DIEP Flap Recovery Tips

What is DIEP Flap?

So if you’ve come across this post and aren’t familiar with the term, DIEP stands for ‘deep inferior epigastric perforator’. It’s a form of breast reconstruction in which, in a nutshell, a microsurgeon transplants a football-shaped area of skin (if needed), tissue, fat and blood vessels from your lower abdomen to your breast/s. And unlike the TRAM flap, there’s no muscle trauma involved. The biggest concern with DIEP is the blood vessels connecting properly, so they’ll keep you in the ICU a couple of nights to make sure the blood flow is working and healthy. And while it’s a doozy of a procedure, in the end you have breasts that are completely you…no implants (which would need replacing at some point…this was the big selling point for me).

I’d like to keep this post about recovering from DIEP flap, but if you’re interested in knowing the path that led me to this surgery, I’ll add a brief-ish version of my story at the end of this post.

And now on to my tips for recovering from DIEP flap!

Walk, walk, walk

If you’re not already a regular exerciser, do yourself a favor and get out and walk as much as possible prior to surgery. Makes a HUGE difference in recovery, and your legs will be stronger…you’ll need to rely on them a lot since you won’t be able to use your abs and arms much in the beginning. They want you walking ASAP after surgery, and I promise it’s much easier if you’ve already been doing it!

Meals

I highly recommend making and freezing some meals to have on hand. My husband was a champ about cooking (typically my realm), but it was great to have some premade options that could be easily heated up on particularly tiresome days. Shoot for high protein (protein is key for healing) and avoid foods that cause bloating (bloating + abdominal surgery = much discomfort). For me that means no beef, broccoli, or beans. Favorites were this easy bolognese (full of good veggies, and I used a mix of ground chicken and pork for the meat), and this stew (a family favorite, so damn good). I also froze some shredded chicken…easy to throw on salads, pasta or to make chicken salad. And of course there’s take-out and we’ve certainly done that a few times during my DIEP recovery!

I found smoothies to be my go-to that first week home. Great way to hydrate AND get your protein. Stock up on your favorite protein powder, frozen fruit and nut butter of choice ahead of time, and make note of your favorite smoothie combos so your partner/kids can whip them up for you.

Set up your recovery area

You are going to be based out of your recovery area for a few weeks. Mine was our bedroom (poor hubby got kicked to the guest room with the dog). It made sense for a lot of reasons, mostly for ease but also that way I could be ‘quarantined’ (no one wants a cough after DIEP…pure misery, and with a kiddo potentially bringing home cooties  from school, this way they could come into the room masked but be mask-free everywhere else). We moved the recliner in there (I highly recommend a recliner as you’ll need to be in beach chair position for quite a while due to the tightness of your tummy…if you don’t have one, you can rent one), set up and tested my bed pillow configuration (image and list of pillows I used coming up), and placed a big tray on the bed next to my nest where I could place any necessities (reaching backward or over to get things off of my nightstand wouldn’t work). We also set up a little table next to the recliner where I could easily grab things. Especially in those first 2 weeks, you want all of your necessities close at hand. And I mean CLOSE…your reach is going to suck (think: T-Rex arms…not allowed to raise your arms above your shoulders for the first few weeks).

Be proactive and avoid post-op constipation!

I learned this the hard way with my mastectomy, and I was bound and determined to avoid any sort of constipation this go-round. I can’t even imagine how bad that would be with abdominal surgery. My DIEP surgeon recommended taking a stool softener twice a day beginning 2 days before surgery (mastectomy it was never mentioned, they just sent me home with a stool softener after that did NOTHING). I went a step further and took Colace 2-in-1 (stool softener AND laxative). I also drank a crap ton of water those 2 days (beneficial for many things).

Set up your bathroom

If you don’t have a counter or wall next to your toilet to aid you, these safety rails are easy to install and a HUGE help when you sit and stand. We also got this height adjustable shower chair, and while nice for sitting in the shower, I mainly found it helpful when I turned it around, pushed it against the shower wall and used it to lean on (early days when you can’t stand up straight, your back starts hurting pretty quickly).

Probably a lot less than you’d think. I definitely took things I never ended up needing or wanting. Of course everyone is different, and it doesn’t hurt to overpack! Here’s what I found helpful:

• Wear to the hospital what you’ll wear home, keeping in mind you’ll want very loose bottoms and a zip/button top.
• Lip balm
• Slide-in shoes (I just wore my Oofas recovery slides…so comfy and didn’t want to bring my slipper to the hospital)
• Non-slip socks (the hospital provides theirs, but they go so high and get so hot…not trying to bring on unnecessary hot flashes. These were great, and the nurses loved them LOL)
• Eye mask – you want to get your Z’s whenever you can, and there’s always light on in the ICU. Some folks like ear plugs, too. This one is super-soft and easy to slide up and down.
• Throat lozenges – your throat might be scratchy from being intubated, and again, coughing is NOT FUN after abdominal surgery.
• Tablet/e-reader – YMMV, but the only time I reached for my iPad was when I was watching my son’s volleyball game. Never read my book, either. Basically vegged out to the TV when I wasn’t sleeping…just didn’t have the focus for games or reading or even a movie. But everyone is different and I think a good idea to bring!

A few things I brought and didn’t use:

• Skincare – again, no energy for all that.
• Hand cream – I had IV’s in both hands, so not really a hand cream friendly time.
• Robe – I’ll mention a fantastic post-op robe in a sec, but it was so extra at the hospital. With all of the tubes and wires attached to you, the nurse using another hospital gown with all of it’s many useful snaps for getting around everything made for a much easier robe when they get you out to walk the ICU.
• iPad Pillow Stand – thought this would be perfect as it’s soft and would also store my Airpods and phone, but I didn’t end up using it since the bedside table swings over your bed and is just easier/simpler. But it was great once I got home!

For the ride home

One of the most helpful items I’ve found is this seat belt pillow. I purchased this for my mastectomy, and realized quickly that I needed it more for the lap part of the belt with this surgery. I’m not sure what kind of magic is inside of it, but it takes away all pressure and discomfort from the lap belt. You can fold up a hand towel to put under either portion of the belt as well, but the seat belt pillow is really the goodies.

Also, my discharge nurse sent me home with one of the hospital pillows so I could hold it against my stomach as I got in and out of the car. Hospital pillows are not the fluffiest, but you know what it ended up being great for? My back! Just flat enough that it worked perfectly on my lower back in my recliner once I got home for extra support.

Once you’re home, the key is ease and comfort. Keep anything you might need close at hand, and easily transferable from your daytime recovery location to your bed. Here’s what I’ve found to be essential items in my DIEP flap recovery:

• Pillows – As mentioned before, you’ll need to be in a semi-reclined beach chair position, and that includes when you’re sleeping. Some even sleep in their recliner, but mine isn’t that cush. The combination of my wedge pillow, the giant U-shaped pillow and my regular pillows created the perfect nest to keep me upright and fairly comfortable while sleeping.
  

  On the right you can see how everything is stacked/placed.

  Not only does the u-shaped pillow provide lower back and arm support, it keeps you from turning onto your side at night (a no-no the first 6 weeks). You can use the bottom ‘leg’ of the U-pillow to go under your knees as well. Or you can use another pillow, though I’ve found that the yoga bolster doesn’t slide down the bed and helps keep me propped up.

• Recovery Bra – I’ve tried many a recovery bra, and I’m telling you, the Elizabeth Pink Surgical Bra from Masthead is far and away the best. Luckily I discovered it before my mastectomy, and 2 years later it’s still the best! The softest, the most comfortable, the most adjustable, AND IT HAS BUILT-IN DRAIN HOLDERS. I was sent home in an uncomfortable post-op bra, and could hardly wait to get this on when I got home. When I wore it to my first post-op appointment, my nurse AND my surgeon were like “where did you get that?!” Do yourself a favor and get this bra.
• Shower Drain Bag – this set was recommended to me when I had my mastectomy, and it’s terrific. Comes with 2 pouches and a belt, plus the shower bag with adjustable neck strap. Can’t beat it for under $20.
• Pajamas – Gownies make great post-op jammies, and I wore these every night while my drains were in. Super soft, super comfortable, wash great and have built-in drain pockets. Not cheap, but I definitely got my money’s worth (plus they’re cute and you’d never know they’re recovery jams!).
• Robe – Gownies for the win again! Especially those first few days when I didn’t want to wear bottoms, this recovery robe was the BEST. Outside pockets, plus inside pockets for drains, soft material…I just loved it. I didn’t use it at the hospital, but boy did I use the heck out of it at home.
• Small toiletry bag with essential items – for all of the little things you want close at hand. For me that was lip balm, hand salve (my hands were a wreck from the IV lines and this really helped heal them), Water Wipes (used before I was ready to tackle showering), my favorite clean deodorant and a few skincare items (skincare was bare minimum the first few weeks…posted about my easy and gentle go-to’s on IG).
• Caddy or basket to hold all of your meds, vitamins, alcohol pads and surgical gloves (for stripping the drains), thermometer, etc. It’s just easier to have it all in one place!
• Protein powder – Upping your protein intake can really speed along healing. KOS Organic is my favorite protein powder for smoothies, but I also put the unflavored Vital Proteins Collagen Peptides in my morning coffee (18g of protein in your coffee, and I promise it adds no flavor to it!).
• Debloating aids – I read many posts about the discomfort of belly bloat after DIEP, and I was determined to avoid it. Luckily I was already a big fan of Golde’s Pineapple Debloat Ade (pineapple contains an enzyme called bromelain that knocks out bloat and aids in digestion), and I added this to my water at least once a day the first few days home, then as needed. I also ate fresh pineapple (or added it to my smoothies).
• Constipation solution – at the hospital they gave me a stool softener once daily. Thanks to my pregame plan, before discharging me the nurse could hear my tummy gurgling away nicely and said I should be in good shape. My first full day home, I took Miralax in the morning and a Colace 2-in-1 at night. Repeated the next day, and booyah. All was well, no struggle. My husband was highly entertained by my excitement at this victory.
• Arnica Montana – I learned about this after my first reconstruction, and it really helped after my mastectomy…bruising was so much better, and for DIEP any initial bruising I had went away quickly. I’ve also not had much swelling to speak of. I purchase this one on Amazon.

Pain management

Heavy duty pain meds and I don’t get along, and thankfully in my case the pain really wasn’t bad by the 4th day. I switched to Tylenol Arthritis every 8 hours, and asked for a muscle relaxer for night (I learned during my first reconstruction that a muscle relaxer was actually more effective than pain meds). By 2 weeks, I was really only taking pain meds at night, and once I was off the aspirin (blood thinner), I switched to ibuprofen at night just to nudge away any swelling.

The abdominal situation makes getting out of bed difficult that first week or so (hubby would literally reach around and gently hug me and pull me upright). If you’ve had a c-section, it’s akin to that. In my case, other than the occasional zinger (sharp, shooting pain that are the nerves reviving), I haven’t experienced much pain in my breasts. Most of the discomfort was the abdominal incision, and my freaking back. Since your belly is initially very tight, you have to walk hunched over, and boy does the back scream after a bit. Many women use walkers to take the pressure off the back, so keep that in mind as a tool if you struggle with walking those first few weeks. One of my nurses recommended Salonpas Pain Patches for any back pain, and I’m so glad she did because they worked GREAT.

Overall I experienced more post-op pain with implant surgery and mastectomy. But DIEP is definitely a longer, slower recovery…I get tired much easier, and everything in the first few weeks just takes everything out of you so easily. My thought is that the body is working hard to heal many different areas with this surgery.

Online Support Groups

If you’re on Facebook, there are several support groups available. You can definitely get a lot of information in these groups, but a word of advice if you join them prior to your surgery: keep in mind that these are SUPPORT groups. Meaning that many of the women posting are in need of support because of something that they’re worried is going wrong or has actually gone wrong. It doesn’t mean that the majority of women have complications after DIEP (in fact it’s the opposite), but reading about and seeing images of complications can really do a number on you (in fact I freaked myself out pretty good the day before surgery). These groups are great resources for getting scoop about a surgeon, recovery-related tips and products, and after surgery it’s really so nice to have somewhere to go to see if anything you’re worried about has been experienced by others.

Other DIEP tips

As mentioned, all surgeons are different and follow different protocols. I came home with no bandaging (other than some sort of special guaze in my new belly button), just glue, even on my drain sites. Which was great in some ways, but also made it more difficult to choose clothing that’s comfortable. I discovered I needed to fold up a bit of guaze under my hip drains and lightly tape them down so they didn’t move to keep them from getting irritated. My surgeon also isn’t a fan of much compression, whereas some surgeons are all about it. I say follow what your surgeon suggests, as they’re going with what they’ve experienced to work the best for their patients.

And speaking of clothing and compression, I’m definitely camp commando since surgery. Everything irritates the incision, and it’s just more comfortable. However I’ve found I need underwear on when I wear leggings for my walks (because the seam on all of my leggings hits right at my incision…arrgh). My doc said light compression is fine (light enough that it leaves no mark on the skin), and I do find a bit of support and compression on my walks makes me more comfortable. I found these high-waisted postpartum panties, and I love them. They’re very soft, the waistband is wide and comfortable, with just a wee bit of compression. Once my incision is scab-free and I’m back to underwear wearing I know these will be my go-to’s.

If you’re reading this and you’re still deciding whether or not to go the DIEP route, my BIGGEST tip is to research your surgeon options. Make a list of questions and ASK THEM during your consultations. I’ve realized after reading posts and seeing images of others that surgeons methods vary widely. As a prime example, I had the ever-so-lovely c-section shelf…didn’t matter my weight, that shelf was there. I was concerned about having that plus a giant DIEP scar above it, as I’d seen images of those that have both (though keep in mind there may be anatomical or medical reasons for where they can make/take the new incision…again, ASK). Luckily not only did my surgeon bring the DIEP down to my c-section scar, but he tucked everything up too…he’s a while-I’m-there-might-as-well-make-it-look-good guy, meaning my shelf is no more! In fact he refers to the procedure as a tummy-tuck-transfer.

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As I finish this post, I’ve just hit the 5 week mark! I feel like I turned a big corner week 3, and this week I definitely feel like another corner is being turned…I just feel stronger, definitely don’t tire as easily, and am even pondering going to a volleyball game. I can also tell my focus is much-improved (thus the tackling of a blog post). Be easy on yourself, follow all of your doc’s care and exercise instructions and you’ll be feeling more yourself before you know it.

As healing continues, I’ll update and add anything helpful here. Or anything I’ve forgotten…I tried to keep notes on my phone along the way, but for sure I’ve forgotten something #DIEPbrain.

And ye olde medical disclaimer: obviously anything I’ve said here is my own opinion based on my experience and research…I’m not a doctor nor have any medical background. Always follow the advice of your own doctors. My only hope is to provide some insight and helpful tools that were of huge help to me in my DIEP recovery.

Please comment below with any questions! And if you’ve already had your surgery, welcome to the DIEP side!

6 weeks post-op

WOUND ISSUES: Just as I was finishing the original post (5 weeks), I started experiencing some issues with my abdominal incision. At the 6 week mark I had several areas that seemed to be opening (I blame the leggings I wore on my walks, rubbing against the scabs). Yes, I freaked out a bit as I’d seen many a post about women who’d had some terrible wound issues. My surgeon’s recommendation was to keep it dry, use a breathable gauze if needed to help with any friction from my pants, but otherwise just leave it alone and it would heal. But gauze would stick (and the ‘breathable’ non-stick gauze wasn’t breathable enough…made everything moist), and it seemed to be getting worse so off I went to the support groups.

It seems that for most women, it was all about keeping things moist?! Wet packing, Medihoney, even using paper tape over it. So I tried that side of things, and it got even worse…the wounds got bigger. I wasn’t willing to ride it out to see if it would eventually work, so I decided to trust my doc and go back to dry dry dry. I stopped my big walks for a few days so I could wear only loose pants that didn’t rub my incisions at all and just took things easy so that I was in ‘beach chair position’ a bit more. And after a few days it was so much better! I could tell the worst hole (yes, hole!) was smaller and things were scabbing over again (and staying scabbed). Before the 8 week mark I was no longer worried, just careful about wearing things that didn’t rub the scabs.

For reference, my surgeon is not a bandage or dressings guy for this procedure…I came home with nothing other than the gauze “plug” in my new belly button; strictly glue over all incisions. It’s so interesting to me that surgeons have such different opinions about the best way to heal, and as I didn’t see many (any??) in the support groups who’s doc followed the dry approach, I thought I’d share here in case anyones does and you’re also worried…it works!

12 weeks post-op

Wow time flies! It’s hard to remember back to the early days of recovery, it already seems so long ago. I’m back to 3.5 mile walks, my stamina is MUCH better (not 100%, but not pooping out at 8pm anymore), and the only discomfort I have is after a big walk or a day spent on my feet, and then my abdominal incision area gets sore/achy. Saw the doc last week, and Phase 2 will be sometime after the summer; luckily doc thinks it will just be fat grafting to get some projection in the DIEP boob…abdominal area looking good!

SCAR TREATMENT: My abdominal incision is almost all the way healed, just 2 tiny spots that have scabs. I’m wearing silicon tape on one half of the scar as no scabs there (this silicon tape was what my surgeon recommended for scar treatment).

BRAS: Finding a ‘nice’ bra without underwire that works with non-comfy clothes has been a challenge in the past. I fell in love with Wacoal’s How Perfect Wire-Free Tshirt Bra after my first breast surgery, and while it’s definitely the comfiest bra in all the land and perfect for everyday, I needed something with a little oomph for a special event. Enter the Trish from Anaono! It looks great, has a plunging neckline so works with more tops, provides some lift and evens me out. LOVE the material, it’s so comfortable and non-irritating (Anaono also makes a wonderful recovery bra…the Rora was one of my favorites when recovering from my mastectomy, so soft!!!). I may never go back to underwire!