DIEP Flap Breast Reconstruction Guide

“We understand that being diagnosed with breast cancer and facing a mastectomy is overwhelming. Our goal is to help you feel whole again. My team and I will support you at every step – from your first consultation through surgery and recovery. This guide explains what to expect during a DIEP flap breast reconstruction. Please don’t hesitate to reach out with any questions or concerns. We are here for you, and together we will get you through this journey.” – Dr. Samarth Gupta

Your journey begins with a thorough consultation. During this visit, Dr. Gupta will explain the DIEP flap procedure, examine you to assess your suitability (checking your abdomen for available tissue, etc.), and discuss timing (immediate vs. delayed reconstruction). You’ll have plenty of time to ask questions. Often, a breast reconstruction nurse or team member will also be present or available to talk you through details after you meet the doctor. This is the time to share your goals and concerns. We encourage you to bring a family member if you’d like another set of ears, as a lot of information is covered. You may also receive educational materials or be invited to speak with past patients who have had DIEP flaps, which many find helpful.

Key points discussed will include: what the surgery involves, recovery time, scar locations, and potential need for smaller follow-up surgeries (like nipple reconstruction). Dr. Gupta will also review your medical history to ensure it’s safe to proceed – factors like previous surgeries or health conditions will be considered.

A DIEP flap uses skin and fat from your lower belly to reconstruct your breast, without taking any muscle. It’s like getting a tummy tuck and a breast reconstruction at once. The skin/fat is completely removed from your tummy area (along with tiny blood vessels) and then reattached to blood vessels in your chest using microsurgery. The result is a warm, living tissue breast mound.

Why patients choose DIEP flap:

• Natural feel and appearance: It’s your own tissue, so the breast can look and feel very natural – often more so than an implant. It also ages and changes with you.
• No muscle sacrifice: Your abdominal muscles are preserved, which maintains your core strength and minimizes hernia risk. This is a big improvement over older techniques.
• Long-term solution: There’s no foreign implant that might need replacement; the reconstruction should last your lifetime.
• Tummy tuck bonus: Removing excess tummy skin/fat gives you a flatter abdomen. Many patients enjoy this secondary benefit.

We offer immediate reconstruction (at the same time as mastectomy) and delayed reconstruction (months or years later) options. Immediate can spare you the experience of ever being without a breast, whereas delayed might be necessary if you need other treatments first. Both approaches can yield excellent outcomes – Dr. Gupta will help determine which is best for you.

Once you decide to proceed, our team will guide you through pre-surgery preparations:

• Pre-op Tests: You’ll undergo routine checks (bloodwork, etc.), and an abdominal CT scan to map your blood vessels.
• Stop smoking: If you smoke, stop at least 3 weeks before surgery – this is critical to healing. We can help with cessation resources.
• Avoid certain medications: We’ll advise you to avoid aspirin, blood thinners, and herbal supplements in the weeks leading up to surgery, as some can increase bleeding. Always inform us of everything you’re taking.
• Fitness & nutrition: Try to eat well and stay lightly active (as you’re able) pre-surgery. Every bit of strength helps in recovery.
• Pack your hospital bag: Use our checklist (below) for what to bring. Key items include: front-opening loose pajamas, a larger-size front-clasp sports bra, slippers, basic toiletries, your regular meds, and importantly, leave valuables at home.

Hospital Bag Checklist: Slippers; Bathrobe; 2-3 pairs of button-up or zip-front nightwear; 1-2 front-opening bras (one band size up); Loose outfit to wear home (no tight waistbands); Personal toiletries (mild soap, toothbrush, lip balm, moisturizer); Any daily medications; Phone charger (and phone); Insurance card/papers (if needed).

On the day of your surgery, arrive at the hospital at the instructed time (usually 2 hours before surgery). You’ll be admitted and meet the team again (surgeon, anesthesiologist, nurses).

Key points for surgery day:

• You’ll have the surgical sites marked on your body with a pen (don’t be alarmed – it’s to guide the incisions).
• You’ll review consent forms and have a chance for last-minute questions.
• Then you’ll be taken to the operating room, put under general anesthesia, and the surgery begins.

Surgery length: A DIEP flap surgery typically takes 4-5 hours. It could be longer if it’s double-sided or if there are additional procedures. It’s a long day, but you’ll be asleep and monitored the whole time.

After surgery, you’ll wake up in recovery, then move to your ward/HDU bed. You may feel groggy or nauseous initially (the nurses can give medication for nausea if needed). Expect to feel sore and tired, but relief that the surgery is over.

The first 3-5 days after surgery will be in the hospital. Here’s what that looks like:

• Pain control: You’ll have IV pain meds or a PCA pump at first. Don’t worry, we’ll keep you comfortable.
• Tubes & gadgets: You’ll have some medical attachments: IV drip for fluids, a catheter to drain your bladder, and a few drains from your surgical sites. You’ll also have compression stockings to prevent clots. These might feel odd, but they’re temporary.
• Monitoring: The nurses will check your new breast (flap) frequently – they ensure blood flow is good. Your vital signs will be checked often too. This is routine after microsurgery.
• Positioning: You’ll lie on your back, slightly propped up, with pillows under your knees to reduce strain on your tummy. We’ll keep you warm to help circulation to the flap. You might be in a high-dependency unit for closer observation the first night.
• Activity: On Day 1 after surgery, you’ll mostly rest in bed, do breathing exercises, and maybe sit up at the edge of the bed with help. By Day 2, physiotherapists will help you stand and take a few steps, hunched over a bit (totally normal after a tummy tuck). Each day you’ll move a little more. We’ll also start gentle arm exercises to keep your shoulder from getting stiff.
• Eating: You can usually start with sips of water then clear fluids later the first day. By the next morning, most patients can have a light meal. Your appetite might be low initially – small frequent snacks are fine. We encourage a high-protein diet to aid healing.
• Visitors: Keep visits short and sweet initially. You’ll be drowsy and won’t have energy for long chats on day 1. From day 2 onward, you can have a couple of visitors at a time, but make sure you also get enough rest.

Before discharge, our team will ensure you’re walking slowly but steadily, your pain is manageable on oral meds, and you’re comfortable taking care of yourself with some help at home. We’ll remove any drains that are ready to come out (most, if not all, by day 4-5). You’ll get a list of instructions and follow-up appointments.

Heading home is a big milestone! Here’s how to manage once you’re home:

• Rest & routine: Take it easy for the first 2 weeks. You will tire quickly, so plan short activity periods and lots of rest. It’s normal to need naps.
• Wound care: You’ll likely have either surgical glue or tapes on your incisions. Follow the nurse’s advice on keeping them clean. Most sutures are dissolvable. If you have any small open areas or scabs, keep them clean and dry. You can usually shower by the time you’re home (often within 2-3 days post-op) – pat incisions dry gently. No soaking in tubs until cleared (typically 6 weeks).
• Pain management: Continue your prescribed pain meds. By 2 weeks, you might be able to reduce the dosage, but don’t stop abruptly if you’re not ready. Manage constipation from pain meds with stool softeners, prune juice, etc., as needed.
• Support garment: Wear your abdominal binder or compression garment as instructed (usually all day/night for 6 weeks). This helps with swelling and support. Also wear your support bra continuously (except when showering) for the first several weeks or as advised.
• Activity: Keep walking daily – short, frequent walks (even 5-10 minutes around the house or outside) are great to boost circulation and mood. No lifting more than 2 kg) and no driving yet. You can do very gentle arm stretches and shoulder rolls – your physio will give specific exercises. Avoid reaching overhead or any fast upper-body movements for a few weeks.
• Sleeping: You may continue sleeping on your back with pillows propping you up. Some patients use a recliner. By about 4-6 weeks you might be comfier on your side (with a pillow under your belly or between knees for support).
• Follow-ups: Attend all your follow-up appointments. Usually around 10-14 days post-op you’ll see the nurse or doctor to check wounds and remove any remaining drains or stitches. You might also see the physiotherapist around that time. Then a 6-week check with Dr. Gupta to discuss progress and next steps.

Signs to watch: If you develop a fever over 38°C, notice increasing redness/swelling at the incision, have sudden pain or swelling in one leg, or any issue that worries you, call us right away. We have a 24-hour contact line for post-op patients. Don’t wait – it’s always better to check if something seems off.

Recovery is gradual. Here’s a rough timeline for returning to activities (individual experiences vary):

• Weeks 1-2: Rest and basic self-care. Walk around the house. No chores except maybe light easy tasks. No driving. Focus on healing.
• Weeks 3-4: You’ll feel a bit more energy. You can do light household tasks like washing dishes or making a light meal. Still avoid lifting anything heavy or stretching the arm too far. If you work a sedentary job, you might start part-time work from home if you feel up to it, but many wait until ~6 weeks.
• Week 6: Typically okay to resume driving now (with doctor’s clearance). Many women start doing more normal daily activities by 6 weeks – e.g., light cleaning, shopping for groceries (with light bags). Gentle exercise like stationary biking or brisk walking can start. Still avoid any high-impact or abdominal straining exercises.
• Weeks 8-12: By 2-3 months, you’re returning to most of your routine. You can usually start more active workouts (jogging, non-contact sports, yoga) around 2 months, building intensity slowly. At 3 months, most restrictions are lifted – you can even begin more strenuous activities, and if you have kids, you can pick them up now.
• Work: Many patients return to work around 6-8 weeks if it’s a desk job, or closer to 12 weeks for physical jobs. It’s highly variable – listen to your body and consult Dr. Gupta on timing.
• Long term: By 6 months, you’ll likely feel fully back to normal, though scars will continue maturing up to 18 months. You can engage in almost any activity you want without thinking much about the surgery.

Your DIEP flap is the major step, but some patients choose or need minor tweaks later for the best result:

• Nipple & Areola Reconstruction: If you want a nipple on your reconstructed breast, we can create one under local anesthesia a few months after your main surgery. Later, the areola can be tattooed to add color and match the other side. These are outpatient procedures with minimal downtime.
• Fat Grafting: If there’s a slight contour irregularity, Dr. Gupta can perform fat grafting (lipofilling) down the line, which uses liposuctioned fat from, say, your thigh to fill in any dimples in the breast. This fine-tunes the shape. Often done 3-6 months post-op if needed.
• Scar Revision or “Dog Ear” removal: If the ends of your abdominal scar have puckers (dog ears) or if a scar is not healing as thinly as hoped, a small revision can be done once you’re healed (usually a minor procedure).
• Opposite Breast Symmetry: For the sake of symmetry, some women opt for a breast lift or reduction on the other side so both breasts match in size/position. This could be done around 6-12 months after reconstruction, depending on how things settle. It’s typically a shorter surgery and recovery.

All these steps are optional. Dr. Gupta will discuss them during your follow-ups if relevant. The goal is to make sure you are happy with your results.