Microsurgical breast reconstruction, Los Angeles
DIEP Flap Breast Reconstruction in Los Angeles
DIEP flap reconstruction rebuilds the breast with your own abdominal skin and fat, reconnected under a microscope, without removing the abdominal muscle. In Los Angeles, Michael DeLong, MD — UCLA fellowship-trained in microsurgery — performs DIEP and other flap breast reconstruction for women after mastectomy, after radiation, or after implants.
Medically reviewed by Michael DeLong, MD, Board-certified plastic surgeon (American Board of Plastic Surgery), UCLA microsurgery fellowship. Last updated .
What is DIEP flap reconstruction?
A DIEP (deep inferior epigastric perforator) flap is a type of flap breast reconstruction that moves lower-belly skin and fat — with their small blood vessels — to the chest to create a soft, living breast.
Because the tissue keeps its own blood supply through vessels reconnected under the microscope, it heals as part of your body and tends to age naturally with you. Unlike older TRAM flaps, the DIEP flap leaves the rectus abdominis muscle in place. Removing the lower-belly tissue also tightens the abdomen, similar to a tummy tuck.
When the abdomen is not a good donor site, other microsurgical flaps — such as the PAP flap from the inner thigh — may be options.
Who is a good candidate for a DIEP flap?
Good candidates generally have enough lower-abdominal tissue, are in good overall health, do not use nicotine, and want reconstruction without an implant.
- Women planning a mastectomy (immediate reconstruction) or who had one in the past (delayed).
- Patients who had radiation, which can make implants less reliable.
- Patients with implant problems who want to switch to their own tissue.
- A healthy weight range and well-controlled medical conditions improve safety.
A prior tummy tuck, very little belly tissue, active smoking or certain clotting disorders may point to a different approach.
How DIEP flap surgery works
Under general anesthesia, the abdominal tissue is lifted with its perforator vessels, moved to the chest, and connected to chest blood vessels with sutures finer than a hair under an operating microscope.
- Planning: a CT angiogram maps the perforator vessels in advance.
- Harvest: skin and fat are separated from the muscle, keeping the vessels intact.
- Microsurgery: the vessels are joined to the internal mammary vessels in the chest.
- Shaping: the tissue is shaped into a breast; the abdomen is closed like a tummy tuck.
- Monitoring: flap blood flow is checked frequently in the hospital.
Surgery often takes four to eight hours depending on whether one or both breasts are rebuilt.
DIEP flap recovery, week by week
Most patients spend two to four nights in the hospital and return to most normal activities around six weeks, with the reconstruction continuing to settle for a year or more.
Week 1
Hospital stay of about two to four nights with frequent flap checks. Walking begins early, slightly bent at the waist. Drains are common.
Week 2
Home with drains, which are typically removed once output drops. Short walks, no lifting heavier than about a gallon of milk, no driving while on opioid pain medicine.
Weeks 3–4
Energy improves and posture straightens. Light desk work may be possible for some patients. Still no strenuous activity or heavy lifting.
Week 6
Many patients are cleared for most daily activities, driving and gradual return to exercise, with core work reintroduced slowly.
3 months
Swelling has largely settled. This is a common time to plan a second-stage refinement, such as fat grafting, symmetry adjustments or scar revision.
6+ months
Scars continue to soften and the breast settles into its long-term shape. Nipple reconstruction or tattooing may be discussed. Healing continues for up to a year or more.
Typical timeline only. Your own instructions may differ.
DIEP flap vs. implant reconstruction
A DIEP flap generally means a longer first surgery and recovery but a result made of your own tissue that usually lasts; implants mean a shorter operation but a device that may need future surgery.
| Factor | DIEP flap | Implants |
|---|---|---|
| Tissue | Your own skin and fat from the lower abdomen | Silicone or saline implant, often with a tissue expander first |
| Feel | Soft and warm; tends to feel more natural | Firmer; edges may be felt, especially in thin patients |
| Longevity | Generally lasts a lifetime and changes with body weight | Implants are not lifetime devices; future replacement is common |
| Recovery | About 6 weeks for most normal activities; two healing sites | Often about 2 weeks for light activity per stage |
| Surgery length | Longer — often 4 to 8 hours | Shorter — often 1 to 3 hours per stage |
| Revisions | Refinements such as fat grafting are common; implant replacement not needed | Additional surgeries over time are more likely, especially after radiation |
Risks of DIEP flap surgery and how they're managed
Like any major surgery, a DIEP flap carries risks; the most specific one is a problem with the flap's blood flow, which is why it is monitored closely in the hospital.
- Flap blood-flow problems or flap loss: uncommon; frequent early checks allow a quick return to surgery if needed.
- Fat necrosis (firm areas): may soften with time or be treated later.
- Abdominal bulge or hernia: reduced by sparing the muscle and careful closure.
- Wound healing problems, infection, seroma, blood clots: managed with nicotine avoidance, early walking, clot prevention and follow-up.
Your personal risks depend on your health history and are reviewed in detail before surgery.
DIEP flap Los Angeles results
These are Dr. DeLong's own consented DIEP flap patients, including immediate, delayed, post-radiation and implant-to-flap cases.
- Immediate Left DIEP FlapOne-sided reconstruction at the time of mastectomy.View before & after
- Immediate Left DIEP Flap with SymmetryIncludes symmetry surgery on the other breast.View before & after
- Delayed DIEP Flap after Previous ImplantsConverting implants to own tissue.View before & after
- Delayed DIEP Flap after Mastectomy and RadiationReconstruction after radiation therapy.View before & after
- Staged DIEP Flap Breast ReconstructionReconstruction completed in planned stages.View before & after
Consented patient photos. Individual results vary.
Is DIEP flap reconstruction covered by insurance?
Yes — when performed after mastectomy, DIEP flap reconstruction is covered under the federal Women's Health and Cancer Rights Act, along with symmetry surgery and treatment of complications.
Deductibles, co-insurance and prior authorization still apply. Read our guide to breast reconstruction insurance coverage.
Related pages
DIEP flap surgery is one of several options for rebuilding the breast.
Compare every option on our page about breast reconstruction in Los Angeles, or read about timing, radiation and insurance in breast reconstruction after mastectomy.
DIEP flap FAQs
Will a DIEP flap weaken my abdominal muscles?
The DIEP flap is designed to spare the abdominal muscle: the blood vessels are carefully separated from the rectus muscle rather than taking the muscle itself. Most patients return to their normal core activities, though a small risk of bulge or hernia remains and is reviewed at consultation.
What does the DIEP flap scar look like?
There is a low horizontal scar across the lower abdomen, similar to a tummy tuck, usually placed so it sits beneath underwear, plus a scar around the new belly button and scars on the breast. Scars fade over 12 to 18 months but do not disappear.
Will I have feeling in my reconstructed breast?
Sensation after a DIEP flap is often reduced and can slowly return over months to years. In selected patients a nerve can be reconnected to support sensation, but results vary and cannot be guaranteed.
How long is the hospital stay after DIEP flap surgery?
Most patients stay about two to four nights so the flap's blood flow can be checked frequently during the most important early period.
Can smokers have DIEP flap reconstruction?
Nicotine in any form — cigarettes, vaping, patches or gum — narrows blood vessels and raises the risk of flap loss and wound problems. Patients are asked to stop all nicotine for several weeks before and after surgery, and testing may be done.
Can I have a DIEP flap if I had previous abdominal surgery?
Often, yes. C-sections and many other prior surgeries do not rule out a DIEP flap. A prior tummy tuck usually does. A CT angiogram helps map the blood vessels before surgery.
Can DIEP flap reconstruction be combined with other procedures?
Yes. It is commonly combined with surgery on the other breast for symmetry, and later stages may include fat grafting, scar refinement or nipple reconstruction. Plans are individualized.
Ask Dr. DeLong whether a DIEP flap fits your goals.
Consultations are personal. Options, recovery and outcomes vary by individual.
This page is general information, not medical advice, and does not create a physician–patient relationship. Individual results vary. No specific outcome is guaranteed.