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In patients with larger breasts, one manner in which the breast can be reconstructed is with tissue from the lower abdomen. When the breast is ptotic, the nipple areola complex may not remain viable at the time of the mastectomy. Often a tissue expander is used at the time of mastectomy to let the skin heal before proceeding with DIEP flap reconstruction.

The lower abdominal tissue is often a good texture and size match to the contralateral breast. The DIEP flap can produce a reconstruction which is natural in appearance, contour, and texture.

The photograph demonstrates pre-operative to post-operative mastectomy and expander placement and finally DIEP flap reconstruction.