Preparing for Your Breast Reconstruction Surgery
Conveniently located to serve the areas of Lake Forest, Glenview and Grayslake, IL
Deep Inferior Epigastric Perforator Flap
At Northwestern Medicine Lake Forest Hospital Plastic and Reconstructive Surgery, we are committed to delivering excellent care. The following information will help you understand what to expect before, during and after your deep inferior epigastric perforator (DIEP) flap surgery.
Contents
Before your surgery
Pick up from your pharmacy the medications your surgeon prescribed at the time of your pre-operative visit. These may include pain medications, a muscle relaxant and a stool softener.
If you are taking a blood thinner, contact your prescribing physician for permission to stop taking it. If cleared to do so, stop taking your blood thinner 1 week before your surgery.
Consult the list we have provided for other medications and supplements you should stop taking before your scheduled surgery date.
On the day before your surgery (or on Friday if your surgery is on Monday), a nurse from the hospital will call and tell you what time to come to the hospital for your surgery.
Two days before your surgery, increase your intake of carbohydrate-rich foods, including pasta, rice, cereals, bread, beans, lentils, milk and fruit.
Do not eat solid food after midnight the day of your surgery.
On the day of your surgery
In the morning (3 hours before scheduled surgery time)
Drink 1 cup (8 ounces) of a clear carbohydrate-loaded drink, such as apple juice or a light-colored Gatorade (avoid red and purple).
If you have been instructed to take your regularly scheduled medications, take them with a small sip of water.
Do not eat or drink anything else before your surgery.
At the hospital
A member of your healthcare team will take you to the pre-operative area and complete a final checklist with you.
You will change into a hospital gown.
You will meet with the surgical team and discuss any last-minute questions you may have.
You will sign consent forms.
An IV will be started in a vein in your hand or arm so that you can receive fluid and medicine during the surgery.
Your surgeon may speak to a family member or friend to discuss your surgery. We recommend that you designate one spokesperson who can share information with other family members and friends. Your loved ones may be able to wait in the waiting room during your surgery
to be updated on your progress. Please review current visitor policies at nm.org/visitors.
You will wake up in the Post-anesthesia Care Unit (PACU). A nurse will check your blood pressure, pulse and incision often, ask you about your pain, and make sure you are comfortable. You will stay in the PACU for 1 to 3 hours until you are fully awake.
You may have:
- An oxygen mask over your face or tubing by your nose
- An IV giving you fluids and medicine
- A urinary catheter (thin, plastic tube) draining urine out of your bladder
Your surgeon will speak with you after surgery, but you may not remember the conversation if you are still recovering from anesthesia.
Visitors are not allowed in the PACU. When you are ready, a member of your care team will take you to your room.
After your surgery
Recovering in the hospital
- A monitor on your breast flap will allow the surgeon to check the flap’s blood flow. Nurses may use a portable Doppler device that uses ultrasound waves to assess the blood flow as well.
- For the first 12 hours after surgery, you will be on a clear liquid diet.
- On the first day after surgery, your urinary catheter will be removed, your IV fluids will be stopped, and you will begin eating a regular diet.
- Your healthcare team will help you sit up in a chair to eat your meals.
- You will walk 2 or 3 times a day with assistance.
- A nurse will teach you deep breathing and coughing exercises that will help prevent pneumonia.
- The goal is for you to go home on the second day after surgery.
Recovering at home
Pain medications
You will likely experience some pain after surgery; this is normal and expected. It is important to start taking over-the-counter pain medications on a regular schedule for the first 7 days after you are discharged from the hospital. The medications and schedule should include:
- Acetaminophen (Tylenol®), two 500-milligram (mg) tablets every 6 hours
- Your choice of either:
– Naproxen, 200 mg every 8 hours
– Ibuprofen (Advil®), 600 mg every 6 hours
For pain that is not controlled with the over-the-counter medications, your surgeon may prescribe the following medications:
- Tramadol, 50 mg every 6 hours as needed for pain
- Tizanidine, 2 mg twice daily as needed
- Gabapentin, 300 mg twice daily for 5 days
You may also be prescribed docusate sodium (Peri-Colace®), a stool softener, 100 mg daily as needed for constipation.
Care for your incisions
Follow the instructions provided separately for incision and drain care. As a reminder:
- Shower daily. Do not soak in a tub or spray water directly on your incisions. You may take a soapy wash cloth and gently dab your incisions.
- Do not place any ice packs or heating pads on your incisions and flap area.
- Do not lie flat for the first week. It is normal for your abdominal incision to feel tight.
Other guidelines
To prevent blood clots in your legs, it is important to get out of your chair or bed at least once every hour while you are awake and walk around for a few minutes. Use caution and ask for assistance if you feel dizzy from your pain medication.
Continue to walk several times each day and gradually increase your activity. Rest if you get tired.
Wear a supportive bra, but do not compress the flap. Wear loose blouses for the first 4 to 6 weeks.
You may resume taking other medications once you return home unless otherwise specified by your surgeon.
Your first post-operative visit will be 7 days after you are discharged from the hospital.
Resume driving only after your surgeon tells you it is OK. Do not drive while taking narcotic pain medication or sleeping pills.
When to call your surgeon
Contact your surgeon right away if you have any of these symptoms:
Temperature more than 100.4 degrees F Drainage or fluid from the incision that smells bad
Increased tenderness or soreness, or new redness or swelling at the incision site
Edges of the incision coming apart
Severe pain that is not controlled by medication Uncontrolled nausea or vomiting
Inability to drink fluids or keep fluids down
If you are unable to reach your surgeon, have someone drive you to the emergency department. If you believe your condition is life-threatening, call 911.
