Ask the Doctor: Phase 2 & 3 DIEP Procedure

shutterstock_2386655895.jpegPatients frequently ask us about performing Phase 2 and Phase 3 of the DIEP breast reconstruction procedure. This is an important step in the overall process of breast reconstruction, and it involves additional surgeries to refine the results of the initial DIEP flap surgery.

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Hello! I’m currently seeking a surgeon for phase 2 DIEP. My plastic surgeon here did a great job for phase 1, but doesn’t seem interested in correcting what I think is a problem for phase 2.

My breast size is currently a DD and I do not like the size. They are heavy and my back hurts by the end of the day. I’m seeking a C cup. Also, my abdomen is hard and bloated from underneath the breasts to just below my belly button. This hardness makes it difficult to breathe.

Is this something you have seen, and something you could fix?


For one reason or another, we routinely work with patients who have had phase 1 DIEP elsewhere, but end up coming to us for the “finishing” work. Of course, we are delighted to help, no matter who has operated on you, and no matter what condition you are in.

Breast size certainly can be reduced; symmetry often can be improved; and the donor site usually can be optimized. It is important to remember that to obtain the optimal result, several procedures are commonly necessary.

Typically, each subsequent procedure decreases in length and complexity as the process progresses. An average stage 2 scenario would include open revisions of the breast mounds and donor site, and stage 3 would involve free-fat grafting to further refine the shape of the breast mounds and lower body.

While the initial flap transfer is obviously the “big procedure,” we believe that the subsequent procedures are absolutely essential to getting the results for most patients to feel confident and pain-free.