Breast reconstruction using abdominal wall tissue has become the gold standard in autologous reconstruction for the past 4 decades and has proved to be a reliable and safe technique. Deep inferior epigastric perforator (DIEP) flap breast reconstruction is an improved method of autologous tissue breast reconstruction with minimal insult to the abdominal wall. The DIEP flap, that includes skin and fat only, spares the rectus abdominis muscle, and therefore preserves adequate abdominal wall competence. The DIEP flap with its long pedicle is a highly versatile flap with minimal inset limitations and can be molded into virtually any breast shape desired. The lower abdomen donor site can mostly provide sufficient material for partial, total and even bilateral breast reconstruction. The flap is compatible with immediate or delayed reconstruction, matching various breast sizes, that are naturally looking and cosmetically acceptable. We present our series of 18 patients that underwent breast reconstruction with the DIEP flap. Oncological breast surgery included radical mastectomy (3 patients), modified radical mastectomy (10 patients), bilateral mastectomy (1 patient), skin sparing mastectomy (1patient), and lumpectomy/quadrantectomy (3 patients). Adjuvant radiation therapy was given to 12 patients. In 2 patients (11%) the reconstruction was done immediately and in 16 patients (89%) has been delayed. In 3 patients the reconstruction with the DIEP flap took place after the failure of implant reconstruction. Overall success rate was 100% with 3 complicated cases, including one distal flap fat necrosis, one partial skin loss at the distal flap edge, and one small dehiscence of the donor site wound. All abdominal donor sites were intact with no signs of herniation or bulging. All patients, while supine, were able to elevate both feet to 10 degrees or more of bed level at post-operative day seven. We concluded that breast reconstruction with the DIEP flap is a highly versatile reconstructive method, applicable for many breast ablative surgery options.