FAQS – DIEP FLAP RECONSTRUCTION

What are the major benefits of the DIEP/SIEA procedure over other types of breast reconstruction?

There are multiple benefits of the DIEP and SIEA procedures over other breast reconstruction, including

• Natural feel and appearance of the breast
  • This procedure uses your abdominal tissue to reconstruct the breasts, creating a more natural look and feel of the breasts, that will change with you as your body changes, i.e. aging and weight loss/gain.
• Flatter, contoured, abdomen
  • This procedure uses your excess abdominal tissue to reconstruct the breast, and as a result also achieves a flatter more aesthetically pleasing abdomen
  • Although this procedure uses your abdominal tissue (skin and fat), unlike the TRAM flap, it keeps your abdominal muscle intact. This allows for full function of the abdominal muscle after the procedure.
• Ability to correct deformity from a prior procedures
  • Skin can be transferred with the fatty tissue of the abdomen to correct a deformity that was created by a previous procedure
• Improved breast sensation
  • After a mastectomy, the sensation of the breast changes due to sensory nerves that maybe cut or removed with the breast tissue. During DIEP or SIEA reconstruction, a nerve can be transferred and connected in the breast to improve sensation
• Improved lymphedema
  • A common complication that can occur with breast cancer treatment is lymphedema. During DIEP or SIEA reconstruction, it is possible to transfer a lymph node with the abdominal tissue. This allows for both breast reconstruction and treatment of lymphedema within the same procedure.

Will the reconstructed breast have sensation?

The final goal of breast restoration is not only, to create a soft, symmetric breast, but also, to restore protective sensation. This can be achieved by microsurgically connecting the sensory nerve of the breast that is severed during the mastectomy to a sensate nerve of the abdominal tissue. Over a period of three to six months, the nerve grows slowly and offers the possibility of regaining normal sensation. For more information regarding breast sensation please visit our Breast Sensation page.

Will the reconstructed breast be made symmetrical?

Yes, a symmetry procedure is performed approximately four to six months after the initial breast reconstruction procedure. The symmetry procedure that is performed is based upon your specific situation, including the breast surgery and breast reconstruction procedure performed, as well as if the reconstruction was bilateral (performed on both breasts) or unilateral (performed on just the affected breast). For bilateral reconstruction, the symmetry procedure, if needed, allows for refinement of the shape and size of the reconstructed breast. For unilateral breast reconstruction, the symmetry procedure, if needed, allows for the reconstructed breast to be refined, and at the same time a procedure is also performed on the other breast (breast lift, breast reduction, etc) to achieve optimal balance between the breasts.

Why do I have to wait 4 months after the DIEP surgery to have symmetry surgery?

4 months is the minimum wait. This allows the flap to establish its own blood flow. In addition, this wait period allows the tissues to return to a state without swelling and to become softer. This is also the time for patients to lose and stabilize their weight prior to symmetry surgery. We recommend that patients attain their goal weight and maintain that weight for 2 months prior to symmetry surgery.

What is done for restoring the nipple/areola?

The final stage of breast restoration takes place about two to three months after the second stage/symmetry procedure. Initially the nipple is reconstructed using the flap or mastectomy tissue. After the reconstructed nipple heals, approximately 6 months, medical tattooing can be performed to restore the color of the areola. For more information regarding this please visit the nipple reconstruction and 3D nipple tattooing pages.

Postoperative care

How do I monitor the flap?

While in the hospital, the flap will be monitored by the nursing staff in multiple ways including:

Internal Doppler: this is a cuff that is placed in the operating room around the venous connection of the flap and allows us to listen to the outflow of the flap, or the vein

External Doppler: This is a handheld Doppler that allows us to listen to the inflow of the flap, or the arterial signal

TSTAT: this is a small sensor that is placed on the flap skin and monitors flap perfusion by hemoglobin concentration of the skin

Physical exam: the skin “island” is the flap tissue that is monitored while in the hospital. The nursing staff will check a capillary refill of the tissue and monitor the color of the flap skin. The nurses will also monitor your drain output and breast swelling.

At home, you will be asked to monitor the breast flap by checking the skin island, which will be identified for you in the hospital. It is important to call the office if you notice any change in color of the flap skin. We also ask you to monitor your breast and call the office if you experience any increased pain, swelling, or increased drain output. You will not need to monitor any Doppler signals at home and the TSTAT will also be removed in the hospital before discharge.

Why is the Doppler wire needed?

The blue wire is used with an internal Doppler that is attached around the internal mammary vein, allowing us to monitor blood flow through your flap. You do not need to monitor this Doppler at home, but you will go home with the blue wire because it is too soon to safely remove the wire while you are in the hospital. The wire will be removed at your first post-operative visit.

Is it mandatory to sleep in the recliner after DIEP procedure?

After the DIEP reconstruction, you are essentially recovering from a “tummy tuck.” We highly recommend that you sleep in the recliner to avoid abdominal wound healing complications. In addition to your tummy, sleeping in the recliner keeps you from sleeping on your reconstructed breast flap.

How long do I have to sleep in the recliner?

Time in the recliner varies with each patient, ranging from a minimum of 4 weeks to as many as 8 weeks depending on the elasticity or “stretchiness” of your tummy tissue.

Where do I purchase/rent a recliner?

Please follow the link for more information regarding the correct type of Recliner.

Does insurance cover the cost of the recliner?

You will need to contact your insurance for the possibility of coverage, they may at least pay the tax for the recliner. We can provide a prescription for the recliner and if you have an FSA (flexible spending account), you may be able to offset the cost of the recliner with that. You can also use the cost of the recliner as a tax write off. Our office will not handle the insurance for the recliner.

When do I stop iron, selenium, and zinc after surgery?

You may stop iron 2-4 weeks after surgery if your energy levels have returned to normal (or you may stop if you are experiencing gastrointestinal issues with the iron). You may stop the zinc and selenium 2 weeks after surgery if you do not have wound healing complications.

When can I start Tamoxifen after surgery?

You can restart Tamoxifen 1 week after surgery.

How many milligrams of aspirin do I take after surgery?

You will take 81mg of aspirin (one baby aspirin) once daily, unless otherwise directed

What bra should I wear post op?

A special surgical bra will be placed post operatively in the operating room that is soft and breathable, allowing for optimal healing after your breast surgery. In the initial post operative period it is important that your breasts are supported and the surgical bra is to be worn both during the day and at night.

How long do I wear the post op bra?

This is very individual and is based on the size of the breasts and your specific post operative recovery. Typically at your one month post op appointment, pending no recovery complications, you will receive information regarding approved bras that you may purchase. After having a mastectomy, most patients have some degree of sensation change to the breasts. This decrease in breast sensation increases the risk of bras rubbing and causing skin irritation. It is important that you wear a bra that is soft, without underwire, and that does not have thick seams, to reduce the risk of skin irritation and breakdown. Our office has spent a lot of time finding bras that are safe and comfortable and you will be given this information when it safe for you to transition from the initial surgical bra.

When can I wear an underwire bra?

We do not recommend wearing an underwire bra. The wire tends to rub in areas that no longer have sensation or have decreased sensation, causing chafing or blistering. If you choose to wear an underwire for a short period of time, check your skin frequently for any breaks in the skin. If you are going to wear an underwire bra (for example for an event), you should wait at least 3 months after your initial surgery or 2 months after your symmetry procedure.

When can I shower?

You may shower 48 hours after surgery (postop day 2), with the water to your back. Showering with the water to your back prevents direct contact of water on the incisions. It is ok if water trickles over your shoulders to the incisions. Just pat the incisions/dressings dry after you shower. Please do not wash/scrub your incision sites. A sterile dressing was placed over your incisions in the operating room and this will stay in place and will be changed during your post op appointment. Please do not remove or change your dressings, unless otherwise specified by our office.

Can I shower with drains?

Yes

How do I care for my drains?

Please strip your drains 5-6 times per day and record the output per drain, per day on your drain log. For specific instruction on how to care for and strip your drains please refer to the drain care page.

What wound care do I need to do?

In most cases after surgery you are not required to do any wound care, unless otherwise specified by our office. A sterile dressing will be placed over your incisions that should remain intact and will be changed in the office during your post operative visit.

When do I start range of motion exercises?

You will begin simple range of motion exercises after all drains have been removed, typically at the 2-3 week appointment. If at 4 weeks you have not been able to restore full range of motion, you will receive a prescription for physical therapy.

How long do I have to walk bent forward?

This varies depending on the individual elasticity of the abdominal tissue and if there are wound healing complications. The general time frame is 4-6 weeks.

Will a walker help me walk better after a DIEP reconstruction?

You will be restricted to “no lifting, pushing, or pulling” with your operative arm. Using a walker causes you to place your weight on your arms for walking which tenses the chest area and can damage the reconstruction.

When can I exercise?

You can begin walking as soon as you return home, but you may not feel like walking long distances at first, and it is important to listen to your body and not push yourself while your body is trying to heal. At 4-6 weeks, we allow you to gradually increase your activity. Most patients can resume light exercise including the stationary bicycle at 4-6 weeks post operatively. More strenuous exercise can typically be resumed at approximately 2-3 months post op. Please discuss with our office before resuming any exercise to ensure it is safe for you to do so in your specific situation.

Can I do abdominal exercises after surgery?

It is important that you do not do core strengthening activities such as sit ups or crunches before the 6 month mark. Using your abdominal muscles too soon can cause the wound to open. In most cases, when it is ok to resume abdominal exercise planks are actually the preferred exercise to evenly strengthen and tone abdominal muscles, rather than crunches.

How long do I have to wear the support binder?

Most patients feel that the binder helps relieve low back discomfort. We recommend 4-8 weeks depending on your abdominal swelling.

Do I wear the support binder during the day or at night?

You do not have to sleep in the binder. We recommend placing the binder on once you wake up in the morning and should be worn throughout the day.

When can I sleep on my stomach or side?

Please discuss with our office before transitioning to sleeping in a new position, including transitioning from your recliner to bed (if you had a DIEP/SIEA flap procedure), to determine if it is safe for you to do so. All patients are required to sleep on their back for a minimum of 4-6 weeks post operatively. Typically at 3 months post op, as long as their are no delays in your recovery, you can sleep on your stomach.

When can I wear deodorant?

Do not wear deodorant on the day of surgery. You may start wearing deodorant after you have been discharged home, unless you had a sentinel node biopsy, in which case you will need to wait until 1 week after surgery. There are no restrictions on the type of deodorant you may use.

When can I resume sexual activity?

Intimacy can be resumed 6 weeks post operatively, as long as there are no recovery complications or delays in healing. Please avoid direct pressure to the breasts until at least 3 months post operatively.

Can I massage my breasts?

Breasts can be lightly massaged at 2-3 months post operatively. Please avoid applying direct heat or cold to the breasts, this can result in burns or damage to the breast due to decreased breast sensation after mastectomy.

How soon can I drive after surgery?

Once you no longer have drains, you no longer are taking pain medication, and you feel confident in your ability, you can return to driving.

In the immediate post operative period you are at an increased risk for blood clots and precautions should be taken to avoid this. If you are driving longer than 2 hours, wear TED stockings and take breaks from sitting. You should only wear a lap belt, however if you must wear one that crosses your chest, be sure to place padding between you and the belt.

When can I travel?

DIEP patients can travel after their first post-operative visit. Symmetry and implant reconstruction patients may travel the day after surgery. There are no restrictions with flying and you can fly with drains. Remember no lifting/pushing/pulling until you have been cleared. If you are flying or driving longer than 2 hours, wear TED stockings and take breaks from sitting. You should only wear a lap belt, however if you must wear one that crosses your chest, be sure to put some sort of padding between you and the belt. You may only drive yourself when you are no longer taking pain medication and your drains have been removed, generally this is one to two weeks post-operatively and is procedure dependent.