Purpose: Breast reconstruction options following mastectomy are numerous; dictated by the clinical scenario, patient preference, and individual circumstances. While deep inferior epigastric perforator (DIEP) flap reconstruction is widely regarded as the gold standard for breast reconstruction in terms of aesthetic outcomes and patient-reported outcome measures (PROMs), there are situations where a DIEP reconstruction may be contraindicated. Tissue expanders, implants, pedicled flaps and dermal matrices remain safe and reliable options when a free tissue flap may not be available. Increasingly, women who have undergone other reconstructive techniques are seeking conversion to DIEP flap. This review summarises the current evidence regarding DIEP flap reconstruction following prior implant-based or alternative breast reconstruction. Methodology: An extensive narrative review of the literature was undertaken on DIEP flap reconstruction following previous alternative reconstruction. In addition, expert opinion was sought from experienced reconstructive breast surgeons on current practice and evolving trends. Results: Women seek DIEP flap reconstruction following implant-based reconstruction for several reasons; concerns about implants such as Breast implant-associated anaplastic large cell lymphoma, capsular contracture, rupture, as well as dissatisfaction with aesthetic outcomes, and a change in personal or medical circumstances allowing autologous reconstruction. The literature demonstrates that conversion from implant-based reconstruction to DIEP flap reconstruction is safe and reliable. Procedural techniques and complication rates are comparable to primary DIEP flap reconstruction. Conclusion: DIEP flap reconstruction following initial implant-based breast reconstruction is a safe and effective option that provides excellent aesthetic outcomes and patient satisfaction. In appropriate cases, DIEP flap reconstruction can and should be considered as an option following initial implant reconstruction.