Deep inferior epigastric perforator (DIEP) flap breast reconstruction is an improved method of autologous tissue breast reconstruction with minimal insult to the abdominal wall. This study summarizes the data collected on 148 consecutive DIEP flaps used for breast reconstruction in 109 patients. Of the patients, 90.7% had immediate breast reconstruction after mastectomy, 6.5% had secondary reconstruction, and 2.8% had bilateral reconstruction after having had a mastectomy and having a new primary cancer diagnosed in the remaining breast. A total of 78.7% patients underwent unilateral reconstruction, 21.3% underwent bilateral reconstruction, and 15.7% needed two flaps to make a single larger breast. There was one flap failure. Incidence of fat necrosis was 6.8% and incidence of incisional hernia was 1.4%. The advantages of a free transverse rectus abdominis musculocutaneous flap breast reconstruction are inherent in DIEP flap breast reconstruction. The increased technical effort for DIEP flap reconstruction is offset by the lesser insult to the abdominal wall with maintenance of the entire rectus abdominis muscle.