap), abdominal bulging and wound-healing problems at the abdominal scar are also discussed in detail before surgery.

Revision and symmetry surgeryFront view comparing an asymmetric reconstruction with the planned corrected contour, showing adjustment of position and volume to match the other breast. CURRENT CONTOUR PLANNED CONTOUR MATCH TO OTHER BREAST
  1. Current contour
  2. Planned contour
  3. Match to other breast
Figure 5After healing, contour and symmetry can be refined in a smaller second stage if required.

DIEP flap reconstruction in Istanbul, Turkey

A DIEP flap in Istanbul is planned with CT angiography of the abdominal vessels, a hospital stay of three to five nights and around two weeks in the city before flying. Wound checks and early follow-up are completed before you return home, and remote check-ins continue afterwards.

The personal assessment processFive steps from sharing your medical history and photographs to a personal surgical plan, surgery in Istanbul and follow-up at home. 01 Your history
Reports, dates of surgery and radiotherapy
 02 Photographs
Front and side views, sent privately
 03 Surgeon review
Individual assessment of options
 04 Your plan
Technique, stages and length of stay
 05 Istanbul & follow-up
Surgery, recovery and remote checks
Figure 6Your DIEP flap journey: history, photographs, surgeon review, personal plan, surgery and follow-up.

Frequently asked questions

How much does DIEP flap reconstruction cost in Turkey?

The cost reflects a longer microsurgical operation, 3–5 nights in hospital and close monitoring. A personal quote is prepared after your CT angiography or imaging and photographs have been reviewed.

Is DIEP flap surgery painful?

Discomfort is usually greatest in the abdomen during the first days and is controlled with regular pain relief. Because the abdominal muscles are preserved, pain is typically less than after older muscle-sacrificing techniques.

How long does DIEP flap surgery take?

A unilateral DIEP flap commonly takes several hours; bilateral reconstruction takes longer. The exact duration depends on vessel anatomy and whether other procedures are combined.

How long should I stay in Istanbul after a DIEP flap?

Around two weeks is generally recommended so that the early recovery and wound checks can be completed before your flight home.

Is a DIEP flap the same as a tummy tuck?

The abdominal closure is similar to a tummy tuck, and many patients notice a flatter lower abdomen, but the aim of the operation is breast reconstruction.

Dr. Fatih Kılıç

Medically reviewed by Dr. Fatih Kılıç, Plastic, Reconstructive and Aesthetic Surgeon. This page is for general information and does not replace an individual consultation.

Further reading — independent sources

Information & application

Considering breast reconstruction?

You do not need to decide on a surgical technique before contacting us. Share your treatment history and what you hope to achieve — your case will be assessed individually.

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