Question: While having Diep Flap Surgery, as the Surgeon is already working inside your abdomen, can he tighten the abdominal muscles at that time? Answer: Thank you for your question. Yes, it is possible to “tighten the muscles” of the tummy wall at the time of DIEP surgery under the right circumstances. There are times when it may not be possible or wise to do that. There are many factors to consider such as the condition of the muscles, how far apart they are and other factors of the DIEP surgery. Technically speaking during DIEP surgery the abdominal cavity is not opened. The surgery takes place on the surface of the abdominal wall. It is important to realize there are always side effects of any procedure. In this case, repairing the muscles will add to the post-op discomfort. More pain can lead to other complications associated with not getting out of bed immediately after surgery and during recovery. The most serious complication is a blood clot occurring in the leg which may become a life-threatening situation. In addition, tightening the muscles may also increase the chance for problems with the repair of the lining of the muscles that occurs during the blood vessel harvest that occurs during the DIEP. Also repairing the muscles will add additional time to the surgery. Many surgeons would repair the muscles at subsequent surgery. That also has special considerations.  Therefore, the answer depends on the judgment of your surgeon and the particular factors of each patient. Thanks again for your excellent question.     Dr. Craigie