DIEP Flap Scars: Where They Are, What Healed Scars Look Like, and How to Care for Them
Illustration: the lower belly is the donor site of a DIEP flap. The scar runs low across the abdomen, like after a tummy tuck.
After a DIEP flap you have scars in three places: a long, low scar across your lower belly from hip to hip, a small scar around your new belly button, and scars on the reconstructed breast. In the first months these scars are red and slightly raised. Over 12 to 18 months they become flatter, softer and paler. Healed DIEP flap scars are usually thin lines that underwear and a bra can cover.
In this article
The three scar areas after a DIEP flap
A DIEP flap uses skin and fat from your lower belly to rebuild the breast. So there are always two operation sites: the belly (the donor site) and the breast. That gives three scar areas.
1. The long, low abdominal scar (hip to hip)
The surgeon removes a strip of skin and fat between your navel and pubic area. The belly is then closed like a tummy tuck. This leaves one long horizontal scar across the lower belly, from one hip to the other. The surgeon places it as low as possible, so that underwear or a bikini bottom covers it. The exact height and length depend on how much tissue was needed and on your body shape.
2. The scar around the new belly button
Your belly button (navel) stays attached to the deeper tissue. The surgeon makes a cut around it, pulls the belly skin down, and brings the navel out through a new small opening. This leaves a fine, round scar around the belly button. You can read more about this below.
3. The breast scars: it depends on your mastectomy
The scars on the breast are not caused by the DIEP flap itself. They depend on the type of breast removal (mastectomy) you had:
Skin-sparing mastectomy. The nipple and areola are removed, but most of the breast skin is kept. A patch of belly skin replaces the nipple area. The scar is often round or oval, around the middle of the breast, or a horizontal line across it.
Nipple-sparing mastectomy. Your own nipple and all the breast skin are kept. The scar is often hidden in the fold under the breast, or runs from the side of the breast towards the areola. Little or no belly skin is visible on the breast.
Delayed reconstruction. If your breast was removed earlier, the surgeon usually reopens the old mastectomy scar. A patch of belly skin fills the gap where skin is missing. The result is a breast with a visible island of belly skin, surrounded by the old scar line.
Ask your surgeon to draw the expected scars on your body before the operation.
What healed DIEP flap scars look like over time
A scar keeps changing for more than a year. It helps to know what is normal in each phase.
First weeks. The scar is a thin red or pink line, often with tapes or glue on it. It can feel tight and slightly raised.
Months 1 to 3. The scar is at its most visible. It is red, firm and slightly raised. It may itch. This is the normal, active phase of healing.
Months 3 to 6. The redness slowly fades. The scar becomes softer and flatter. Tightness improves as the belly skin stretches.
Months 6 to 12. The scar becomes paler, often lighter than the skin around it. Most of the visible change happens in this year.
12 to 18 months and beyond. The scar is mature: pale, flat and soft. Many women see further fading in the second year. A scar never disappears completely, but most healed DIEP flap scars are thin lines that clothes cover.
Dog-ears at the ends of the abdominal scar
At both ends of the long belly scar, near the hips, a small fold or bump of skin can form. Surgeons call this a dog-ear. It happens because the long lower cut is shorter than the skin above it. Dog-ears often become smaller as the swelling settles. If they remain, they are easy to correct in a small procedure later.
The scars on the breast
The breast scars follow the same pattern: red and firm first, then pale and soft. The patch of belly skin on the breast can look slightly different in colour from the breast skin. This usually becomes less obvious over time.
The belly button after a DIEP flap
Many women worry about the belly button (navel) after a DIEP flap. This is what usually happens:
Your own belly button is kept. The surgeon brings it out through a new small opening and stitches it into place.
In the first weeks the navel can look swollen, deeper or slightly different in shape. Small crusts around it are common.
Healing around the navel can be a little slower, because the blood supply there is poorer. Keep it clean and dry as your team advises.
Over a few months the swelling settles. Most women end up with a natural-looking navel and a fine scar around it.
If the navel stays very deep, tight or off-centre, tell your surgeon. A small correction is possible in a later phase.
Scar care after a DIEP flap, month by month
Scar care cannot make a scar disappear. But it can help scars become flatter, softer and paler, and it can lower the chance of a thick scar. The advice below is general. Your own team's instructions always come first.
Weeks 1 to 3: protect the wound
Leave the wound tapes, glue or dressings in place as long as your team tells you. Do not pull them off early.
Keep the scars clean and dry. Shower only when your team says it is safe, and pat the scars dry.
Do not put creams, oils or ointments on a wound that is still open or crusted.
Avoid stretching the belly scar: walk slightly bent in the first days, and do not lift heavy things.
Weeks 3 to 8: start gentle scar care
Once the wounds are fully closed and your team agrees, start moisturising the scars once or twice a day with a simple, unscented cream.
Gentle scar massage: press with your fingertips and make small circles along the scar for a few minutes a day. This helps the scar become softer and less stuck to the tissue below.
Silicone gel or silicone sheets can be used on closed scars, if your team allows. Silicone is one of the best studied ways to keep scars flat.
Wear soft clothing that does not rub over the belly scar.
Months 2 to 12: keep going
Continue massage and silicone for as long as the scar is red and firm, often several months.
Protect all scars from the sun for at least the first year. Cover them with clothing or use a high-factor sunscreen. Sun can make a young scar darker for good.
Watch the scar. If a part becomes thicker, wider, painful or very itchy, contact your team early. Treatment works best when started early.
Practical tips for each week of recovery are in the DIEP flap recovery week-by-week guide.
What can go wrong with DIEP flap scars
Most scars heal well. A small number of women see one of the problems below. All of them can be treated or improved.
Delayed healing in the middle of the belly scar. The middle of the long scar, just above the pubic area, is under the most tension and has the poorest blood supply. Here a small part of the wound can open or heal slowly. It is usually treated with wound care and closes by itself over some weeks, sometimes leaving a slightly wider scar.
A widened scar. When there is pull on a scar, it can stretch into a wider, pale line. This is more common on the belly than on the breast. It can be narrowed later if it bothers you.
A thick, raised scar (hypertrophic scar). The scar stays red, thick and itchy for longer than usual, but it stays within the line of the cut. Silicone, pressure, massage and sometimes corticosteroid injections by your surgeon help it settle.
Keloid. A keloid grows beyond the original cut into the healthy skin. It is rare, but more common in darker skin types and in women who have had keloids before. Tell your surgeon before the operation if you have had one.
Numbness around the scars. The skin above the belly scar and around the reconstructed breast is often numb, because small skin nerves were cut. Some feeling can return over months to years, but numbness is often permanent. The belly button area can also feel different.
Small dents or bumps. Fat under a scar can soften unevenly, leaving a dent. Dog-ears at the ends of the belly scar are the most common bump. Both can be corrected later.
Other belly problems after a DIEP flap, such as a hard or swollen belly, a bulge or long-lasting numbness, are explained in the article on abdominal problems after a DIEP flap.
Contact your team the same day if a scar becomes red, hot, swollen or painful, if fluid or pus leaks from it, or if you have a fever. These can be signs of an infection.
Scar revision and phase 2 after a DIEP flap
A DIEP flap is usually one big operation, followed by one or more small corrections. Surgeons call this second step phase 2. It is usually planned 6 to 12 months after the DIEP flap, when the scars and the new breast have settled. Not everyone needs it. Common phase 2 procedures are:
Dog-ear removal: the small skin folds at the ends of the belly scar are cut away. This slightly lengthens the scar, but makes it flat.
Scar revision: a wide, thick or irregular part of a scar is cut out and closed again neatly.
Lipofilling: your own fat is injected to fill a dent near a scar or to soften the edge of the breast. Read more about fat grafting (lipofilling).
Nipple reconstruction and areola tattooing: a new nipple is made from the belly skin on the breast and the areola is tattooed. See the article on nipple reconstruction and 3D nipple tattoo.
Adjusting the other breast: a lift or reduction for better symmetry.
Phase 2 is usually a short operation, often as day surgery. Scar revision cannot remove a scar, but it can make it thinner, flatter and less visible.
DIEP flap scars before and after: what to expect from photos
Many women search for before-and-after photos of DIEP flap scars. Photos can help you understand what is possible. But keep these points in mind:
A photo shows one woman, at one moment, in one light. Scars look very different at 3 weeks, 6 months and 18 months.
Skin type, age, weight and the type of mastectomy change how scars look. Compare only with women who resemble you.
The most useful photos come from your own surgeon: real patients with a similar body and the same type of operation, at different stages of healing.
Ask your surgeon to show you examples and to point out the scars in each photo. Also ask what they would expect for your body.
Frequently asked questions about DIEP flap scars
What do healed DIEP flap scars look like?
Healed DIEP flap scars are usually thin, pale lines. The long abdominal scar sits low, from hip to hip, and is hidden by underwear. The breast scars depend on the type of mastectomy. In the first months the scars are red and slightly raised. Over 12 to 18 months they become flatter, softer and paler.
Where is the DIEP flap abdominal scar?
The DIEP flap abdominal scar runs across the lower belly, from one hip to the other, just above the pubic area. It is placed low so that underwear or a bikini bottom covers it. The exact height depends on how much skin the surgeon needs and on your body shape.
Does a DIEP flap leave a scar on the breast?
Yes, but the breast scar depends on your mastectomy. After a skin-sparing mastectomy the scar is often around the areola or across the middle of the breast. After a nipple-sparing mastectomy it is often in the fold under the breast or at the side. In a delayed reconstruction the surgeon usually reopens the old mastectomy scar and a patch of belly skin fills the gap.
What happens to the belly button after a DIEP flap?
Your belly button stays attached to the deeper tissue. The surgeon cuts around it, moves the belly skin down, and brings the belly button out through a new small opening. This leaves a fine scar around the navel. In the first weeks it can look swollen or different in shape. It usually settles over a few months.
How do I care for scars after a DIEP flap?
Keep the wound tapes or dressings on as long as your team advises. Once the wounds are closed and your team agrees, you can moisturise, gently massage the scars and use silicone gel or sheets. Protect the scars from the sun for the first year. Do not use creams or oils on a wound that is still open.
How long do DIEP flap scars take to fade?
Most of the change happens in the first year. Scars are red and firm in the first months, then slowly become paler and softer. Full maturing usually takes 12 to 18 months, and many women see further improvement after that. Scars never disappear completely, but they become much less visible.
Can DIEP flap scars be revised or improved?
Yes. Small corrections are often done in a second, minor operation (phase 2), usually 6 to 12 months after the DIEP flap. Examples are removing dog-ears at the ends of the abdominal scar, smoothing a thick or wide scar, and lipofilling to soften a dent near a scar. Nipple reconstruction and tattooing can be done at the same time.
What should I expect from DIEP flap scars before and after photos?
Photos show one woman, at one moment, in one light. Scars look very different at 3 weeks and at 18 months, and skin type, age and healing vary a lot. Ask your surgeon to show you examples of patients with a similar body and a similar type of mastectomy, at different stages of healing.
Questions to ask your surgeon
Can you draw on my body where the belly scar and the breast scars will be?
Which type of mastectomy do you advise for me, and how does that change the breast scar?
When may I start scar massage, moisturising and silicone, and which products do you recommend?
Do I have a higher chance of thick scars or keloids, and what can we do about that?
What corrections are possible in phase 2, and when would you plan them?
Written by Dr. Mahyar Foumani, plastic and reconstructive surgeon specializing in breast reconstruction. Based on the book 'Breast Reconstruction Explained.'
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This article is education, not medical advice
This article explains in plain words how breast reconstruction works. It is meant to help you understand what is possible, so that you and your doctor can make a good decision together. It does not replace personal medical advice.
Every situation is different. What is best for you depends on your body, your illness, your treatment and your own wishes. So always follow the advice of your own doctor or care team. Do you have symptoms, or are you unsure about something? Please contact your doctor or GP. In an emergency, call your local emergency number.
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