Muffin Top and Other Complications After DIEP Flap Surgery

When faced with breast cancer and the potential for a mastectomy, many women consider having a DIEP flap surgery. This reconstructive surgery uses your own tissue rather than breast implants to restore a more natural look and feel to the chest after a mastectomy procedure. The DIEP procedure works well for many women and is considered to be a step above the previously performed TRAM (transverse rectus abdominis muscle) procedure. The DIEP procedure can come with a few potential complications you should be aware of, however.

What is DIEP Flap Surgery?

DIEP stands for deep inferior epigastric perforator and refers to a major blood vessel that runs through the abdominal wall. During a DIEP flap procedure, a surgeon removes a section of fat and skin from your abdomen, being careful to take the arteries and blood vessels along with the skin flap. The surgeon will then place the skin flap in your chest, reattaching the abdominal blood vessels to those in your chest to provide adequate blood supply. Once the blood is flowing again, the surgeon will shape the new “breast” tissue and close the incision. This allows a surgeon to reconstruct your breasts using only donor tissue from your own body, eliminating the need for breast implants or other foreign materials.

How is DIEP Flap Surgery Different from a Tummy Tuck?

During DIEP flap surgery, your surgeon will make an incision from hip to hip just below your bikini line as they would for a tummy tuck. They will also remove excess fat from the area. This is where the similarities end, however. During a tummy tuck, your surgeon will check the muscles of the abdominal wall for hernias or other damage and repair them if necessary. But the abdominal muscles remain untouched during a DIEP flap procedure.

If your surgeon removes enough fat during your DIEP flap procedure, your stomach may appear flatter, and it may look as if you’ve gotten a tummy tuck. But the focus of flap surgery is to reconstruct the breasts — not to improve the look of the tummy. Some patients notice very little change in the way their stomach looks after a DIEP flap procedure.

Is DIEP Flap Surgery Better than Breast Implants?

When it comes to plastic surgery, the better choice often depends on the individual patient. Patients who have had previous abdominal surgeries, have abnormal abdominal artery placement, or have insufficient abdominal fat may not be eligible for DIEP flap surgery. For these patients, breast implants may be the better option.

A DIEP flap procedure is a better option for patients who prefer to use their own tissue over breast implants. DIEP flap recipients also enjoy permanent results without concerns that their implants will shift, harden, or need to be replaced in time. Because nerves are also relocated along with the skin flap, some patients report a more natural sense of feeling and sensation after a DIEP flap than with implants after a mastectomy.

How Much Belly Fat is Needed for DIEP Flap Surgery?

Because every patient’s reconstructive needs are different, there is no magical amount of body fat that makes you eligible for a DIEP flap procedure. Some women with a BMI as low as 20 are able to have the procedure despite being slim overall. It depends on how much fat you have and where you carry it. If you don’t have enough fat in your abdomen, your surgeon may be able to take donor fat from other sites, so all hope is not necessarily lost. The only way to know if you have enough abdominal fat for DIEP flap surgery is to consult with a plastic surgeon.

Will My Stomach Be Flat After DIEP Flap Surgery?

Your stomach may or may not be flatter after DIEP flap surgery. Many women do enjoy a flatter tummy after the procedure, but as stated above, this is not always the case. The goal of the surgery is to take the necessary amount of tissue to rebuild the breasts, not to sculpt the abdomen.

To promote faster healing and a less painful recovery, surgeons performing DIEP flap surgeries focus on taking as little tissue as possible and making sure they don’t disturb the abdominal wall. This means that problems like splits in the abdominal wall muscle resulting from pregnancy or a C-section are not addressed during a DIEP flap. If your tummy is caused by this type of an issue, you will still have it after your flap procedure.

Why Do I Have Muffin Top After DIEP Surgery?

A muffin top can occur after DIEP flap surgery and is sometimes temporary. Your body naturally swells after surgery, and it can take up to a full year for the swelling to completely subside. Until it goes back down, abdominal swelling after a DIEP flap can create the appearance of a muffin top.

A DIEP flap that results in a flatter stomach can also accentuate hip and flank fat, creating a muffin top on the sides of the body. A DIEP flap takes tissue only from the abdomen. Creating a flatter stomach without addressing issues in the flanks or lower back can make these areas appear more pronounced than they did before the surgery.

You can also end up with a muffin top if the surgeon takes more tissue from the lower abdomen than the upper abdomen. The result is that the upper abdomen may stick out above the lower portion of the stomach, creating a muffin top appearance. A DIEP flap also focuses on taking enough tissue only to construct the breasts, which means some excess fat deposits could remain even after the surgery. If you had a muffin top before your DIEP flap procedure, you may still have one after.

How you eat and exercise after your surgery also matters. You must maintain a relatively stable diet and exercise regimen after plastic surgery if you want to maintain your results. If your surgeon removes excess belly fat but you gain a substantial amount of weight, you can redevelop excess belly fat and end up with a muffin top.

Sometimes the appearance of a muffin top comes from excess skin. Although a DIEP flap procedure takes fat and skin, it is possible for fat to be taken while some excess skin is left behind. If the skin is too inelastic to go taut over the flatter stomach, it itself can hang down over your waistband and create a muffin top.

Fortunately, a plastic surgeon can often address all of these issues with a little liposuction or other corrective surgeries.

READ MORE: Get Rid of Muffin Top Once and For All

Other Complications and Disadvantages of DIEP Flap Surgery

DIEP flap surgery is a complex procedure but an advanced one that tends to have few complications. There are some, however, and you should be aware of them if you’re considering this procedure.

Dog Ears

One common complication of DIEP flap surgery is dog ears, which also sometimes occur after a tummy tuck. As the incisions from your DIEP flap heal, they create scar tissue. Sometimes the skin over this scar tissue is tighter than the skin around it, creating a loose patch of skin that hangs down like a dog’s ear.

Fortunately, because dog ears are just extra puckers of skin at the end of a scar, they are easy to remove. They can often be removed quickly and easily in your surgeon’s office. In some cases, the scar will need to be reopened, the extra skin trimmed away, and any fat deposit in the area removed with a touch of liposuction.


Scar tissue can form at the site of a newly transplanted skin flap, and this tissue can sometimes create hard lumps. These lumps aren’t generally painful and sometimes go away on their own with time. If they don’t, a surgeon can remove them.


This is a very rare complication but an important one to note. Upon occasion, it is possible that the newly transplanted tissue won’t be able to establish an adequate blood supply. When this happens, necrosis, or tissue death, is possible. Sometimes the solution is as simple as removing a small area of dead tissue. The problem can be extensive enough to necessitate a removal and replacement of the entire flap, however.

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