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The Role of Manual Lymphatic Drainage in DIEP Flap Reconstruction Recovery

Manual lymphatic drainage (MLD) is a specialised technique important in mitigating lymphoedema risk, particularly following breast cancer surgery. It employs gentle massage to enhance lymph flow, aiding in the reduction of unwanted swelling and promoting recovery. Given its significance, understanding the integration of MLD in the context of DIEP flap surgery—a leading form of breast reconstruction post-mastectomy—is crucial for optimal healing.

The therapeutic journey post-DIEP flap surgery significantly benefits from lymphatic drainage massage, targeting the lymph nodes to alleviate swelling and foster a smoother recovery process. In this blog, Sydney Specialist Plastic Surgeon Dr Bish Soliman will walk you through the science behind manual lymphatic drainage, its indispensability post-operatively and practical guidance on performing lymph drainage massage at home.

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What Is DIEP Flap Reconstruction

DIEP flap surgery is a breast reconstruction option. This procedure, deeply rooted in the precision of microsurgery, transfers skin and fatty tissue from the abdomen to the chest, meticulously avoiding any muscle movement to preserve strength and reduce recovery complications. Below is a detailed exploration of this complex surgery:

Procedure Overview

  • Surgical Approach: The Deep Inferior Epigastric Perforator (DIEP) flap reconstruction involves a careful incision in the abdominal area to harvest skin and fat without disturbing the muscle, ensuring a muscle-sparing technique.
  • Microsurgical Precision: Tiny blood vessels from the harvested flap are connected to vessels in the chest using microsurgery, a testament to the procedure’s intricate nature and the surgeon’s dexterity.
  • Dual Benefits: Patients often experience a ‘tummy tuck’ – abdominoplasty effect, resulting in a flatter abdomen, alongside the primary goal of breast reconstruction.

Considerations and Recovery

  • Good Candidates: While offering numerous benefits, including a reduced risk of weakness or hernia, the surgery is best suited for non-smokers who have not undergone significant abdominal surgeries previously. Slender individuals or those with chronic conditions may need to explore alternative options.
  • Recovery Timeline: Post-operation, a hospital stay of approximately five days is expected, with a recovery period spanning six to eight weeks. The approach promises a quicker return to regular activities compared to traditional TRAM flap reconstructions.
  • Post-Operative Care: Initial weeks may showcase swelling and bruising, with the final aesthetic settling over several months. Support and minimal physical activity are advised in the early recovery phase to facilitate healing.

The Role of Lymphatic Drainage Massage Post-Operatively

In the aftermath of DIEP flap surgery, the role of manual lymphatic drainage (MLD) emerges as an essential component in the recovery process, especially in instances where oedema is prevalent. The systematic approach towards MLD, as underscored by research, offers a nuanced understanding of its efficacy and application in post-operative care. Here are more details about how lymphatic drainage massage aids in recovery:

Efficacy of Lymphatic Drainage Massage

  • Despite mixed findings in broader contexts, the specific application of MLD in DIEP flap recovery shows promising outcomes. A study evaluating lymphatic drainage in patients post-breast reconstruction highlighted the directed flow of lymph towards various lymphatic basins, suggesting a targeted relief from oedema.
  • The benefits extend beyond oedema management; massage post-DIEP surgery is instrumental in enhancing lymphatic drainage, reducing bruising, swelling, and inflammation, softening scar tissue, and increasing mobility. This multifaceted approach underscores the critical role of MLD in fostering a smoother recovery trajectory.

Practical Application and Techniques

  • Scar Massage: An essential aspect of post-operative care involves scar massage, which not only prevents the scar from becoming firm but also assists in overall abdominal healing. Initiating with light pressure and gradually increasing to deeper, firmer strokes, the massage should be performed daily, two to three times, for ten minutes to mitigate excess collagen build up. Incorporating small circles along the scar line and using two fingers to massage the scar and surrounding area can further enhance the healing process.
  • Self-Massage Guidelines: For patients navigating the recovery phase at home, self-massage serves as a critical tool in managing lymphedema and promoting lymph flow. Key techniques include:
    • Utilising light pressure with the flats of the hands instead of fingertips.
    • Directing the massage towards areas of the body unaffected by cancer treatment, thereby facilitating the movement of fluid away from swollen areas.
    • Ensuring comfort and avoiding any actions that cause pain or strain, particularly around sensitive areas.

Professional Guidance and Timing

  • The integration of professional lymphatic drainage therapy into the recovery plan should be deliberated with Dr Soliman to determine the most opportune timing post-surgery. In some cases, it is recommended to begin lymphatic work as early as three to four days post-surgery, with surgeon’s consent, to effectively reduce swelling and provide mental comfort.
  • Emphasising the importance of mental and physical preparation, both before and after surgery, highlights the benefits of MLD, extending beyond physical recovery to include emotional and psychological well-being.

The Benefits of Lymphatic Drainage for DIEP Flap Recovery

Embarking on the recovery journey after DIEP flap surgery, the incorporation of manual lymphatic drainage (MLD) presents many benefits, enhancing the healing process in a gentle yet effective manner. Here’s an overview of how MLD contributes significantly to your recovery:

Immediate Physical Benefits:

  • Enhanced Lymphatic Drainage: Facilitates the removal of bodily waste and reduces lymphoedema risks.
  • Reduction in Bruising, Swelling, and Inflammation: Accelerates the resolution of post-surgical symptoms.
  • Softening of Scar Tissue & Prevention of Excess Scar Tissue Development: Ensures a smoother healing process and aesthetic outcome.
  • Increased Mobility: Restores range of motion, contributing to a quicker return to daily activities.
  • Regeneration of Tissues: Promotes the repair of skin and underlying tissues damaged during surgery.

Holistic Healing Advantages:

  • Pain and Discomfort Reduction: Alleviates acute sensations of pain through gentle manipulation.
  • Relaxation and Stress Reduction: The soothing nature of MLD, often complemented by aromatherapy, music, and the use of natural butters and oils, offers a tranquil respite from the stressors of surgery and recovery.

Technique and Application:

  • MLD is characterised by gentle, light, and rhythmic strokes, targeted to stimulate lymph flow. This specificity in technique underlines the non-invasiveness and safety of the massage, making it an ideal choice for patients recovering from DIEP flap surgery. The versatility of MLD, devoid of side-effects, renders it an invaluable tool in the post-operative care regimen.

A systematic review and meta-analysis of randomised controlled trials have underscored the efficacy of MLD in reducing lymphoedema, particularly in patients under the age of 60 years, with an intervention time of one month. Despite its nuanced role in preventing lymphoedema post-breast cancer surgery, the tangible benefits in scar healing and overall recovery post-DIEP flap reconstruction are substantial. By integrating MLD into your recovery plan, you not only address the physical aftermath of the surgery but also embrace a holistic approach to healing, ensuring a smoother, more comfortable recovery trajectory.

How to Perform Lymphatic Drainage Massage at Home

Performing lymphatic drainage massage at home can be an empowering step in your recovery process after DIEP flap surgery. Here’s how you can effectively carry out this gentle, therapeutic technique:

Step-by-Step Guide to Home Lymphatic Drainage Massage

  1. Prepare Your Environment: Choose a quiet, comfortable space where you won’t be disturbed. Consider soft lighting and maybe some soothing music to create a relaxing atmosphere.
  2. Positioning: Begin in a comfortable lying or slightly reclined position. Ensure your body is supported with pillows as needed, especially under your knees and head for optimal comfort.
  3. Starting the Massage:
    • Warm-up Touches: Gently place your hands on either side of your neck. With light pressure, stroke downwards towards your collarbone. This helps to open the lymphatic pathways for drainage.
    • Abdominal Strokes: Place your hands flat on your abdomen. Using a soft, sweeping motion, move your hands in a circular pattern from the right side of your abdomen towards the left, directing the fluid towards the groin area where major lymph nodes are located.
    • Limb Massage: For your arms and legs, always massage in a direction towards your heart. Use gentle, sweeping motions starting from the extremities and moving inwards. This encourages the lymph fluid to flow towards the central part of your body for proper drainage.

Key Points to Remember

  • Gentleness is Key: The pressure applied should be light, as lymphatic vessels lie just beneath the skin. Heavy pressure can compress these vessels and hinder the flow of lymph.
  • Frequency: Ideally, dedicate time for this massage 1-2 times daily, especially in the initial weeks post-surgery, to maximise benefits.
  • Hydration: Drink plenty of water before and after your massage to help flush out toxins and support the lymphatic system.

When to Pause or Seek Professional Guidance

  • Monitor Your Body’s Response: Any increase in pain, swelling, or discomfort after the massage may indicate the need to adjust your technique or seek advice from a professional.
  • Professional Check-ins: While performing lymphatic drainage at home is beneficial, regular appointments with a certified lymphoedema therapist can provide personalised guidance and adjustments to your technique as needed.

By incorporating these steps into your recovery routine, you engage in a proactive approach to managing swelling, enhancing healing, and ultimately promoting a smoother recovery journey post-DIEP flap surgery. Keep in mind that patience and consistency with these gentle massage techniques can significantly contribute to your overall well-being during the healing process.

Professional Lymphatic Drainage Therapy

Seeking professional lymphatic drainage therapy post-DIEP flap surgery is an important step in ensuring optimal recovery. While self-massage techniques are beneficial, the expertise of a trained professional can significantly enhance the healing process. Here’s when and where to seek professional help:

When to Seek Professional Lymphatic Drainage Therapy

  • Persistent Swelling or Lymphoedema: If you notice continuous swelling or signs of lymphoedema that doesn’t improve with self-massage, it’s time to consult a professional.
  • Scar Tissue Concerns: For patients experiencing issues with scar tissue, such as hardness or discomfort, professional lymphatic drainage can aid in softening and promoting healing of the scar.
  • Post-Operative Complications: Any complications or concerns post-surgery should prompt a visit to a lymphatic drainage therapist to address and alleviate symptoms effectively.

Lymphoedema and Cancer Rehabilitation Services

Onccare offers early intervention services as well as chronic lymphoedema management, garment prescription, bandaging, pneumatic compression pumps and laser, as well as personalised exercise programs including yoga, pilates and cardiovascular exercise for post op recovery.

  • For the office in Lakeview Private Hospital Suite 3, Level 1, 17Solent Circuit, Norwest, call 88508252 with details on surgery and background diagnosis.
  • For the office in French’s Forest, Level 1 Suite 4, 1/49 French’s Forest Rd, contact Elizabeth Ringrose by email ( and provide details on surgery and background diagnosis.

Choosing Professional Help:

  • Expertise and Specialisation: Opt for therapists who specialise in post-operative recovery and are familiar with the complexities of DIEP flap surgery.
  • Techniques and Equipment: Consider therapists who incorporate a range of techniques and advanced equipment, such as LED light therapy, to support your recovery journey.
  • Accessibility and Comfort: Ensure the therapy location is accessible and provides a comfortable environment for your sessions.

Incorporating professional lymphatic drainage therapy into your recovery plan not only addresses physical aspects of healing but also supports your overall well-being, ensuring a smoother and more effective recovery process.

FAQs about Lymphatic Drainage Massage

What is the scientific basis for manual lymphatic drainage?

  • Manual lymphatic drainage (MLD) is a recognised part of complete decongestive therapy, a non-surgical treatment that has been shown to help prevent the onset of lymphoedema after surgery. Research has reviewed the literature on MLD to understand its potential mechanisms of action.

When is it safe to start lymphatic drainage massage following a surgical procedure?

  • Lymphatic drainage massage can be initiated within days after a surgical procedure, as it involves very gentle techniques. For optimal results, it’s advised to begin the massage within 3-5 days post-surgery, in consultation with a certified therapist.

Does lymphatic drainage massage offer real benefits?

  • Lymphatic drainage massage is not only relaxing but has also been found to be effective in reducing stress and anxiety. A study involving 50 women with fibromyalgia showed that lymphatic drainage massage was more effective than connective tissue massage in alleviating symptoms of anxiety.

Further Reading about DIEP Breast Reconstruction with Sydney Specialist Plastic Surgeon Dr Bish Soliman

Medical References about Lymphatic Drainage Massage

About Dr Bish Soliman

Dr Bish Soliman - Sydney Plastic and Reconstructive Surgeon, about us 01 2x
Specialist Plastic, Reconstructive and Cosmetic Surgeon
FRACS (Plas), MS (Plas), MBBS (Hons 1), BCom

AHPRA Registered Medical Practitioner MED 0001679053 Specialist Registration in Plastic Surgery

Dr Bish Soliman is a Sydney-based Specialist Plastic and Reconstructive Surgeon who performs aesthetic surgery of the face, breast, and body as well as skin cancer surgery.

He currently holds two consultant microsurgery positions in major Sydney hospitals performing complex microsurgical reconstruction including DIEP breast reconstruction.

After graduating from The King’s School, Dr Bish completed a Bachelor of Commerce degree at the University of Sydney. After working briefly at a major Sydney finance firm, he decided to pursue his passion and long-term goal of a career in medicine. He graduated from the University of Notre Dame at the top of his class, receiving First class honours and the prestigious Bower and Sherrard medal. He then went on to complete his junior medical training at Westmead Hospital during which time he was awarded Junior Medical Officer (JMO) of the Year, as well as a finalist for NSW Doctor of the Year.


Next Steps

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  • A GP Medical Referral is now essential to see Dr Bish Soliman for any type of surgery.
  • You can book your consultation with Dr Bish Soliman by paying the consultation fee in advance – when you make your appointment.

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