A DIEP flap breast reconstruction is essentially the more modern, evolved version of the traditional TRAM flap. Like the TRAM flap, it uses the lower abdominal tissue to reconstruct the breast and gives a natural-looking and feeling breast, without the use of an implant. The advantage of the DIEP over the TRAM flap is that the abdominal muscles are left in place. This translates to less abdominal weakness and a decreased incidence of hernias. The DIEP also allows for reconstruction of a larger breast and more flexibility in shaping the breast. Unlike the TRAM, where the flap remains connected to the patient by their rectus abdominis muscle, the DIEP involves removing ONLY the skin and fat from the lower abdomen and re-establishing the tissue’s blood supply by connecting its blood vessels to an artery and a vein in the patient’s chest. The DIEP flap is typically only performed by plastic surgeons specially trained in microsurgery and takes 4-6 hours to complete. Many consider the DIEP flap to be the gold standard in autologous breast reconstruction. A three day hospital stay is required and total recovery usually takes between 6-8 weeks.