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Stacked Flap Breast Reconstruction

This procedure uses multiple natural tissue flaps to reconstruct one breast.


Most patients who choose natural tissue reconstruction have enough extra tissue in one area of the body to reconstruct at least one breast. Patients who require more volume to reach a proportionate breast size and shape may be able to combine two flaps to reconstruct a single breast. This technique is called stacked flap breast reconstruction.

Most stacked flap breast reconstructions involve at least one DIEP flap. In some cases, two DIEP flaps—one from each side of the abdomen—are used to construct one breast. Other stacked flaps combine a single DIEP flap with a thigh flap. These procedures are most commonly used in thinner women with full busts who prefer to avoid breast implants.

Types of Stacked Flap Breast Reconstruction procedures

Stacked DIEP flaps

Surgeons transfer fat from both sides of the abdomen to one breast. Each flap is independent and has its own blood supply.

stacked flap diep

© Image Credit

Immediate left breast reconstruction with stacked DIEP flaps after nipple-sparing mastectomy.

SHAEP flap

This flap combines DIEP flaps with hip flaps to reconstruct both breasts.

Stacked DIEP and TUG/PAP flaps

This approach combines DIEP flaps with inner thigh flaps to reconstruct both breasts.

Procedure details:

  • Surgeons use a CT angiogram to look at blood supply to help plan for the procedure
  • In most cases, skin and fat is elevated from both sides of the lower abdomen
  • The perforator vessels that provide the best blood supply are identified on both sides
  • Muscles are preserved during the perforator blood vessel exposure through careful technique
  • In stacked DIEP flap cases, both flaps are transferred to the side where the mastectomy took place
  • In cases where each DIEP flap will be stacked with a flap from another part of the body, that flap is also carefully elevated and brought to the chest wall
  • Surgeons connect the blood vessels from the flaps with blood vessels in the chest to reestablish blood flow to the flaps using microsurgical techniques.
  • Incisions at the donor site(s) are repaired and closed

Risks & Benefits

All microsurgical free flap procedures carry a small risk of flap loss. Stacked flap breast reconstruction requires sophisticated techniques. Its risks depend heavily upon your surgeon’s level of experience in microsurgery and perforator surgery.