MICROSURGICAL BREAST RECONSTRUCTION (DIEP FLAP)

About Microsurgical Breast Reconstruction (Diep Flap)

DIEP Flap:  The Deep Inferior Epigastric Perforator (DIEP) Flap is one of the most current and state-of-the-art methods to elegantly reconstruct a breast and limit the damage to the donor site.  It is a “muscle-sparing” technique and can be a “nerve-sparing” technique as well.  This technique uses the same abdominal skin and fat that used in a TRAM Flap and is the same tissue that is removed in a standard “Tummy Tuck.”  The significant difference between a DIEP Flap and the TRAM Flap is that the DIEP Flap saves all the rectus abdominus muscle that the TRAM Flap removes.  It significantly reduces the trauma to the abdominal donor site and spares the abdominal muscles.  The skin and fat of the abdomen around the belly button is relocated onto the chest to reconstruct the breast.

This Perforator-based Microsurgical Breast Reconstruction is usually a slightly longer procedure because dissecting the blood vessel through the muscle is difficult and takes a high degree of skill.  This extra time is worth the effort because it saves the patient’s abdominal muscles, which helps to speed recovery and prevent long-term donor site/abdominal weakness.  Only approximately 60 surgeons across the United States perform this operation, less than 5% of all Plastic Surgeons.  It is the only surgery where there is a possibility to reconstruct the nerves that go to the breast skin.

The DIEP Flap is the preferred method for Autologous Breast Reconstruction performed by the surgeons of the Rocky Mountain Center for Breast Surgery.

Who Is The Best Candidate For DIEP Flaps?

• Patients who desire immediate or delayed reconstruction
• Patients with few serious medical problems who desire a Breast Reconstruction using their own skin and fat
• Patients who want a less risk of abdominal weakness or bulging
• Patients who have extra tissue, skin and fat, in their lower abdomen and desire a better abdominal contour similar to a tummy tuck
• Patients with the emotional strength and support group to be able to cope with an occasional set-back or loss of the Flap (less than 3% risk of Flap loss) 
• Patients who understand that extra “investment” in using their own skin and fat is likely to produce a more natural, longer lasting result than an Implant-Based reconstruction

Post-operative Instructions For DIEP Flap:

What should I expect with regards to my body?

• You will have a drain in the breast and both sides of the abdomen.  All of your sutures will be under the skin. 
• You will either have a layer of skin glue that resembles clear nail polish or steri-strips, similar to tape, on all of your incisions. 
• A wire will be attached to each flap for post-operative monitoring.

What activities should I avoid?

• Do not wear a bra for at least three weeks.  We will provide you with camisoles. 
• No driving for 3 weeks or longer if taking prescription pain medication. 
  
• No sexual activity for 3 weeks.
  
• No smoking for 1 week after surgery.
  
• No lifting over 5 pounds for 4 weeks.                 
  
• No heavy exercise for 4 weeks (tennis, yoga, Pilates, jogging, aerobics, weights, etc.)
  
• Avoid standing straight at the waist for the 1 week. 
  
• No abdominal exercises for 8 (+) weeks.
  
• Flying or traveling is permitted after the first week as tolerated.

How do I sleep?

• Week 1-2:  2 pillows behind the knees and under your head is recommended, but some patients find a recliner to be most comfortable to have the upper body supported. 
  
• Week 2-4:  Sleeping on your side and back is permitted, but not on your stomach. 
• Week 5 and beyond:  No restrictions.
• Note:  Occasionally sleeping medication will be necessary.  Please ask your surgeon if needed. 

Medications

• Take the prescribed antibiotic medication as directed after being discharged. 
• Take pain medication as needed for up to 4 weeks in moderation and at night if needed. 
• Stool softeners are recommended while on pain medication since narcotics cause constipation.
• Do not take Motrin/Ibuprofen or Aspirin products for 3 weeks after surgery.

What can I eat and drink?

• Light meals are good for the first week after surgery.
• Avoid alcohol while on pain medication. 

How do I care for my drains?

• Empty and record in cc amounts of your drainage (a drain kit with instructions will be given to you in the hospital).
• It is not necessary to call daily; however, if you have questions or the drainage appears cloudy, please call the office. 
• A visiting nurse will be seeing you after discharge.

When can I shower?

• You can shower 2-3 days after your surgery in the hospital or once at home.
• Support your drains in the shower.

When can I return to work?

• Return to work is possibly within 4-6 weeks; however, some patients take up to 12 weeks before returning to work.
• If your job involves lifting, please allow 8-12 weeks before returning to work.

When should I call my doctor?

• Persistent fever of 101.5 or higher
  
• Spreading bright pink discoloration
  
• Rapidly expanding swelling under the skin
  
• Pus drainage from the incisions
  
• Severe pain that is not relieved by your medication

What can be expected post-operatively?

• Moderate swelling in the reconstructed breast, underarm, and abdomen for 4-6 weeks
  
• Numbness in the reconstructed breast, abdomen, and possibly upper arm for 6-12 months
  
• Tightness in the abdomen region for 1-3 months—a binder/girdle will support the back and abdomen (this is provided and will be worn after drains are removed)

When can I start physical therapy?

• Phase I exercises are started approximately 1-2 days after surgery
  
• Phase II exercises are started 14 days after surgery
  
• Abdominal exercises may resume no sooner than 8 weeks after surgery

When will follow-up visits be necessary?

• The first follow-up visit will be approximately 1 week after surgery.  Drains will be removed at this visit, depending on the output of fluids as well as the Doppler Wire. 
• The next follow-up visit will be 2-3 weeks after surgery, and the remaining follow-up visits will be bi-monthly until the reconstruction is complete. 
• After your reconstruction is complete, you will be seen yearly. 

When will further touch-up surgery be performed?

• Nipple reconstruction with touch-up of the breast reconstruction, abdominal revision and surgery or the opposite breast is performed approximately 3-4 months after the initial surgery. 
• If chemotherapy is necessary, the secondary procedures are performed no sooner than 1 month after chemotherapy is completed. 
• If radiation therapy is recommended, the scheduling of the secondary procedures, as well as the initial reconstruction may be delayed. 
• All touch-up procedures are generally outpatient procedures. 
• Nipple tattoo is the last step and is performed no sooner than 3 months after the nipple reconstruction.