This is a question I wanted to write about after attending PSTM17 in Orlando as a patient advocate. Speaking to ASPS board certified plastic surgeons at the meeting afforded me the opportunity to understand the answer to, how long does a DIEP flap breast reconstruction surgery take?
It is an intricate, microsurgical procedure that includes incisions and work on both the abdominal area and the breast area. The assumption is, the surgery is long. In fact, when assessing my own DIEP flap, I often report my DIEP flap lasted nine hours. What we don’t often take into consideration is what the surgery entails from start to finish.
I reviewed my own surgical report to write this blog. I also spoke with plastic surgeons at PSTM17 and wanted to share some important points of discussion. I gathered information from my sister, a nurse, who also shared some pre-op and post op data we don’t often think of. I have always included the entry time at hospital to awake time and being wheeled back to my room. I know now this is not an accurate report of the time spent for my actual DIEP flap breast reconstruction.
Here are some points to consider:
PRE-OP
This is the time spent gathering health data including but not limited to recording weight, blood pressure, starting IV’s, talking to the anesthesiologist, being marked by your plastic surgeon, compression stocking placement on your legs, and the surgical team speaking to your care giver about communication on your progress throughout the day.
Prep in the OR
You will be sedated just before being taken to the operating room. After you reach the operating room there are still several preparatory steps required before surgery can start.
First, you will be put to sleep.
Monitoring of your heart rate and your other vital signs will begin. The OR nurse will place your Foley catheter. Your arms will be extended and secured, your heels will be padded. A grounding pad will be placed on skin not in the surgical site (eg thigh), so you are not shocked by the electrical cautery devices used during surgery to stop bleeding. IV fluids are started by the anesthesia team. TED (thromboembolism-deterrent hose) with SCDs (sequential compression devices) are placed over your compression stockings to minimize the risk of a DVT (blood clot).
Actual Time for a DIEP flap
Your chest and abdomen will be prepped and draped. Soon after this time the plastic surgeon will begin his work. Only now does your DIEP flap breast reconstruction begin. If you are having immediate breast reconstruction, the breast surgeon will start first; your plastic surgeon may or may not start at the same time depending on your team’s specific approach.
Post-op
After the microsurgeon works his magic and all your incisions have been sutured closed, your surgical sites will be cleaned and dressings applied. You may or may not have surgical garments placed (eg bra and abdominal binder) depending on your surgeon’s preference. You will be slowly awakened from anesthesia and transferred from the operating table to a recovery bed. You are then taken to a post anesthesia care unit until you have recovered enough to be safely transferred to your room. In some institutions you will be taken to the ICU for the first day (or 2) after surgery. In my case, I was taken to a “breast unit” which is a regular hospital floor.
Considering all the pre-op and post-op prep, you can roughly count on at least an hour on either side of the work done by your plastic surgeon to do your DIEP flap procedure. Sometimes the additional pre-op and/or post-op time will be longer. I wake up very slowly from anesthesia. This added time before I was wheeled to my room.
There will be individual conditions warranting longer times to perform a DIEP. Unilateral DIEP flaps will take a shorter time than bi-lateral DIEP flaps. In high-volume centers performing DIEP flap breast reconstruction regularly, the time will be shorter due to the improved efficiency that typically comes with familiarity and experience. I had two microsurgeons performing my DIEP flap. There was a primary plastic surgeon along with a “co-surgeon” who worked together. This, too, can shorten the time of the procedure.
I hope this detailed information helps the reader understand the actual time involved for DIEP flap surgery. I think it is a valid question to ask your plastic surgeon at your initial consult what the general time is for them to complete a DIEP flap procedure. I know now mine did not take the nine hours I report. The time in pre-op and post-op preparation is truly not part of the total time it takes to perform this type of breast reconstruction.
