With current consumer disquiet about silicone implants, more patients may request autologous reconstruction. This can cause difficulties in patients who have undergone massive weight loss. The authors describe an ingenious solution, modifying the deep inferior epigastric perforators (DIEP) flap to include a fifth ‘Fleur-de-lis’ zone. This allows a very convincing reconstruction. The importance of verifying the presence of adequate perforators to supply the flap is emphasised and preoperative computed tomography (CT) angiography is recommended. The fifth (vertical) zone of the Fleur-de-lis DIEP is an intriguing and useful addition to breast reconstruction techniques.