Recovery after DIEP flap breast reconstruction

The DIEP flap breast reconstruction is today's most advanced form of breast reconstruction. The procedure uses the patient's lower abdominal skin and fat to reconstruct a breast after mastectomy but unlike the TRAM flap procedure, preserves all the abdominal muscles.

Benefits of the DIEP flap procedure over implant reconstruction include:

• No foreign objects. Only the patient's skin and fat are used.
• The reconstructed breast(s) are warm and soft to the touch, not cool like some implant reconstructions.
• Sensory nerve reconstruction can be performed with the DIEP flap (and SIEA flap) to restore sensation after mastectomy.
• The reconstructed breast is permanent. Unlike some implant patients, DIEP patients do not experience increasing breast hardening (capsular contracture) or implant ruptures over time, and rarely need additional surgery once the reconstructive process is complete.

When considering DIEP flap breast reconstruction, a big concern for many patients is post-operative pain. Many patients believe reconstruction with implants is the least painful option since the procedure is less invasive and has a shorter operative time than DIEP flap. However, studies have shown this is not the case.

Although the DIEP flap procedure is more invasive and requires a longer surgery than traditional (subpectoral) tissue expander/implant reconstruction, DIEP flap patients experience less pain for a couple of reasons:

• Minimal muscle trauma. Most implant-based reconstructions involve placing the implant under the chest muscle. This requires releasing and lifting the "pec" muscle off the chest wall to create a pocket for the implant. This is painful and adds to patient recovery.
• For patients who are not candidates for direct-to-implant procedures, tissue expanders are filled over time to stretch the overlying breast tissues. This expansion process can be very uncomfortable for patients when the expander is placed under the muscle.

Healing and recovery after DIEP flap breast reconstruction can be significantly easier than most patients think. With the implementation of ERAS Protocols, most patients experience little discomfort after surgery, require little if any narcotics, and can be discharged from the hospital after 3 days or less.

Here is a quick snapshot of what to expect:

Week 1

First 2-3 days are spent in the hospital to recover. Patients should expect to be walking multiple times the day after surgery and can gradually increase walking time and distance as they feel comfortable. By day 3, most patients can head home.

Week 2

If drains are used they are removed once drain output is low enough. Patients can continue to increase their cardio endurance and begin easing into post-operative range of motion arm exercises. By the end of the second week patients can switch from surgical garments to a bra and panty girdle (be sure to get clearance from your doctor or nurse first).

Week 3-4

Patients should feel more capable of doing things on their own. Patients with low impact desk jobs can return to work.

Week 5-6

Most patients are getting back to their normal routine. By week six there are no restrictions.

The DIEP flap is an excellent alternative to implants for patients seeking to recreate a warm, soft, "natural" breast after mastectomy. ERAS protocols have minimized post-operative discomfort and shortened recovery significantly, further strengthening the DIEP flap's position as today's "gold standard" in breast reconstruction.