Pre-operative Instructions for DIEP Flap Reconstruction Surgery

Patients who have undergone a mastectomy due to breast cancer are likely to be particularly anxious about undergoing a deep inferior epigastric perforators (DIEP) procedure to reconstruct the missing breast or breasts. After having been diagnosed with cancer, undergoing a mastectomy, and possibly starting a course of chemotherapy, these patients are likely to be reticent to consider yet another surgery.

What Is DIEP Flap Reconstruction?

In a DIEP flap reconstruction, a new breast is constructed using excess tissue and fat from the abdominal region. The breast skin is preserved, and a space is opened up inside the breast for the transferred tissue and fat. It may either be done in conjunction with a mastectomy or several months later. If there is a waiting period between the mastectomy and the DIEP flap procedure, a temporary spacer is placed in the chest to preserve space. The DIEP procedure is an improvement over the earlier transverse rectus abdominis myocutaneous (TRAM) procedure because it does not use abdominal skin or muscle to reconstruct the breast.

Prior to DIEP Flap Reconstruction Surgery

Diet: Now is the time to make healthy changes to the diet, to help build up the body’s immune system and healing abilities. Eliminate simple sugars from the diet, and add in complex carbohydrates (such as whole grains, fruits, and vegetables) and protein from lean meats. Increase water intake, and cut out caffeine, which can dehydrate the body. Be sure to cut back on sodium.

COX₂ inhibitors: Certain foods contain what are known as COX₂ inhibitors. These inhibitors thin the blood and can increase bleeding. Foods to avoid starting three to four weeks before surgery include: garlic, onion, ginger, green teas, turmeric, and cayenne. Eliminate flax oil, vitamin E (except as part of a multivitamin), or any omega 3 or fish oils. Aspirin and ibuprophen should also be eliminated from the diet. Alcohol is also a known COX₂ inhibitor.

Smoking: In addition to increasing risks for bleeding, smoking will also lower the body’s natural immune system and lengthen healing time from the incisions. Patients who smoke should ideally quit three to four months before surgery, or at minimum, three to four weeks prior, and not resume until at least one to two months after surgery. Of course, it is best if the patient quits smoking altogether.

Exercise: Exercise is important to prepare the body for surgery. Even something as simple as climbing up and down flights of stairs several times will get the body moving.

Antibacterial regime: Starting three days prior to surgery, including the day of surgery, wash the entire body thoroughly with an antibacterial soap. Specifically concentrate on those areas between the neck and the knees. An antibacterial soap will cut down the chance of infection.

The best advice is to discuss any pre-operative instructions with our plastic surgeons during one of the consultation visits. Together, a customized plan can be devised that will both help the surgery go more smoothly and alleviate any patient concerns or fears.

Contact Crawford Plastic Surgery to schedule a DIEP flap consultation.