Postoperative DIEP flap Recovery

Postoperative DIEP flap recovery, pain management, and progress with movement and activity, are some of the most common questions, concerns, and fears women ask me about. I wanted to share my photos in this blog to give women visual of progress I made during my recover from DIEP flap surgery. This was my recovery time and everyone will be different to some degree. I had very few “hiccups” in my recovery and it went as expected. The most difficult part for me was not pain, which was controlled quite well. My challenge came in lying still for five days. But as I frequently tell interested candidates, you have just been re-sculpted by an artist, your plastic surgeon. Treat your piece of art, your newly built breasts, with respect and nurture it back to health with patience and care. All good art work takes time!

My First Words After Waking Up

I have had surgeries before and clearly remember the recovery room. Not this time. I have no recollection of ever being in recovery. The first thing I remember after surgery is being in my room. It was late at night, 10pm. I remember waking up and looking at my new breasts as the nurses checked the Doppler to check the blood flow. I distinctly remember giggling and saying, “Nipples down. Nipples down”. Don’t ask me why but that’s what I said.

I really hesitate to show this picture because it’s very unflattering and scary, at best. But I want you to visibly see the quick progress made during your hospital stay. My face is visibly swollen from surgery, all normal and to be expected. My eyes still have remnants of the lubricant used when they tape your eyes shut during surgery. This is to prevent injury to your eyes and to help them from drying out. The stick you see with a green tip is a moist sponge dipped in water. I’ve never felt or tasted anything so wonderful in my life. The anesthesiologist uses an endotracheal tube to administer anesthesia as well as monitor your breathing during surgery. Having it in for the duration of surgery causes your throat to feel dry and irritated. This little green sponge was my friend the first few hours after I was wheeled back to my room. Although I have the “you look like you got hit by a Mac truck” look, trust me, I was in no pain and drifted in and out of sleep most of the night and into the next morning.

You will likely have oxygen, the tubing you see in my nose. They will keep a monitor on your finger. You really don’t this or the oxygen tubing. It is kept in your nose until you are able to breathe enough oxygen into your system on your own.

I think you know what the blue bag is for! I didn’t need it but they put it there just in case. I know very well nausea is a post-surgical problem for many, present company included. When I met my anesthesiologist and explained my past history of post-surgical nausea, she smiled at me with great assurance. She was going to give me whatever it took that day, a combination of drugs, to guarantee I would not get sick after surgery. Who wants that when you have an abdominal scar from hip to hip? She was on the money in her promise. The bag was never used in my case and I felt lucky.

Lots of Equipment for Monitoring

There is a lot of equipment here in this picture so I’m going to bullet these items with a quick run-down of their purpose. This was the morning after my surgery and I was still drifting in and out of sleep from the pain meds and anesthesia.

• Doppler probe monitors: Wire leading out of my surgical gown used to check the viability and blood flow of the newly built breasts. These will be checked frequently the first 24 hours post surgery as this is when the greatest risk of flap failure occurs. The white monitor box just to my right is what the nurses viewed for accurate numbers. My surgeon was actually able to monitor this on his phone from home the evening after my surgery. Fascinating technology! It is a lovely sound when the nurses come in to check them and you here the “whoosh, whoosh” sound of the blood flow. It reminded me of the sound you so wait to hear when they ultrasound your baby’s heartbeat.
• Call button and phone for contact. I made very few phone calls. The first two days just talking on the phone for more than five minutes wore me out.  Remember, your vocal chords are healing from the breathing tube.  Having throat lozenges to suck on helps this but just don’t go to sleep with one in your mouth!  BIG HINT HERE:  Make absolute sure you can reach the call button.  Sometimes it seems like it’s close but you really need it to almost be in your hand the first few days.  Duly noted, OK gals?
• IV’s in both hands: I was administered antibiotics and saline post surgery to eliminate the risk of infection as well as to keep your body fluids at normal levels
• Leg compression & Air tubes connected to a pump to prevent DVT: You run the greatest risk of developing blood clots in the days and first few weeks following surgery. You cannot see it in this picture but these leg compression sleeves will remain on you through most of your hospital stay while you are in bed. They will squeeze intermittently to promote blood flow since you are lying still for a great deal of your hospital stay.
• Pillows, pillows, pillows! Needed for support. I brought my fav from home, the light brown pillow you see by my left hand. I used it often and the nurses teased me about stealing it because it was so soft and squishy.
• Blood pressure monitor: Seen just above my head, will be used frequently by the PCA, patient care assistant, to monitor and record your blood pressure.
• Catheter: Again, and thankfully, you cannot see this but, a urinary catheter is kept in place for about 4 days post surgically to help drain your bladder. The day you get it out and are able to sit on the toilet yourself is a very blissful experience. Ah, the small blessings as you progress through surgery!

You will be kept in a “beach chair” position while you are in the hospital. This is to minimize the tension on your abdominal incision. If you laid flat it would cause too much pulling on the incision. This is also true for the new breast mounds. Those pillows come in handy for extra support.

Drum roll…. This is me just 24 hours, day 2, after surgery, smiling and awake, and in the chair. That was an experience I will not forget from my hospital stay, moving into the recliner. It took the nurse fully 30 minutes just to de-tangle all of the wires and IV’s, swing my legs over the bed, get me in a standing position, only to move me all of about 3 feet to get me into the recliner next to my bed. Touchdown! My legs felt like they weighed 200 pounds each! It was truly the strangest feeling of my hospital stay. I hear women talk about it but until you experience it you just don’t quite understand it.  It was not painful.  You simply just don’t know if your legs are even going to move they feel so heavy.

The black tube with the button on the end I am holding in my right hand is my PCA (patient controlled analgesia)… AKA… happy cocktail. You cannot over-medicate by using since it is regulated. This it is an important part of your healing. It has been well-documented proper control of pain management post-surgically greatly increases the healing process in patients. After about 2-3 days this is removed and you will be put on oral pain medication. It is important to communicate with the nurses and give them a fair assessment of your pain and tolerance of the medication.

I will admit, day two was my toughest day. I was still coming off of the anesthetics and my head was just crazy foggy. My plastic surgeon popped in to check on me during his morning rounds. He must have remembered I was an ESL teacher. I think he was testing my cognitive ability or trying to jump start my brain. He came in and said, “Como estas?” My response, “No muy bien”. The one thing I do remember is how clean he smelled as did the nurses who came in to check on me. It just made me want to jump out of bed and wash my hair and take a shower. I’d have to wait for my shower until dismissal day.

The last think I want to point out in this post are two other items in this picture. You will notice a plastic item in the foreground with numbers going up the side. It is called a spirometer. This is to strengthen your breathing and lung capacity after surgery. It’s the “gift that keeps on giving” while you’re recovering. Seriously, it is a necessary evil and for me became a bit of a personal challenge to get the little ball to the desired number. They will ask you to use this frequently, every hour the first few days. It’s not exactly fun but the exercise is quick. You blow into it first to get all the air out of your lungs then breathe in to fill your lungs. Makes sense, right? It is important ladies, so just think of it as part of your gym workout for the day.

Not a Happy Camper

Additionally you may be asked to do breathing exercises with an albuterol sulfate inhalation device. Sorry for the “middle finger” sign language while it was in my mouth. I wasn’t too happy my hubby took this picture so I strongly but quietly protested and let him know since I couldn’t talk at the time.  I didn’t like it when respiratory therapy walked into my room for this event. But, again, it was short, only about five minutes per treatment. I just didn’t particularly like the taste of it.

Gotta Love those Special Items

The final item I want to point out: Your cell phone ! Don’t leave home without it! OK, maybe it’s not necessary but anyone who knows me will understand why I always keep it nearby. I’m not sure of the clarity of my texts post surgery but it did help keep me sane and feeling connected while I recovered. My favorite card is one I received from a friend who knew the attachment to my cell phone all too well.

Note: Since writing this blog and having my surgery in 2014, the plastic surgery group I went to is now practicing ERAS protocol with shorter hospital stays.

 

Disclaimer

References made to my surgical group, surgeon and healthcare team are made because they are aligned with my values and met my criterion after I did research of their practices and success rates. Any other healthcare provider that displays the same skill, compassion education and outreach to patients will be given consideration and recognition on this website.  The information contained on this website is not a substitute for or should be construed as medical advice. Please consult a licensed physician for medical advice.