Physical Therapy and Rehabilitation after DIEP Flap Surgery

The Role of Rehabilitation and Physical Therapy after Breast Reconstruction Surgery

DIEP flap surgery is a breast reconstruction technique that offers you a path to recovery with fewer complications than traditional methods. By utilising your own abdominal tissue, this procedure not only aids in creating a natural breast shape but also results in a flatter abdomen, combining the benefits of reconstruction with those of a ‘tummy tuck’ – abdominoplasty.

But your journey doesn’t end post-surgery; it’s crucial to engage in physical therapy and rehabilitation to fully recover after DIEP flap surgery. These steps are key to regaining strength and mobility, ensuring you can return to your daily activities with confidence and ease.

In this blog, Dr Bish Soliman, a well-known plastic surgeon from Sydney, discusses what comes after DIEP Flap Surgery, focusing on getting back to normal with physical therapy and rehab. He explains in simple terms how important these steps are for healing and getting your strength back. Dr Soliman shares his knowledge on how a little bit of exercise and care, guided by professionals, can make a big difference in recovery.

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The Role of Physical Therapy in Recovery

The role of physical therapy in the recovery process after DIEP (Deep Inferior Epigastric Perforator) Flap Surgery is critical, facilitating not just a return to daily activities but also ensuring the long-term success of the surgical procedure.

Immediately following surgery, the primary focus of physical therapy is to manage pain, reduce swelling, and prevent complications such as blood clots and pulmonary issues. Physical therapists employ gentle, hands-on techniques and prescribe specific exercises that promote blood circulation, enhance mobility, and support the healing of surgical sites. These early interventions are designed to lay a solid foundation for more advanced rehabilitation efforts in the weeks and months to follow.

As recovery progresses, the goals of physical therapy evolve. A significant objective becomes the restoration of strength and flexibility, particularly in the abdominal and donor site areas, which are crucial for core stability and overall body function. Dr Soliman will recommend a professional that will work closely with you to develop customised exercise programs that target these key areas, gradually increasing in intensity and complexity as your condition improves. This careful, structured approach ensures that activities such as lifting, bending, and twisting are reintroduced safely, reducing the risk of injury or strain to the affected regions.

Another vital goal of physical therapy is to address scar tissue management. Scar tissue, if not properly managed, can lead to restricted movement and discomfort. Through techniques such as manual therapy, stretching exercises, and guidance on scar massage, you can help minimise the formation of restrictive scar tissue, thereby enhancing the cosmetic and functional outcomes of the surgery.

The Initial Stages of Rehabilitation

In the initial stages of rehabilitation following DIEP flap surgery, your focus will be on gentle exercises and activities that promote healing while preventing complications. Here’s how to begin:

1. Breathing and Circulation Exercises:
   1. Breathing Exercises: Start with deep breathing exercises on day 1 to keep the chest clear and prevent complications. This also aids in relaxation and easing nausea.
   2. Circulation Exercises: Perform simple movements 3-5 times per hour to encourage blood flow and prevent muscle strain.
2. Mobilisation and Basic Exercises:
   1. Day 2 Mobilisation: Begin walking short distances with support, aiming to gradually increase both distance and independence daily.
   2. Day 4 Exercises: Introduce basic exercises for your tummy and arms/shoulders to regain normal posture and prevent tight scar tissue. This includes shoulder shrugs, arm raises, and abdominal exercises like arching and flattening the lower back.
3. Progressive Activities:
   1. Reducing Pillow Support: Gradually reduce the number of pillows under your knees at night until you can lie flat, aiding in the return to normal sleeping positions.
   2. Post-Surgery Exercises: Include shoulder exercises such as shrugging, raising arms, and reaching behind the neck and back within the first few days post-surgery.

DIEP flap surgery recovery is a gradual process, typically taking six to eight weeks before resuming normal activities. During your hospital stay of five to seven days, pain and swelling can be managed with painkillers and dressings, and walking without discomfort is expected within two weeks. Always consult with Dr Soliman or a physical therapist specialised in post-surgical rehabilitation to tailor these exercises to your specific needs and progress.

Regaining Range of Motion and Strength

As you progress through your DIEP flap surgery recovery, regaining range of motion and strength becomes a pivotal part of rehabilitation. Here’s a structured approach to gently reintroduce physical activity and strengthen your body:

Abdominal and Core Strengthening:

• Pelvic Tilt Exercise: Begin with pelvic tilts to engage and strengthen your core. Lie flat, bend your knees, and flatten your back against the floor by pulling your belly button towards your spine. Aim for 10 repetitions.
• Tabletop and Advanced Tabletop Exercises: Gradually introduce tabletop exercises to further engage your core. For an added challenge, incorporate a 3-5 pound weight in each hand.
• Bridge Exercise: Strengthen your lower back and buttocks with bridge exercises. Lift your hips while keeping your feet flat on the ground, hold, then lower. Repeat.

Neck and Shoulder Mobility:

• Neck Stretches: Perform gentle neck stretches three times a day to relieve tension and improve flexibility.
• Shoulder Exercises: Include shoulder shrugs, circles, and assisted arm lifts to regain movement and strength. Gradually increase repetitions to 10 as comfort allows.

Yoga, Pilates, and Scar Tissue Massage:

• Gentle Yoga and Pilates: After Dr Soliman gives the go-ahead, start with gentle yoga and Pilates to improve flexibility and core strength.
• Scar Tissue Massage: Once the incision is fully healed, begin scar tissue massage to improve elasticity and reduce discomfort.

Incorporating these exercises into your daily routine will not only aid in regaining physical strength but also contribute to overall well-being during your DIEP flap surgery recovery.

Building Strength and Mobility

Building strength and mobility after DIEP flap surgery requires a careful, structured approach to ensure a smooth recovery. Here are some exercises and practices to incorporate into your rehabilitation routine:

Posture and Heavy Lifting:

• Avoid heavy lifting for at least 8 weeks to protect the healing tissues.
• Maintain an upright posture to minimise stiffness and support wound healing.

Arm and Shoulder Exercises:

• Raising Arms: Gradually raise straight arms up and over the head to improve flexibility.
• Raising Arms Away: Lift straight arms away from the side, enhancing shoulder mobility.
• Reaching Behind: Practice reaching one hand behind the back to increase range of motion.
• Behind Neck: Place hands behind the neck and raise elbows, promoting upper body strength.

Abdominal and Scar Care:

• Abdominal Exercises: After the removal of wound drains, perform exercises like arching and flattening the lower back against the bed, and lowering knees to the side to strengthen the core.
• Scar Massage: From weeks 2-3, start massaging the donor site and chest wall with oil or non-perfumed moisturising cream to improve elasticity and reduce discomfort.
• Moisturising Scars: Begin moisturising scars from week 3 post-surgery to prevent tightness that could restrict movement.

Incorporating these exercises and practices into your daily routine not only aids in building strength and mobility but also ensures a more comfortable and successful recovery.

Advanced Rehabilitation Techniques

As you transition into advanced rehabilitation techniques following DIEP flap surgery, it’s essential to build upon the foundation of strength and mobility you’ve established. Here are targeted exercises and general advice to guide you:

Advanced Exercises (Week 6 Onwards):

• Single Leg Extensions: Lie on your back, extend one leg at a time while keeping the other bent. This strengthens the core and improves balance.
• Heel Taps: Lying down with knees bent, slowly lower one heel at a time to the ground. This engages abdominal muscles.
• Knee Rolling: With knees bent and together, gently roll them side to side, keeping your upper body still. Enhances lower back flexibility.

General Recovery Advice:

• Massage: Once fully healed, gently massage the wound with moisturising cream to improve elasticity.
• Activity Graduation: Gradually increase the use of your arm and shoulder, avoiding strenuous or repetitive tasks and heavy lifting.
• Listen to Your Body: Tiredness and feeling down are normal. Prioritise rest and gradually return to activities.
• Exercise: Walking is excellent for overall health. Aim to start swimming and other leisure activities within two months, ensuring scars have healed.

FAQs about Physical Therapy and Rehabilitation after DIEP Flap Surgery

How soon after DIEP flap surgery can I start physical therapy?

• The timeline for starting physical therapy can vary depending on individual factors such as your overall health, the complexity of the surgery, and your surgeon’s protocol. Typically, light physical therapy exercises focusing on gentle movements and breathing exercises may start within the first week after surgery to promote circulation and prevent complications. More intensive rehabilitation exercises will likely begin after your surgeon has confirmed adequate healing, usually around 6 weeks post-surgery.

Will physical therapy help in reducing scars and improving the appearance of my surgery site?

• Yes, physical therapy can play a role in managing scar tissue and improving the appearance of your surgery site. Therapists can employ various techniques such as manual lymphatic drainage, soft tissue mobilisation, and specific exercises to enhance tissue flexibility, reduce scar thickness, and promote a more natural appearance. Additionally, they may advise on the use of silicone sheets or gels which are known to help in scar management.

Are there any specific exercises I should avoid after DIEP flap surgery?

• In the initial weeks following your surgery, you should avoid exercises that strain the abdominal area, heavy lifting, or high-impact activities that may compromise the healing of the surgical site. Your physical therapist will provide a tailored exercise program that safely progresses in intensity as you heal, ensuring that activities are reintroduced at the appropriate time to avoid risks of hernias or damage to the reconstruction.

How does physical therapy address the risk of lymphoedema after DIEP flap surgery?

• Physical therapists trained in lymphoedema management can significantly reduce the risk of developing lymphoedema through early intervention and education. They may use manual lymphatic drainage (MLD) techniques, compression garments, and specific exercises to promote lymphatic flow and prevent fluid accumulation. They will also educate you on self-care strategies to manage or prevent lymphedema effectively.

What should I do if I experience pain during my rehabilitation exercises?

• Experiencing mild discomfort during rehabilitation exercises is normal, but pain is not and should be addressed immediately. Always communicate openly with your physical therapist about any pain you experience. They may need to adjust your exercise regimen or incorporate additional pain management techniques into your therapy plan. It’s crucial to follow their guidance closely to avoid injury and ensure a smooth recovery process.

Further reading about Breast Reconstruction with Sydney Plastic Surgeon Dr Bish Soliman

• Read more about DIEP Flap Breast Reconstruction and Radiotherapy
• Read more about FAQs about DIEP Breast Reconstruction Surgery
• Read more about Why Dr Soliman Prefers DIEP Breast Reconstruction?
• Read more about Who Are the Best DIEP Breast Reconstruction Surgeons in the World?
• Read more about Medicare for DIEP Breast Reconstruction
• Read more about Combining DIEP Flap with Other Reconstructive Techniques
• Read more about Secondary Procedures after DIEP
• Read more about How to Reduce Scars after DIEP Surgery

Medial References about Physical Therapy and Rehabilitation after DIEP Flap Surgery

• Physiotherapy advice after breast reconstruction surgery – Oxford University
• Rehabilitation For DIEP Reconstruction – Rehabilitation For DIEP Reconstruction
• Physiotherapy after DIEP Surgery – NHS
• Patient Perspective on Post-Breast Reconstruction – Science Direct
• Post-operative Exercises DIEP Reconstruction -NHS