Length of Hospital Stay: DIEP flap Breast Reconstruction
The length of your hospital stay after DIEP flap breast reconstruction will likely be four to five days. My surgery was on a Monday morning, I was in my room by 10 pm that evening, and I left the hospital on Saturday morning. Although my surgeon came in to ask if I was ready to leave on Friday, I stayed one extra day only because I didn’t feel strong enough to go back to the vacation rental. He gave me the option to stay another night based on how I was feeling. Remember, I flew in from out-of-town, 800 miles out of town! I had to be 100% positive in my mind that going back to a foreign environment, the vacation rental, was going to be conducive to my healing process for the week I would be there following my release from the hospital.
Diet and Appetite in Hospital
So what happens after you wake up and you begin the slow recovery process while you’re in the hospital? The first order of business is what you’re going to eat. It is very likely that you won’t have much of an appetite the first 24-48 hours and perhaps beyond that. I was absolutely amazed at my flat, tight stomach when I got a first look. I was certain I could bounce a quarter off of it. You will not have the same appetite in part because you simply don’t have the room you used to since your extra tummy skin and fat has been moved up to make your new breasts. Additionally, the anesthetic and medication you are on often suppresses your appetite.
What is important is that you maintain your fluids and at least try to eat. You will be on a liquid diet until you do the all important “fairy dusting”, AKA, flatus, fart, passing gas… call it what you will but that was my indicator that I could get off of the lovely liquid bouillon and begin eating solid food. There are certain events in the hospital during those first couple of days that are rather vague to me. But, one thing I do remember is having the hospital chaplain come into my room. I was raised Roman Catholic and checked that off on the hospital forms as my religious preference the morning of admittance. They came into my room to ask if I wanted to receive Communion. I was a very compliant patient. I looked at them and said, “I’m not sure. I’m not on solid food yet.” I don’t know why but I think of that event now and it makes me chuckle just wondering what they were thinking. They quietly gave me a blessing and walked out.
Getting Up and Moving = Moving the System
Maria, my healing angel nurse.
Getting up and walking is so important to get your system going and working again. It amazed me that my nurse got all those hoses, catheter and all attached to me or the pole so I could do those laps.I 
walked the halls with this beautiful nurse, Maria, who became my healing angel in the hospital. This young lady worked five, twelve hour shifts in a row so I saw a lot of her that week. She called me “darlin’” when she came into the room and kept asking me if I had passed any “fairy dust” yet. Finally, after a long walk in the halls with no luck and my husband standing next to me it happened!! I was doing some gentle squats to strengthen my legs and wah-la! Fairy dust! I started giggling and all I could say was, “That was EPIC!” So, on the third day of my hospital stay, Wednesday, I got my first full meal. It was the most beautiful plate of fruit I had ever seen. Of course, I couldn’t eat the whole thing but it tasted like magic to me.
Protein is a very important part of the healing process after surgery. Eat as much as you can from the plates of food they give you, eggs, meat, legumes. They will bring you Ensure to boost your protein levels. Drink as much water as is comfortable. Remember, you will have a catheter so getting up to use the restroom isn’t an issue. They will also give you Colace daily to get the ol’ system humming again. If they don’t, ask for it. You likely will not have your first bowel movement until the week you leave the hospital. I actually took a Colace tablet two nights before my surgery just to make sure my system would stay on track. I wasn’t sure if I was supposed to take it before surgery so I called the doctor on weekend duty the Saturday afternoon before my surgery. Oddly enough, it was the surgeon who assisted my main surgeon in the operating room that day. I have never personally met him but I actually spoke to him two days before my surgery. A coincidence. Perhaps I’ll be fortunate enough to meet him in person some day and thank him for his skill.
Dietary Restrictions in Hospital
The hardest part for me was not having coffee. My surgical group has you refrain from coffee, chocolate and alcohol two weeks prior to surgery and four to six weeks after surgery. I love my morning coffee. My husband would walk in with a Starbucks in the morning and I would make him open it up and let me smell it just to get my “fix”. He was so sweet and told me he could wait to finish it outside but I was ready 
for his company and told him he could just bring it up to the room so I could at least enjoy the aroma. Then he proceeded to beat me in a game of Backgammon. There is something fundamentally wrong about not letting the patient win! All in good fun and it sure helped pass some time while healing.
Freshening Up During Recovery in Hospital
Although I brought a robe as suggested, I honestly didn’t need it. The PCA, patient care assistants, were very good at covering your back side with an extra gown. The blue socks they give you in the hospital with the non-grip soles are certainly good enough for a lap around the nursing ward; however, it’s not a bad idea either to slip into an easy pair of non-skid slippers. They want you to get up and walk a couple of times a day. I was up more than that and would challenge myself to walk more than one lap of the floor. I think it helped me sleep better when I got back in bed and I certainly felt good doing it as it helped me stave off boredom.
It’s a bit difficult to brush your own hair as they don’t want you to raise your arms above your head to 
protect incisions and the newly transferred flaps. Bring a small brush and have your spouse, friend, or helper give your hair a brush once in a while. The PCA will give you a shower and wash your hair while you sit on a shower chair the day you go home. It’s a glorious experience and feels wonderful but will indeed wear you out the first time.
The pre-loaded, pocket-size toothbrushes, like Colgate wisps, come in so handy and I made sure they were within my reach. I was always concerned about my breath because all the healthcare providers from your surgeon to the nurses and PCA’s are very close to your face. I would use them to cleanse my breath a couple of times a day.
Long Nights during Hospital Recovery
Nighttime seemed to drag by the longest for me. My husband did not stay with me at night. He is not fond of hospitals to begin with and I wanted him to have a break so I could enjoy his company during the day. It’s difficult to be a care-giver and I simply wanted him to get some good rest back at the vacation rental. But, it did make for long evenings. It is difficult to get more than a couple of hours of good sleep with all the monitoring they do while you are recovering. There is your temperature to be taken, your blood pressure to be monitored, Doppler check, you will call the nurse when you’re thirsty or need to get up for a walk, you need to breathe into the spiro-meter to avoid getting pneumonia. The nursing staff worked hard to keep it very quiet and dark at night but there were times when the darkness seemed to last forever when you couldn’t sleep.
Pain Management in the Hospital
I do want to point out that I had very little pain during my entire hospital stay. That is a fear for many women before this surgery. Pain management is imperative for easier and more productive healing. The nurses at Methodist Hospital where I had my surgery are there exclusively for women who have had breast reconstruction. They are in tune to your needs and monitor your pain carefully.
Other aspects of your hospital stay will be addressed in separate posts: surgical garments, visitors, preparing to go home, to mention a few. There are times when the minutes seems to go by in slow motion but before you know it they will be placing you in the wheelchair and your hospital stay will come to an end.
Please note: Since writing this post, there are now new protocols, ERAS, for recovery and quicker release from hospital. Progress in Breast Reconstruction!