Will my insurance cover DIEP flap reconstruction?

Since the passage of the federal Women's Health and Cancer Rights Act of 1998, insurance companies have been required to cover breast reconstruction if they cover mastectomies. In addition, many state legislatures have passed laws that clarify what must be covered within their particular states; you can read brief summaries of the laws in New York and New Jersey (as well as other states) here.

In general, when insurance covers breast reconstruction, it must cover all types, including DIEP flap surgery. A patient and her physician must decide together what the best option is; however, many insurance carriers are not as familiar with DIEP flap surgery and may require extra information and pre-authorization steps.

Even if you have an HMO (no out-of-network benefits), you may still be able to see a DIEP flap surgeon of your choice, because there are few experienced microsurgeons that perform DIEP flap reconstruction -- and since patients have a right to this type of reconstruction, HMOs often must look outside of their network for qualified surgeons.

Our office is experienced in helping patients navigate insurance issues, so please call if you have any concerns or questions.

Dr. Redstone is the founder of the Microsurgical Breast Reconstruction Program at St. Barnabas Medical Center and has offices in West Orange, New Jersey and in New York City. For more information on DIEP flap reconstruction, as well as other reconstructive procedures, please call us at 212.249.1500 (New York) or 973.867.8388 (New Jersey).

Some DIEP FAQs

What is DIEP flap reconstruction?

DIEP flap reconstruction is a type of breast reconstruction in which your own tissue is used to create a new breast after a mastectomy. A “DIEP” flap is a Deep Inferior Epigastric Perforator flap, which means that skin, fat and tiny blood vessels are taken from the abdominal area and used to create the breast.

What are the benefits of DIEP flap reconstruction?

DIEP flap reconstruction preserves the abdominal muscles, which reduces the risk of an abdominal hernia.  There is also significantly less pain associated with a DIEP flap, allowing you to be mobile and active sooner than with other procedures.  In addition, DIEP flap reconstruction involves removal of skin and fat from the belly, which can improve your abdominal contour -- similar to the results from a tummy tuck.

Who can have DIEP flap reconstruction?

Most women who are healthy enough to undergo breast reconstruction are good candidates for DIEP flap reconstruction. Active smokers and those who are not able to tolerate general anesthesia are not good candidates for DIEP flap reconstruction.

Who performs DIEP flap surgery?

DIEP flap reconstruction is performed by plastic surgeons with specialized training in microsurgery.  It’s important for you to choose a surgeon who has made this procedure a focus of his practice. 

Can I have DIEP flap reconstruction immediately after my mastectomy?

Immediate reconstruction is an excellent option for many women.  However, if you need radiation after your mastectomy, then it is best to delay the DIEP flap reconstruction until the radiation treatment is complete.