DIEP Breast Reconstruction: The Benefits
DIEP flap reconstruction is widely considered the gold standard in breast reconstruction surgery, offering the most natural and long-lasting results.
This technique allows the breast to be rebuilt using only the patient’s own tissue—no implants or foreign materials are needed. The reconstruction is performed using skin and fat taken from the lower abdomen, similar to a tummy tuck, without removing the underlying muscle.
DIEP Breast Reconstruction: What Does It Involve?
The goal of this procedure is to restore the shape and volume of the breast in a single surgery using autologous tissue (your own body tissue). It can be performed either:
- Immediately following a mastectomy (immediate reconstruction), or
- Later, as a secondary procedure (delayed reconstruction).
During surgery, skin and fat from the abdomen are harvested while preserving a small artery and vein. These are then reconnected to blood vessels in the chest under a microscope using microsurgical techniques. This complex yet highly effective procedure restores both form and body integrity in a natural and permanent way.
The Surgical Procedure
- Anesthesia: Performed under general anesthesia. A pre-op consultation with the anesthesiologist is required at least 48 hours before surgery.
- Pre-op Imaging: A CT angiogram is performed about one month prior to surgery to map abdominal blood vessels.
- Surgery Duration: 4 to 6 hours.
- Hospital Stay: 5 to 7 days, including 3 days in a specialized care unit.
- Recovery: Most patients can resume work around 2 weeks after the procedure.
Contraindications for DIEP Flap Surgery
Not every patient is a candidate for DIEP reconstruction. Contraindications include:
- Insufficient abdominal fat or skin to allow for tissue harvesting.
- A history of traditional abdominoplasty (tummy tuck), which excludes DIEP, though prior liposuction may be acceptable with vascular imaging.
- Recurrent deep vein thrombosis, severe obesity (BMI > 35), or age over 75.
- Microsurgical challenges such as the inability to suture vessels smaller than 2 mm.
Other specific cases include:
- Heavy smoking (more than 15 cigarettes/day). Complete cessation is mandatory at least 2 weeks before and after surgery. Support with nicotine replacement or smoking cessation specialists is strongly encouraged.
- Raynaud’s disease, causing poor circulation in the extremities.
- Homozygous sickle cell anemia, primarily affecting individuals of African descent.
Possible Complications
Although complications are rare, they may include:
- Microsurgical thrombosis (blockage of blood vessels), which occurs in under 2% of cases and may result in flap loss if not promptly treated.
- Postoperative blood transfusion, required in fewer than 5% of cases due to the length and complexity of the surgery.
Preoperative Guidelines
For delayed reconstructions, a recent oncological follow-up is required to rule out recurrence.
Patients taking Tamoxifen must discontinue use 15 days prior due to the increased risk of blood clots.
Additional preparation includes:
- Ordering an abdominal compression garment and anti-embolism stockings
- Undergoing a CT angiogram to assess the abdominal vasculature
Results of DIEP Flap Reconstruction
DIEP reconstruction offers durable, natural results. Since the breast is rebuilt using your own living tissue, it behaves like natural breast tissue—adapting to weight fluctuations and aging.
Notably:
- The reconstructed breast may experience natural sagging (ptosis) similar to the healthy breast.
- In more than 50% of cases, no additional surgery is needed to adjust the opposite breast, avoiding extra scars.
- Unlike implant-based reconstruction, there’s no risk of implant rupture or need for long-term maintenance or replacement.
- Patients undergo an average of 2.5 surgeries compared to 5 with implants, based on clinical studies.
Cost and Insurance Coverage
DIEP flap reconstruction is covered by French Social Security.
However, the base reimbursement for this extensive procedure is under €700, which does not cover the cost of a full surgical team. Our team includes:
- Two surgeons
- Two surgical assistants
- A dedicated night nurse for post-op monitoring
As such, we charge additional fees between starting from €7,500, depending on the complexity of the case. A private hospital room is also required, costing €250 per day.These costs may be reimbursed by your supplemental health insurance (mutuelle).
Before/After Photos
Dr. Benjoar and Dr. Berdah have performed DIEP flap breast reconstructions for over 20 years. Explore their before-and-after photos to see the outstanding results of this advanced technique.
