After Surgery - Autologous reconstruction – DIEP/TRAM

Pain control

In hospital:
While in the hospital any postoperative pain you have you have will be carefully monitored and treated. You will have a PCA (patient controlled analgesia) pump, which delivers the precise amount of strong analgesia (usually morphine). You will be gradually weaned off this after 1-2 days when we will introduce pain tablets. We suggest taking these regularly for the first week, as pain is much easier to control if it is prevented rather than try to control it after it has set in.

At home:
After the first week the amount of analgesia you require will decrease. You may only need to take an analgesic first thing in the morning and just before bed while managing on Tylenol and/or Advil alone during the day.

Everyone's pain tolerance is a little bit different. Some people find they do not need tablets after the first couple of weeks, some people use them a bit longer, especially at night or after a more strenuous day. There is no right or wrong length of time to be on pain medication.

Diet

In hospital:
You will receive sips of fluid overnight and then will be slowly advanced to a normal diet as tolerated. This may take one to three days and differs from patient to patient.

At home:
Generally a normal healthy diet should be fine. We recommend adding fiber/bulk (e.g. grains/leafy vegetables and fresh fruit) to the diet for the time you are on additional painkillers as they can sometimes cause constipation. Straining at stool may cause discomfort to the tummy.
A diet rich in protein (low fat meat/fish/nuts) will help with healing.

Drains & Dressings

In hospital:
When you wake up, you will find 2 drains from your lower abdomen and 1 drain from each breast. While in hospital, the nurses will measure the drain output every few hours. Any dramatic increase in drain output or new bright red bleeding may indicate a haematoma in the surgical site and should be assessed by a member of the plastic surgery team. It is important for you to learn how to strip the drain, a maneuver that the nurses should teach you to prevent clot formation in the tubing. You should continue to strip the drains every few hours while awake once you are discharged home.
You may wake up wearing an abdominal binder. If so this should be worn at all times for the first 3 weeks. It may be worn for comfort when mobilizing for the next 3 weeks (6 weeks total)

At home:
A home care nurse will be assigned to help care for the drains and change any dressings that are required.
If you are discharged home with drains in place, they generally stay in place until there is minimal output which time the home care nurse will remove them. You can shower with the drains in place.

Dressings should be minimal over most of the surgical site when you go home and wounds may be exposed in the shower and washed with soap and water. A light dressing to prevent staining of clothes may be needed. This can be provided by homecare.
A fragrance free moisturizer can be massaged into the surgical sites at about 3 weeks, once all wounds are fully closed, with a gentle circular motion to help the scars mature.

Activity

In Hospital:
Generally your body will be your guide for activity levels over the first 6 weeks. For the first week, we encourage you to walk around the ward.

At home:
You mustavoid lifting anything over 5 pounds for the first 3 weeks, and 10 pounds for weeks 3-6. Following this a gradual increase in lifting is appropriate. After 6 weeks you may start introducing more formal exercise. It may take nearly 3 months before you are fully back to normal.
Driving is something that must be assessed with respect to individual healing. You must feel comfortable to perform an emergency stop or avoid a child/pet/accident. You must be physically able to look behind you and to each side and wear a seatbelt for the length of time in the car with comfort. In addition, you are legally not allowed to drive while taking prescription pain medications.

Slow Healing:
It is very common in this type of reconstruction to have a small area along the abdominal incision, or on the breast that is a little slow to heal.. Do not be discouraged. With a few weeks of dressings, attention from the home care nurses and possible minor trimmings in clinic, these wounds will heal very well with surprisingly little scarring.