Surgical compression garments for revision phase of Diep Flap breast reconstruction are an important part of healing. I can share with you what compression garments I was required to wear after phase two, the revision surgery of my DIEP flap breast reconstruction. However, know that each of you will experience your own individual recovery and your surgeon will tell you which garments to wear based on where the fat was extracted and liposuction was done. There are similarities in the revision surgery for implants and autologous flap fat grafting in that fat is injected into areas of the breast to achieve optimal aesthetic outcomes and to make the breasts look as natural as possible. Again, it will be an individual procedure based on your body composition and where the fill will come from and where it will be re-injected to achieve symmetry and contouring. Surgeons will discuss with you their method and reasoning for fat grafting both in autologous free flap breast reconstruction and for implants, if deemed necessary.
The difference between the fat fill in autologous free flap surgery and implants is this. Phase two, revision, of Diep flap surgery, autologous free flap like the procedure I had done, involves both the fat injections to achieve optimal aesthetic outcomes, scar revision to minimize the thickness and overall aesthetics of abdominal and donor site scars and in cases of women who have not had a nipple sparring mastectomy, the surgeon may consider rebuilding the nipple at that time using the patient’s own tissue. Implant phase two involves removing the tissue expander that was put in place a few weeks or months prior to phase two, exchanging that for the implant and if necessary, filling in areas to achieve the optimal contouring and aesthetic outcomes.
First I want to emphasize again the importance of finding a qualified plastic surgeon who knows the technique of fat grafting in the contouring phase of reconstructive surgery. I want to share with you the specific experience I had the morning of my surgery to give you a sense of achieving optimal patient outcomes. I truly do believe that patient outcomes correlate directly to a plastic surgeon that has the following qualifications. First and foremost, they are board certified by the American Society of Plastic Surgeons. Secondly, they are very familiar with the nature of fat grafting and have successfully performed many of these procedures, and lastly, the plastic surgeon has keen, artistic skills and vision.
The morning of my surgery I was sitting on the surgical bed being prepped by the nurses and given information and instruction by the anesthesiologist. My plastic surgeon then walked into the room. My sister was with me. She is a nurse and politely asked if she needed to step out of the room while he worked his magic with the marking pen. Because I knew the confidence level of my plastic surgeon, I knew he would be agreeable to her staying there. It was only for my benefit because I wanted her to see firsthand this surgeon’s skill and expertise and perhaps help me spread the word about his talent.
He asked me if I could hop down off of the bed so he could take a look. That is when the artistic eye came into play. He politely gathered my gown with one hand to cover my private area. He got down on one knee and began taking a look at the entire contour of my body. He was examining the areas that would achieve the most favorable balance in my body. He began marking my thighs. He knew that was an area I had favorable fat deposits that not only would balance my body out after phase two but also achieve optimal aesthetic outcomes for fat grafting around my breast area. I was covered with marks. We have developed a positive, and at times, jovial personal relationship but when he got out that pen and I saw that he had his game face on, I was silent. I let him do his magic. And that he did!
I woke up with a full body, below my breasts to the middle of my calves, compression garment. I didn’t like it but it felt good in a medical sort of way. I could tell it was giving me excellent support. This is a very vascular surgery so I was bruised from the liposuction to the outside my thighs and yes, it hurt but only for about 3 days, honestly! It is tantamount to a good workout at the gym. The best thing about that garment, it was crotch-less! Not having to pull that garment on and off every time you had to use the restroom made it far easier. It did make going to the bathroom very easy after you achieved the optimal opening method. Until that time, I had to remove it a couple of times to clean before I figured out the magic squatting position. My sister and I had more than a few laughs over that! I loved her drying method in the hotel room and we just about burned the hairdryer up.
You will have small cannula incisions where the fat was extracted that will be covered by steri strips for a few days. Mine are hardly visible now. You will also be placed back into a surgical bra to help the fat deposits get reabsorbed properly into the areas where they were injected. Unlike phase one, there is no massaging this time. That fat needs to be absorbed and become a part of your body so no touching, no massaging! The good news… NO DRAINS this time.
You will wear your assigned compression garments according to your plastic surgeon’s instructions. This will likely be for a couple of weeks, 24/7 and then you can transition into a lighter garment just as you did after phase one. These lighter garments can be purchased at local department stores such as Walmart, Macy’s, Penny’s or Kohl’s. You cannot sleep on your stomach or side for 4 weeks. Let the fat do its work and settle into the areas it was injected into. I will say that putting my compression garment on for the two weeks following surgery was a workout after getting out of the shower. It was a strong garment and I needed to sit down and rest after I finally had it on. Remember, it’s temporary and as they say, “This too shall pass”. Sitting in the sun is not recommended as it may cause undo swelling to the surgical area.
Compression garments are part of the surgery but they are temporary. I hope this helps you to understand the importance of these garments for phase two and the contouring and symmetry part of breast reconstruction.