Abstract Introduction The deep inferior epigastric perforator (DIEP) flap is the gold standard for autologous breast reconstruction. One or two pedicles may be used. Our study is the first to compare unipedicled vs bipedicled DIEP flaps on donor site morbidity and breast outcomes in the same set of patients. Methods A retrospective cohort study comparing outcomes of DIEP flaps between 2019–2022 at our hospital. Results There were 98 patients, categorised differently based on breast or donor site. The three breast groups were unilateral unipedicled (N=52), bilateral unipedicled (N=15) and unilateral, bipedicled (N=31) and donor site groups were, unipedicled (N=52) and bipedicled (N=46, bilateral unipedicled and unilateral bipedicled). Bipedicled DIEPs had 1.15 times greater odds of a donor site complication than unipedicled DIEPs (95% CI 0.52, 2.55). Adjusting for operative time which was longer in bipedicled DIEPS (p<0.001), odds ratio decreased and there was a lower probability of developing a donor site complication for bipedicled (OR 0.84, 95% CI 0.31, 2.29). Odds of developing a breast complication were not significantly different between groups. Unilateral unipedicled DIEPs had a significantly higher rate of revisional elective surgery than unilateral bipedicled DIEPs (40.4% vs 12.9%, p=0.029). Conclusion Our study shows no significant difference in donor site morbidity between unipedicled and bipedicled DIEP flaps. Bipedicled DIEPS have slightly higher donor site morbidity rates, which can be partly explained by longer operative times. There is no significant difference in breast complications and bipedicled DIEP flaps can reduce rates of further elective surgery.