Wednesday, April 9, 2014

Diep Flap Reconstruction Surgery & Recovery - Week 1

Well, I took the plunge and had reconstructive surgery on St. Patrick's Day. When my surgeon asked how I was doing that Monday morning, I said "I'm fine, but the more important question is how are YOU doing?" He replied "I'm GREAT," and I was happy to hear that!

My surgery took 4 hours and 10 minutes for a unilateral diep flap reconstruction (definitely the short end of the 4-8 hours my surgeon told me to expect!). There were two microsurgeons present (I did not meet the second surgeon). I remember talking to the anesthesiologist, who seemed very understanding about my concerns with nausea after surgery. As they wheeled me to the OR, the anesthesiologist told me I should be feeling light-headed. I was! The next thing I knew, I was in my room in the ICU and settling in for an evening of hourly flap checks. I was pretty groggy (and honestly don't remember much of Monday afternoon), but each time my nurse came in to check the circulation on the flap and I heard the reassuring "whoosh whoosh" of the vein and artery through the Doppler, I knew things were going well. And blessings on the anesthesiologist! I did not have any nausea or vomiting this time around! (Besides the typical IV anti-nausea medications, I also had a patch behind my ear).

My surgeon told me to expect a 3-4 day hospital stay. Surgery day is Day 0, so a 3-4 day stay meant going home Thursday or Friday. Here is a rundown of my week in the hospital:

Day 0:  The reason for ICU (my surgeon told me "You're not sick!")  is the higher level of nursing care. My nurse had 2 patients to care for, instead of 6 or 7. That made it easier to monitor my transferred flap tissue. I could not eat or drink anything those first 24 hours. I didn't feel like eating, actually, but my mouth was incredibly dry. My nurse did bring me a sponge on a stick in a cup of ice chips so that I could moisten my mouth. That helped, but I really wanted some water! In the ICU, I was hooked up to a PCA (pain pump, where I could give myself a boost of pain meds every so often), an IV, a catheter, oxygen, a wire in my transferred flap (along the vein connection) so they could monitor my circulation, and three drains (two in my abdomen, and one in my chest). The nurses would listen to the vein on the Doppler wire, and then take a sensor and hold it on an area marked with a stitch by my surgeon to hear the arterial flow. This is completely painless as there is no feeling in the transferred tissue. I dozed off and on throughout the night. My hospital bed was kept flexed to keep tension off my abdominal incision.

Day 1:
Tuesday morning I saw my surgeon, and by afternoon I was moved to a room on the floor and was out of ICU.  I was able to order lunch and have my first meal since Sunday evening. The nurses continued to monitor my flap and give me medications intravenously. On Tuesday, I also worked with a physical therapist on getting out of bed. The technique is to roll onto your side, let your legs swing down off the bed, and push yourself upright with your arm. It does hurt to do this, but once you are sitting, the pain goes away. I took a short stroll down the hospital hallway (hunched over a walker) and sat in a chair for awhile. I was allowed to eat anything on the hospital "room service" menu, and was encouraged to drink plenty of water. My surgeon came to check on me twice on Tuesday, and said the goals for Wednesday included unhooking me from as many things as possible (catheter, IV, etc.), and transferring me to oral medications. Sitting was not painful, and even walking wasn't too bad with the walker. My pain levels were probably between a 3 and a 6 on Tuesday (on a scale of 0 -10), depending on what I was doing. I was not using my PCA pump much, although the physical therapist made a great suggestion to use it prior to getting up for therapy. My husband slept on a crummy cot in my room Tuesday night. I felt so sorry for him, I did not ask him to stay on Wednesday! I don't think he got much sleep.

Day 2:
Wednesday was kind of boring, actually. My flap was doing well, my vital signs were good, and it was time to move forward. I took more walks in the hospital, spent more time in a chair, was given a couple of leg exercises, and was started on oral medications and taken off the IV. Removing a catheter is no big deal, either. You sit on the toilet while your CNA deflates the saline-filled balloon which holds the catheter in your bladder. Then, there is a gentle tug, and you are done! I read a bit on Wednesday, did some Sudoku puzzles, watched a little TV, visited with family, and slept some more. I saw my surgeon once on Wednesday. He informed me Thursday was mandatory shower day, and then I could see how I felt about going home.

Attractive TED stockings!

Day 3:
I was getting in and out of bed by myself to use the bathroom, and was feeling pretty good. For pain control, I was taking mostly ibuprofen and tylenol. The physical therapist told me she had signed off on me, so that was another milestone achieved. The shower was tiring, but I did it! I had my CNA make a necklace for me from some oxygen tubing to hang my drains on while I showered. She suggested pinning the drains to either a towel or washcloth around my neck, but when I suggested the necklace, she was happy to accommodate me. I had a shower chair, for which I was very grateful. It felt good to be clean. My hospital did not provide shampoo. My hair is still pretty short after chemo, and I used the mild liquid soap on it. Not ideal, but it worked pretty well, and it felt good to have clean hair. You might want to bring shampoo with you to the hospital. Getting back into the abdominal binder was a bit tricky, but overall I was happy to handle the shower myself.  My surgeon came by and I told him I was thinking of going home. He pulled the Doppler wire, and put everything in motion (did all the paperwork) for me to check out, but told me I could absolutely stay another day if I felt I needed to. I was glad I didn't have to leave before I was ready to, but to be honest, I really wanted a night of uninterrupted sleep!  After I saw my surgeon the third time on Thursday, I told him I was pretty sure I would be going home that day. I ended up leaving the hospital about 5 pm that Thursday.

Getting comfortable at home:
I don't own a recliner, so my surgeon suggested getting foam wedge pillows. I bought 2 prior to surgery, and used one under my back and head, and one under my knees. I put additional pillows on top of the wedges to get comfortable. My surgeon wants me sleeping in a "V" position on my back while my abdominal incision heals. It was a bit tricky getting in and out of a regular bed, but I was able to do it.  I am not using much pain medication. The most painful part so far has been my back, from walking hunched over. I had heard that was the hardest thing, and people were not kidding! Ouch!  There is also some discomfort at the drain sites and along my abdominal incision. I have occasional nerve pain from things being disturbed again in my chest, but am so grateful my poor pectoral muscle has been put back down where it belongs. The nerves are not nearly as aggravated as they were after the mastectomy. In many ways, I think this surgery is easier than my initial cancer surgery. Things are progressing nicely. I walk laps around my kitchen with my walker, and am trying to get more mobile. I also have some leg exercises from the physical therapist, and am still wearing my lovely white "TED" compression stockings, since I am laying around quite a bit.

Foam wedge pillows are nice to have for comfort at home.

Some Tips:
Do take a robe to the hospital. It was good to slip something on over my attractive hospital gown for those walking sessions.
Do take something to pass the time. I was glad to have puzzle books, music,  and a novel to distract me.
Do take advantage of the time in the hospital to rest as much as possible.
Do communicate what your needs are to your nursing team and your doctor.
Do prepare for your return home before you go to the hospital (I bought my wedge pillows, planned clothing I could get on over the abdominal binder and the drains, set things like tissues in easy reach of my bed, etc.  My surgeon mentioned having a different compression garment like Spanx, but not until Day 3 of my hospital stay! Ask your doctor what he/she recommends for you, so you can plan ahead! Do make arrangements for a walker and shower stool).
Do make your follow up appointment with your surgeon.
Do take pain medications as needed. I have not found this surgery to be particularly painful. Certain movements hurt, and I am sore, but it has been easy to manage the pain levels.
Do get plenty to drink, eat healthy, and move as much as you comfortably can. I am feeling sort of "full" and I think it is from abdominal swelling. My surgeon recommended I eat small amounts throughout the day, and also said I would probably need some naps while recovering at home.

I had FABULOUS medical care, and the best nursing team I could have imagined. I know I am forgetting a few people, but just want to give a shout out to my awesome surgeon Dr. Reuben; Dr. Richards, the anesthesiologist; Dr. Rinard, the other surgeon who assisted; my OR team (I was out before I got to the OR, so I didn't meet any of you!); my two physical therapists; Maria, who cleaned my room; and my nursing team: Stephanie, Jordan, Matt, Sarah, Mica, Cherysh, Emily...and 3 other wonderful men and women whose names I am sorry to say, I cannot remember. They were all competent, kind, caring, personable, hard working, and helpful throughout my hospital stay. I am so grateful to every one of them for the great care they gave me!

So, one week out, how am I feeling about surgery? I still can't believe I am on the other side, after waiting so long! My flap is soft and warm, and should heal up nicely. I know when my abdomen heals, I won't miss the fat they took to reconstruct the breast. The first week is over, I think I might be lucky and get a drain or two removed during my first follow-up visit, and I am well on my way to recovery. I can honestly say this has been easier than I thought it would be, and I have NO REGRETS about doing this surgery!

Non-prescription medications recommended for me at home:  Senna-S (stool softener/mild laxative), Ibuprofen (800 mg at meals), Tylenol (every 6 hours), 81 mg baby aspirin (once a day for 4 weeks). I did not take the Senna-S but used a different stool softener instead (similar to Colace).

My decision to have DIEP flap reconstruction


  1. You are a model patient. Positive attitude has helped you a lot as well I am sure. Thanks for sharing!

  2. Yay for Amy and all they people who helped her get to this point! You are all awesome!