Is a deep inferior epigastric artery perforator flap (DIEP) done in stages?

This depends on what the DIEP is reconstructing.  In the case of breast cancer reconstruction, the DIEP flap is usually performed in one stage (ideally at the time of mastectomy) if the patient is not recommended for radiation treatment after mastectomy.  It is not uncommon, however, for the reconstructed breast to undergo some adjustments to improve symmetry with the breast or breast reconstruction on the opposite side.  Most commonly the reconstruction of other structures associated with the breast, such as nipple reconstruction, are performed at a separate time. 

If a woman is likely to undergo radiation after her mastectomy, it may be wise to undergo definitive reconstruction after radiation is complete.  In such cases, a tissue expander might be placed at the time of mastectomy to preserve breast skin.  Once the radiation treatment is complete and the tissues have recovered, the tissue expander may be removed and the mound replaced with the DIEP flap.  In many cases, this improves the overall aesthetic outcome despite the negative effects radiation has upon the chest.