Pre and Post Operative Instructions

I have prepared preoperative and postoperative instruction sheets which I provide to all patients, giving them the choice of reading the sheets if they want more information or sharing them to their support people to read. Below is the information I provide to my patients. Please note that although these are DIEP pre/post op instructions, they apply to all of the reconstrutive procedures.

Pre Operative DIEP Flap Instructions

First, understand that everyone is a bit nervous and this is normal. The purpose of this sheet is to familiarize you with what will happen in the period just before the surgery and during the hospital stay.

If you smoke, you should have stopped already. If you are still smoking, stop immediately. Smoking and nicotine gum increase your risk of problems, and both take time to be removed from your body.

Often I will mark, in my office, the incisions for the flap and the mastectomy on the skin the day before the surgery. If this is the case, then you must shower before coming to the office. You cannot shower after the marks are made.

Have a light meal the night before surgery, as most patients do not move their bowels for several days after surgery.

Bring pajamas, a bathrobe and slippers to the hospital. For the first few days after the surgery, it is easier to wear the hospital gown then your PJ's.

If you will be having breast cancer reconstruction at the same time as the mastectomy, then I encourage your loved ones to go home after they have spoken to the surgeon who has performed the mastectomy. (Please leave a phone number where they can be reached.) The reconstructive part of the diep flap surgery takes a long time and "bulletins" will not be issued as to how thing are going. When I am finished, I will call the loved ones and tell them how things went. If they would like to visit, it will be at least one hour from the time of the phone call before they will be allowed into the recovery room.

The decision to transfuse blood is based on your starting blood count, the amount of bleeding during surgery, and your overall health. The order of any transfusion is: first, your own blood (if you donated blood), next, donor designated blood (from people you asked to give blood), and last, blood from the blood bank.

You will spend the first night in the recovery room. This is a good place to monitor you overnight. The next morning, if all looks OK, then you will be transferred to the floor. You will have an intravenous line (IV). The pain pump is connected to this line. Push the button as needed. The machine is calculated so that you cannot overdose on the pain medication. A Foley catheter will be placed into your bladder while you are under anesthesia. This will eliminated the need to get on a bed pan. When you are ready to walk to the bathroom, it will be removed. Special stockings connected to a pneumatic pump will be placed so that you don't get a blood clot in your legs. These can be removed when you begin to walk. The hospital bed will be flexed. This will take the tension off the abdominal incision. You, and only you, can change the position of the bed. It is unlikely that you will put the bed in a position that makes the abdomen feel too tight. There will be multiple drains from the abdomen and chest. These are about the thickness of a pencil and go from inside your body to an outside collection device that looks like a grenade. It's not as bad as it sounds. The drains are used to remove any fluid collection. They are removed when they stop draining which is usually at one to two weeks after the surgery. You will probably go home with the drains and we will arrange a visiting nurse to help you empty them.

The first day after surgery, we will ask you to sit in a chair. Getting into the chair may be difficult, but sitting there is not uncomfortable. Use the pain pump. You will begin to eat. You will also feel very tired. Generally, the day after your surgery, I also feel very tired. You may begin to walk with assistance if you feel up to it.

The second say after surgery, we will ask you to begin to ambulate. We will remove the catheter for the urine, the compression stockings on the legs and later that day the pain pump. Oral pain medication will be started around the clock. I do not want you to wait until you are uncomfortable to take the pain medication.

Generally a patient will go home on the third postoperative day. Going home does not mean that I think that you are all better. It only means that I think that there is nothing else that will be done for you that requires hospitalization. You will be given a prescription for pain medication and antibiotics. You should also take one baby or regular aspirin per day for one month. Arrangements for a visiting nurse will be made to help with the drains. You will make an appointment to see me in the office at about one week post op.

Post Operative DIEP Flap Instructions

The worst is over. There will be a visiting nurse to come to your home once a day to help you empty the drains. When you feel that you can empty the drains yourself you may tell the visiting nurse that she need not come any longer. Please be sure to record the drainage from each individual drain and bring the report sheet with you to the office.

You will be given a prescription for pain medication and antibiotics. You may use Tylenol or extra strength Tylenol if you do not need the narcotic. The narcotic is particularly useful at night, for if you have pain you will not sleep well. Please also take one baby aspirin a day for the next month.

You may shower. Pin the drains to a cloth necklace (i.e. bathrobe belt worn around the neck) so that they do not hang. Every part of your body can be washed with soap and water including all stitched areas. Pat dry. Have someone around the first time that you take a shower as occasionally one can become lightheaded in the warm water.

If you have stairs, you may initially go up and down once a day. You do not need to move your bed to a different level of the house. As you feel stronger, you may make the trip more often.

Try not to nap during the day. If you do, you will have a hard time sleeping the whole night.

Eating small frequent meals will be more comfortable initially than a few large meals.

Make an appointment to be seen one week after the surgery. At that time I will remove most of the sutures and possibly the drains. Please bring your drainage sheet, as the amount of drainage from each individual drain determines if it can be removed.

Low grade temperatures are common (up to 101o). There is no need to take you temperature unless you feel you have a fever. Increasing redness around an incision is not expected. Please call for a fever (above 101o) or increasing redness.

Patients usually feel better wearing loose fitting clothes. Please do not wear a bra until you are told that you may.

If you need chemotherapy you may begin it when the oncologist feels you are ready, unless, either I or your surgeon tell you otherwise.

Patients who have had this procedure feel stronger day by day. Full recovery can take as long as one year. I will give you arm exercises when an if appropriate. You should have no restriction of arm motion. You may drive a car when you feel that you can control it. Generally that is between two and four weeks post operatively. For the first six weeks you should carry nothing heavier than a single shopping bag (10 lbs.) This is important for healing of the abdomen. You may return to work at six weeks after the surgery. If you feel OK and your job does not involve much physical labor, you may return to work sooner.

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