01 OVERVIEW
What is a DIEP flap ?
The Gold Standard in Breast Reconstruction, Norwich Norfolk
Serving the East of England, including Suffolk, Peterbourough, Cromer, Kings Lynn, Ipswich and the wider UK
DIEP (Deep Inferior Epigastric Perforator) flap reconstruction is an advanced microsurgical technique that uses your own abdominal tissue to reconstruct the breast after mastectomy.Precision, natural results, and expert care in Norwich.
Unlike implant-based reconstruction, the DIEP flap creates a natural breast using skin, fat, and blood vessels from your lower abdomen—similar to a tummy tuck procedure. Crucially, the abdominal muscles remain intact, preserving your core strength.
Within the NHS, access to breast reconstruction—and particularly delayed DIEP reconstruction—can involve significant waiting times, often extending over several years. For many patients, this delay can impact recovery, body image, and overall wellbeing.
Choosing private care provides timely access to a consultant-led service with Miss Dhalia Masud, an experienced UK consultant specialising in microsurgical breast reconstruction. Earlier reconstruction can support faster psychological adjustment, improved confidence, and a more complete recovery journey.
Patient Suitability
A detailed assessment including medical history, physical examination, and imaging will determine your suitability. Generally, patients have to meet criteria.
01.
Sufficient abdominal tissue available
02.
Good general health for major surgery
03.
Non-smoker (or willing to stop)
04.
Preference for autologous tissue
05.
Desire for natural, long-lasting results
06.
Realistic expectations of recovery
02 THE SURGEON
Ms Dhalia Masud Plastic & Reconstruction Surgeon
FRCS (plas) | GMC Register Plastic Surgery | BAPRAS member | Consultant Plastic and Reconstruction Norfolk and Norwich Hospital NHS | Private Practice Cutane Clinic
Experience & Surgical Expertise
Miss Dhalia Masud is a Consultant Plastic and Reconstructive Surgeon with over 20 years of NHS experience, specialising in complex breast reconstruction.
She performs 1–2 DIEP flap reconstructions per week across NHS and private practice, reflecting a high-volume, specialist microsurgical service.
The DIEP flap is widely regarded as the gold standard in autologous breast reconstruction, using abdominal tissue while preserving muscle to optimise recovery and long-term function.
Her practice focuses on delivering safe, reliable, natural results, particularly in patients requiring complex or revision reconstruction.
Research, Innovation & Microsurgical Leadership
Miss Masud has a strong academic focus, with particular interest in enhanced recovery, operative efficiency, and outcomes following DIEP reconstruction. Her clinical work aligns with key published research in the field, including:
Efficiency in DIEP Flap Breast Reconstruction: Process Analysis
Optimizing Perforator Selection in DIEP Flap Reconstruction
Enhanced Recovery After Surgery (ERAS) in DIEP Reconstruction
During the COVID-19 pandemic, Miss Masud played a key role in re-establishing DIEP reconstruction services, with her unit among the first to safely restart microsurgical breast reconstruction in the UK—demonstrating leadership in complex surgical service delivery.
Training, Education & Patient-Centred Care
Miss Masud is deeply committed to microsurgical training and education, recognising that outcomes in DIEP reconstruction depend on both surgical skill and team expertise.
Modern research highlights that microsurgical training is now a core component of plastic surgery education, requiring structured case exposure and skill development.
Her approach combines high-volume consultant-led surgery, teaching and mentoring future reconstructive surgeons, and continuous refinement of technique based on evidence.
Above all, she is passionate about delivering natural, long-lasting reconstruction, supporting patients through what is often a life-changing journey.
03 BENEFITS
Why Chose DIEP Reconstruction
Natural Look and Feel
01
Reconstructs the breast using your own tissue, resulting in a soft, natural-looking breast.
Unlike implants, DIEP flap reconstruction uses your body's own fat and skin from the abdomen to create a new breast.
This tissue maintains its natural warmth, softness, and movement, closely mimicking the feel and appearance of a natural breast. It also ages with your body, providing a more consistent aesthetic over time.
Long-Lasting, Permanent Results
03
Provides a durable and permanent breast reconstruction that typically does not require future surgeries.
Once the DIEP flap is successfully established, the reconstructed breast is considered permanent.
The transferred tissue continues to live and grow with your body, meaning there's no need for future implant exchanges or removals, which are common with implant-based reconstructions. This offers a long-term solution with lasting aesthetic and functional benefits.
Avoids Implant-Related Complications
02
Eliminates risks associated with breast implants, such as rupture, capsular contracture, and BIA-ALCL.
By utilizing autologous tissue, DIEP flap reconstruction bypasses the potential complications inherent with silicone or saline implants. Patients avoid concerns like implant rupture, leakage, capsular contracture (hardening of scar tissue around the implant), and the rare but serious risk of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). This often means fewer future surgeries for implant maintenance or replacement.
Preservation of Abdominal Muscle
04
Reconstructs the breast without cutting or damaging the abdominal muscles, preserving core strength.
A key advantage of the DIEP flap is its meticulous technique, which involves taking only skin and fat from the lower abdomen while carefully preserving the underlying rectus abdominis muscles. This minimizes the impact on core strength and abdominal function, leading to a quicker recovery and reduced risk of abdominal wall weakness or hernias compared to older flap procedures like the TRAM flap.
04 THE PROCESS
What happens on the day of surgery in Norwich
01
Pre-operative Planning and Marking
Detailed planning and vessel mapping are crucial for successful flap transfer.
Before the surgery begins, the surgical team meticulously plans the procedure. This involves identifying the optimal abdominal tissue for the flap, marking the incision lines on the abdomen and breast, and mapping the perforator blood vessels using Doppler ultrasound or CT angiography to ensure a healthy blood supply for the transferred tissue.
02
Harvesting the DIEP Flap
Abdominal tissue, including skin, fat, and blood vessels, is carefully harvested while preserving muscle.
Dhalia Masud with team: An incision is made across the lower abdomen, similar to a tummy tuck. The skin, fat, and blood vessels (Deep Inferior Epigastric Perforator arteries and veins) are carefully dissected and separated from the underlying abdominal muscles. The muscle itself is preserved, minimizing abdominal wall weakness. The flap is then detached, ensuring the perforator vessels remain intact.
03
Breast Site Preparation and Vessel Connection
The breast site is prepared, and the flap's blood vessels are microscopically connected to chest wall vessels.
Simultaneously, or immediately after flap harvest, the recipient breast site is prepared. This involves creating a pocket for the new tissue and identifying suitable recipient blood vessels (typically in the chest wall) to connect to the flap's vessels. Using microsurgical techniques, the arteries and veins of the DIEP flap are meticulously sewn to the recipient vessels, restoring blood flow to the transferred tissue.
04
Shaping and Insetting the Flap
The transferred tissue is sculpted and positioned to form the new breast, with drains often placed.
Once blood flow is established and confirmed, the transferred abdominal tissue (the flap) is carefully shaped and sculpted to create a natural-looking breast mound. The excess tissue is removed, and the flap is then secured into its new position within the breast pocket. Drains may be placed to prevent fluid accumulation.
05
Initial Recovery
The patient enters recovery with close monitoring of the flap's health.
Both the abdominal donor site and the breast recipient site are meticulously closed in layers. The abdominal incision is closed, often resulting in a scar similar to a tummy tuck. Dressings are applied, and the patient is moved to recovery. Close monitoring of the flap's viability (blood flow) is critical in the immediate post-operative period, often involving frequent checks by the nursing staff.
05 HEALING
Recovery
Hospital Stay
2-5 DAYS
Close monitoring of the flap in the initial 48-72 hours to ensure adequate blood supply.
Initial Rest
FIRST 2 WEEKS
Assistance needed with daily activities. Drains removed once output decreases. Light walking encouraged.
Light Activity
2-6 WEEKS
Gradual return to light activities. Avoid heavy lifting. Return to desk-based work possible after 4-6 weeks.
Normalization
6-12 WEEKS
Progressive increase in activity. Resumption of normal activities, including exercise, by 3 months.
Final Result
12-18 MONTHS
Full recovery. The reconstructed breast ages naturally with your body and responds to weight changes.
06 CONSIDERATION
Clinical Risk
Transparency is paramount. Understanding potential complications allows for informed decision-making.
Radiotherapy Impact
Pain
Post-operative pain is expected, but its intensity and duration can vary. It can range from acute pain immediately after surgery to chronic pain lasting for months or years.
Radiotherapy Impact
Radiotherapy can cause nerve damage (neuropathy) or inflammation in the treated area, which can exacerbate post-surgical pain or lead to new chronic pain syndromes that are more difficult to manage.
Infection
Bacterial or viral infection at the surgical site or in other parts of the body post-surgery. This can range from superficial wound infections to more serious systemic infections.
Radiotherapy Impact
Prior radiotherapy can compromise the immune system and reduce blood supply to irradiated tissues, making them more susceptible to infection and impairing healing. The risk is higher if the surgical site is within the previously irradiated field.
Scarring and Fibrosis
Formation of scar tissue at the incision site. This can be cosmetic, but extensive scarring or fibrosis (thickening and hardening of tissue) can also affect function and mobility.
Radiotherapy Impact
Radiotherapy can alter the normal healing process, leading to more prominent, harder, or keloid-like scars. It can also induce fibrosis in deeper tissues, which may restrict movement or cause discomfort.
Bleeding/Hemorrhage
Excessive blood loss during or after the surgical procedure, which may require blood transfusions or further surgical intervention to control.
Radiotherapy Impact
Radiotherapy can cause tissue fragility, reduce the elasticity of blood vessels, and impair the clotting cascade in the irradiated area, significantly increasing the risk of intraoperative and postoperative bleeding.
Damage to Adjacent Organs/Structures
Accidental injury to nearby healthy organs, nerves, or blood vessels during the surgical procedure due to their proximity to the surgical site.
Radiotherapy Impact
Prior radiotherapy can cause inflammation, edema, and fibrosis, which can distort normal anatomical planes and make tissues more difficult to distinguish. This increases the risk of inadvertent injury to adjacent structures during dissection.
07 POST RECONSTRUCTION
Refining the reconstruction
After breast reconstruction, many patients benefit from refinement surgery to improve symmetry and final shape. This may include nipple reconstruction, breast uplift (mastopexy), or fat grafting (lipofilling).
Within the NHS, these secondary procedures can involve long waiting times, often several years, as priority is given to initial cancer treatment and reconstruction.
Accessing refinement surgery when you feel ready can support earlier psychological adjustment, improved body confidence, and a more complete, natural result.
Breast Reduction or Uplift
A breast reduction on the opposite breast may be required after DIEP reconstruction to improve symmetry and achieve a balanced, natural result.
Nipple Recontruction
Nipple reconstruction is often the final stage after DIEP breast reconstruction, helping restore a natural appearance and complete the overall result.
Scar or Skin revision
Scar revision and dog ear removal are minor procedures that refine the final result by smoothing irregularities and improving the contour after reconstruction.
Lipomodelling
Liposculpting can be used after DIEP reconstruction to refine the shape of the flap or surrounding areas, improving contour and overall symmetry.
08 POST RECONSTRUCTION
Long-Term Results.
DIEP flap reconstruction provides natural, long-lasting results that age with your body. The reconstructed breast will feel soft and warm, with sensation potentially returning over time in some patients.
Unlike implants, the DIEP flap does not require replacement or maintenance procedures. The breast will respond naturally to weight fluctuations, maintaining proportion with your body over time.
Scarring is inevitable but carefully planned. The abdominal scar is positioned low, similar to a cesarean section scar, and typically hidden beneath underwear.
09 PRICE GUIDE
Guide Price
These prices are provided as a guide only. The final cost will vary depending on your individual needs and the complexity of your surgery.
Bilateral Both sides DIEP Reconstruction
Using DIEP Microsurgery 22,000-40,000
500
Procedure duration in minutes
Price in GBP
Consultation
A comprehensive discussion and examination on needs and expectations
45
Procedure duration in minutes
Price in GBP
250
Removal of one dog ear each
Excess skin in the abdomen or in the breast region
60
Procedure duration in minutes
Price in GBP
500
Liposuction and lipofilling to contour the breast only
Shaping the flap
90
Procedure duration in minutes
Price in GBP
5000
One sided DIEP Reconstruction
Using DIEP microsurgery 15,000-22,000
360
Procedure duration in minutes
Price in GBP
Nipple reconstruction each
Options including using the flap skin or sharing from the opposite nipple
60
Procedure duration in minutes
Price in GBP
500
Liposuction and lipofilling to contour the breast only
shaping the flap
90
Procedure duration in minutes
Price in GBP
5000
Breast Reduction
Reducing the opposite breast
100
Procedure duration in minutes
Price in GBP
5000
