Post-Operative Care

First Days of Recovery

Once surgery is completed you will be taken to the Post Anesthesia Care Unit (PACU) where you will slowly wake up. You’ll be here for approximately two hours, or until the anesthetic wears off.

When you wake up you will be connected to a number of monitors and may have an oxygen tube in your nose and a catheter to empty your bladder, as well as your IV. Your new breast(s) and donor site(s) will have drain tubes coming from under your skin, and you’ll be wearing your bra and other support garment on your donor site. You may also be wearing compression stockings that inflate and deflate to decrease the risk of blood clots developing in your legs.

Visitors are not allowed in the PACU, but they may call to check your status from the phone in the visitor lounge.

Once the PACU teams feels you are ready, you will move to your room in the GH5 ward. Your loved ones may see you now, but we recommend you keep visitors to a minimum during the first few post-surgery hours.

The First 24 Hours After Surgery

You will be monitored very closely in the first 24 hours after your surgery. Doctors and nurses will check the blood flow through your newly attached blood vessels every hour during the first 24 hours.  A small blue stitch on your breast indicates where the blood vessels were sewn together. Your medical team will monitor this spot with a special Doppler monitor.

You won’t receive any food or liquids in the first 24 hours, just in case any follow-up procedures are tequired within this first day. Your fluids will be maintained through an IV.

If you had a procedure with tissue from your abdomen (DIEP or SGAP) you may require pillows under your knees and also to keep your head raised by at least 30 degrees to decrease tension on your abdomen.

If your procedure used tissue from your inner thighs or buttocks (TUG, SGAP or IGAP), you will need to lie flat in bed with your knees together and no hip flexion (movement).

You will receive pain medication through your IV. You may have a pump which allows you to self administer a dose as needed.  Once you are allowed to eat, your pain medication will be given in pill form.

Day Two of Recovery

You can expect to feel very weak and tired on this first real day of rest and recovery. As you rest, your body is adjusting to its changes and working to keep itself healthy.

DIEP and SIEA (abdominal tissue) patients are usually able to sit up and walk short distances with assistance the day after surgery. When walking, patients need to bend slightly to decrease tension on their abdominal area.

Patients who underwent the TUG or IGAP/SGAP procedure (using tissue from the inner thighs or buttocks) typically need bed rest for three to five days.

Your pain will be managed with medication administered through your IV or in pill form. If you are still experiencing pain be sure to let your nurse know. Good pain control speeds up recovery by allowing you to rest, so your body can heal itself.

Doctors will ask you to do breathing and coughing exercises every hour while awake to help speed your recovery and decrease the risk of developing chest problems.

Family and friends can visit during the regular visiting hours of 8:30 a.m. to 8:30 p.m.

Days 3-5 of Recovery

You will make small steps towards going home between the third and fifth day after surgery. You may be released as early as the third day depending on your ability to move around and manage your drainage tubes.

When you are able to move well enough to get to the bathroom on your own, medical staff will remove your cathetor. Next, you’ll be shown how to empty and measure the fluid coming out of your drainage tubes accurately, as you’ll need to continue this procedure at home.

DIEP and SIEA patients are usually able to shower on day three. TUG, SGAP and IGAP patients are usually able to shower on days five to seven.

Going Home

When your team feels you are ready, you will be sent home with drain and wound care instructions, as well as any required prescriptions for pain medication and antibiotics.

You’ll receive your first follow-up appointment date before you leave the hospital unless you are discharged over the weekend, in which case you’ll be asked to call us the following Monday to book an appointment.

If you live out of town, we prefer you make arrangements to stay in Winnipeg until your first follow-up appointment which will take place within one week.

Follow-up Visits

To ensure your healing and recovery are a perfect success, most patients will see their breast reconstruction team three times after surgery.

Within a week of being discharged, you will come in to see your clinic nurse. The following week you will see your doctor and an appointment for drain removal will be scheduled as needed.

If you have any questions about your condition once home, please contact your clinic nurse

After Surgery Care: 0 – 3 weeks

Monitoring Your Breast and Surgery Incisions

It’s important to check your breast and all incisions daily for signs and symptoms of infection. Contact the clinic nurse or on-call Plastic Surgery Resident immediately if you observe the following changes to your breast or incision:

• Increased size

• Increased firmness

• Cool temperature to skin

• Change in color

• Incision line separation

Check your incision for:

• Increased warmth or spreading redness of skin near a site

• Increased swelling

• Increased pain or tenderness

• Increased discharge at site (creamy yellow/green)

• Foul smelling odor

• Fever or chills

• Elevated temperature greater than 38°C

Preventing Blood Clots

To prevent blood clotting it is important to do short periods of light activity like walking at least five or six times each day. If they develop in your legs, blood clots can break off and travel to the heart or lungs and become potentially fatal.

Seek medical attention immediately if you experience:

• Pain or swelling in your legs

• Difficulty breathing or shortness in breath

• Coughing up blood

• Chest pain

• Anxiety

Sutures

Most sutures are dissolvable and do not require removal. The blue stitch on your breast will be removed at your first follow up appointment. Your drain tubes are held in place with a suture that will be removed when your drain is ready to come out.

Dressings

Patients generally require minimal dressings.  You may receive a light non-stick dressing along the incision you experience any oozing along the incision line.  Dressings should be changed daily.

Bathing and Wound Care

You are normally allowed to shower four days after your surgery.  Do not soak in a bath. While showering, let the water run gently over your incisions and drain sites.  Do not allow the water to directly spray on the incisions.  Pat all incision lines dry. If you have steri-strips on your incisions simply pat them dry and leave them intact until they fall off on their own.

Medications

You may be sent home with number of prescriptions.  It is important to avoid alcohol while taking any prescription medications. Antibiotics are prescribed to treat or prevent infection.  Please follow instructions for use, and take them all until finished.

Pain Medication: Tylenol 3 is most commonly prescribed. As soon as you feel comfortable doing so, you may switch to extra-strength or regular Tylenol to avoid the nausea and constipation commonly associated with Tylenol 3.

Iron: Your doctor may recommend iron supplements to help you recover from blood loss.

Stool softeners: The combination of pain medication, iron pills and decreased mobility may leave you constipated.  We suggest an over-the-counter aid such as Senekot or Colace to maintain bowel regularity.

Drain Care

You will likely go home with drains in your breast and donor site. You must empty these drains twice each day and record the amount of output from each.

Walking, Sitting, and Sleeping

Abdominal DIEP/SIEA flap patients:

1. Maintain a bent forward posture for two to four weeks.

2. Sleep on your back with your head and knees elevated.

3. Rest with your head and knees elevated.

4. Do not lay on your side or back.

5. Wear your compression bra and other garments except while showering.

  Buttock SGAP/IGAP patients:

1. Please lay flat on your back or stand straight.

2. Sleep flat on your back.

3. To avoid any tension on your buttock incision line – do not sit.

4. Wear your compression bra and other garments except while showering.

Inner Thigh TUG flap patients:

1. Keep your knees together.

2. Sleep flat on your back, with your knees together.

3. Sit in a reclined position, leaning back, to avoid any tension on your inner thigh incision.

4. Wear your compression bra and other garments except while showering.

Other Important Information

1. Wear your front closing wireless bra and other compression garments at all times. You may remove them while showering.

2. Only climb stairs when absolutely necessary.

3. Do not lift your elbows above shoulder height.

4. No sexual activity.

5. Do not lift more than 2 kilograms/5 pounds (example: a phone book).

6. No driving.

7. Avoid smoking and exposure to second hand smoke.

8. Avoid sun exposure for six months.

After Surgery Care: Week 4

Walking, Sitting, and Sleeping

Abdominal DIEP/SIEA flap patients:

1. Maintain a bent forward posture.

2. Sleep on your back with your head and knees elevated.

3. Rest with your head and knees elevated.

4. Do not lay on your side or back.

5. Continue to wear your compression bra and other garments except while showering.

Inner Thigh TUG flap patients:

1. Keep your knees together for four weeks.

2. Sleep flat on your back, with your knees together.

3. Sit in a reclined position, leaning back, to avoid any tension on your inner thigh incision.

4. Continue to wear your compression bra and other garments except while showering.

Buttock SGAP/IGAP patients:

1. Please lay flat on your back or stand straight.

2. Sleep flat on your back.

3. To avoid any tension on your buttock incision line – do not sit.

4. Continue to wear your compression bra and other garments except while showering.

5. Increase your daily walking (2-3 blocks).

General Instructions

1. There are no restrictions to shoulder movement. Start by lifting your arm above your head and work towards full movement. By week five, your shoulder movement should be back to normal.

2. Most patients may return to work four to six weeks following a breast reconstruction surgery, or two to four weeks following reconstruction with an implant. If your job requires physical exertion, more time may be needed.

3. No sexual activity.

4. Do not lift more than 2 kilograms/5 pounds (example: a phone book).

5. You may drive unless you are on a narcotic pain medication or you have abnormal blood results.

6. Avoid smoking and exposure to second hand smoke.

7. Avoid sun exposure.

After Surgery Care: Week 5 - 6

Walking, Sitting, and Sleeping

Abdominal DIEP/SIEA flap patients:

1. Sleep on your back with your head and knees elevated.

2. Rest with your head and knees elevated.

3. Do not lay on your side or your back.

4. Continue to wear your compression bra and other garments except while showering.

Buttock SGAP/IGAP patients:

1. Sleep flat on your back.

2. To avoid any tension on your buttock incision line, do not sit.

3. Continue to wear your compression bra and other garments except while showering.

Inner Thigh TUG flap patients:

1. Sleep flat on your back, with your knees together.

2. Sit in a reclined position, leaning back, to avoid any tension on your inner thigh incision.

3. Continue to wear your compression bra and other garments except while showering.

Other Important Information

1. Most patients may return to work four to six weeks following a breast reconstruction surgery, or two to four weeks following reconstruction with an implant. If your job requires physical exertion, more time may be needed.

2. Do not lift more than 5 kilograms/10 pounds (example: a newborn baby).

3. No sexual activity or strenuous exercise.

4. Avoid smoking and exposure to second hand smoke.

5. Avoid sun exposure.

After Surgery Care: 6 Weeks to 3 Months

• You no longer need to wear your compression bra and garments. Keep in mind increased tension on the incision may cause your scars to stretch, so a proper supportive bra should be worn until your scar fully matures, which may take up to a year.

• Some swelling of the breast and donor site is normal.

• No restrictions on lifting, but star slowly as your muscles will be weak.

• You may begin to do normal household activities again (example: laundry and vacuuming).

• You may resume sexual activity.

• You may increase your general activity level (example: swimming or working out at the gym). If after three months you are not back to your normal activities, ask your doctor for a referral to a physiotherapist.

After Surgery Care: 3 Months

The nipple and areola are created approximately three months after your breast reconstruction.  Nipple reconstruction is done under local anesthesia and only takes 30-45 minutes to complete.  The areola is done through a tattoo process, which makes the surrounding skin the colour of a nature areola.  Each tattoo can take one hour and may need to be done one or two additional times to achieve the right colour. 

Continue to avoid sun exposure.