Reconstruction Update

Surgery is now 7 days away and 4 months have passed since I last met with my plastic surgeon.  Back in May, I had planned on immediate reconstruction during the same surgery as the mastectomy, but my breast surgeon kiboshed that idea when it appeared I might also need radiation therapy (which thankfully turned out to be unnecessary).  Anyway, I recently emailed Dr. Orman with some questions and he just replied as shown below.  I was pleasantly surprised to find out I might end up with a DIEP (Deep Inferior Epigastric Perforator) reconstruction in which no muscle but only blood vessels, fat, and skin are removed during the surgery.  If I instead need to have the Muscle-Sparing Free TRAM (our fall-back plan), I would also lose a small portion of abdominal muscle along with accompanying muscle strength while simultaneously increasing the risk for a hernia.

1) Will my hospital stay still be 5-7 days and will I need 3 drains even if I’ve already had the mastectomy?  Yes.

2) Should I be purchasing any special garments to wear after the surgery (e.g. bra, abdominal compression)?  No.

3) The expected recovery time is 6-12 weeks, but how long should I wait until I can swim, run & bicycle again? FYI, 3 wks after the mastectomy, I biked 25 hilly miles and felt normal. I observed the mandated 6 week waiting period for swimming and running, and my incision had healed well before that time.  At least six weeks… This is a much bigger procedure here, operating on both your breast/chest area and your abdomen.

4) If the perforating artery is free, will I effectively end up with a DIEP?  If you have a large enough single or two close vessels big enough to feed the whole flap, yes you would be getting a DIEP flap breast reconstruction.

5) Is there anything I can do to help prevent necrosis and flap failure other than staying in the hospital for observation after the surgery?  Avoid the medications on the list that the surgery schedulers should have given you prior to your surgery.

6) My rib cage is fairly exposed and slightly uncomfortable (upon pressure) where Dr. Bitar removed all of my breast tissue. Will the transferred tissue cover the entire excised area?  Yes, that is the intent.

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