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Advancements in anatomic understanding of the abdomen have resulted in decreases in donor site morbidity and improved abdominal outcomes. Patient satisfaction regarding aesthetics has been enhanced through careful consideration of mastectomy techniques and recipient site modifications in addition to improved quality of life outcomes through sensory innervation. The study reviews the evolution and current state of abdominally-based breast reconstruction in its goal of optimizing aesthetic, patient-reported and quality-of-life outcomes while minimizing complications.<\/jats:p>","DOI":"10.3390\/jcm14176248","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T10:55:37Z","timestamp":1756983337000},"page":"6248","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Pushing the DIEP Envelope: Where Are We Now?"],"prefix":"10.3390","volume":"14","author":[{"given":"Chase","family":"Clark","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Davis School of Medicine, University of California, Sacramento, CA 95817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Daar","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Keck Medicine of the University of Southern California, Los Angeles, CA 90033, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0659-6242","authenticated-orcid":false,"given":"Ara A.","family":"Salibian","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Davis School of Medicine, University of California, Sacramento, CA 95817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Steele, T.N., Teotia, S.S., and Haddock, N.T. 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