I've spoken to several ladies recently who have had the same misconception about DIEP flap surgery. They were scared they were "too skinny". The truth of the matter is that you don't need to be overweight to be a candidate for DIEP flap surgery. What matters is the distribution of the fat that you do have. Unfortunately that can't be determined over the phone. Sometimes it can't even be determined by emailing pictures.
I can say that we have successfully performed DIEP flap reconstructions on women with BMI's of 20 and even less. In instances where the reconstruction ends up too small, many women are candidates for autologous fat grafting. This involves liposuction of fat from another part of the body, purifying this fat, and then re-injecting it into the reconstructed breast for additional volume.
We used to occasionally place a breast implant under the DIEP flap in women who needed more volume. Unfortunately the patient is then exposed to the risks of breast implants like capsular contracture (hardening of the implant and breast) and even deformity.
Fat is not free of issues either though - some of it can become reabsorbed or form little pea-sized areas of hardening (fat necrosis), especially if the fat grafting is not performed in a meticulous way. There were fears for a while that the injected fat could cause calcifications on a mammogram that could look like or even mask a new breast cancer. Several studies have since proven that fat grafting is safe though some plastic surgeons are still reluctant to perform the procedure because of these previous fears. Even though fat grafting may not be 100% predictable, it has served our patients very well and we now prefer it to implants in these situations.
If you'd like to know for sure whether you're a candidate for a DIEP flap please visit with an experienced DIEP surgeon. It's the only way to really be sure.