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How to Safely Return to Exercise after DIEP Flap Reconstruction

DIEP (Deep Inferior Epigastric Perforator) surgery is a type of breast reconstruction procedure that uses your own abdominal skin and fat to create a new breast after mastectomy. Unlike other reconstruction techniques, DIEP surgery spares your abdominal muscles, which can result in a more natural-looking breast and a quicker recovery. The procedure involves transferring skin and fat from the lower abdomen to the chest and reconnecting the blood vessels to ensure proper blood flow.

In this blog, Sydney Specialist Plastic Surgeon Dr Bish Soliman will offer recommendations for a safe return to exercise after DIEP surgery.

Recovery Timeline – What to Expect

Recovery from DIEP surgery varies from person to person, but generally, you can expect a hospital stay of about 5 days. During this time, you will be monitored closely to ensure proper blood flow to the reconstructed breast. Pain management will be a priority, and you will be encouraged to start moving around as soon as possible to aid circulation and prevent complications such as blood clots.

Once you are home, it is important to follow Dr Soliman’s instructions carefully. You should avoid strenuous activities and heavy lifting for at least six weeks. Most people can return to light activities and work after 6 weeks, but full recovery can take several months. Dr Soliman will provide a personalised timeline based on your progress.

Regular follow-up appointments will be necessary to monitor your healing and address any concerns that arise. During these visits, Dr Soliman will check the appearance of the reconstructed breast and the abdominal donor site to ensure everything is healing as expected.

Importance of Exercise After DIEP Surgery

Incorporating exercise into your recovery plan after DIEP surgery can be highly beneficial. Regular physical activity helps to improve blood circulation, which can aid in healing and reduce the risk of complications such as blood clots. Exercise also helps to maintain a healthy weight, which is important for overall health and recovery. Additionally, engaging in physical activity can help manage post-surgery pain and discomfort by releasing endorphins, the body’s natural painkillers.

Psychological and Physical Advantages

Physical activity is not just beneficial for your body but also for your mind. Exercise can help to reduce feelings of anxiety and depression that can sometimes accompany major surgeries and recovery periods. By focusing on gentle, consistent exercise, you can create a positive routine that boosts your mood and provides a sense of accomplishment. Physically, exercise can help to rebuild strength and flexibility, making daily tasks easier and improving your overall quality of life.

Long-Term Health Considerations

Establishing an exercise routine after DIEP surgery can set the foundation for long-term health. Regular physical activity helps to reduce the risk of chronic diseases such as heart disease, diabetes, and osteoporosis. It can also help to maintain a healthy weight and improve cardiovascular health. By making exercise a part of your recovery plan, you are investing in your long-term health and well-being.

Starting an exercise routine after surgery should be done gradually and with. It’s important to choose activities that are gentle and low-impact, especially in the early stages of recovery. Walking is an excellent starting point, as it is easy to control the pace and intensity. As you progress, you can incorporate other forms of exercise that focus on flexibility, strength, and endurance.

When to Start Exercising after DIEP Flap Surgery

Before starting any exercise routine after DIEP surgery, it’s important to have a thorough discussion with Dr Soliman. He has a comprehensive understanding of your specific case, including the details of your surgery, your overall health, and how your recovery is progressing. He will provide personalised recommendations that ensure your return to physical activity is safe and effective. Don’t hesitate to ask questions and express any concerns you might have.

While each person’s recovery journey is unique, there are general guidelines that can help you understand when it might be appropriate to begin exercising after DIEP surgery. Typically, light activities such as walking can be initiated as soon as you feel ready, often within the first few days to weeks post-surgery. However, more strenuous activities, including strength training and high-impact exercises, are usually off-limits for at least six weeks. Always prioritise your safety and well-being by progressing at a pace that feels comfortable and sustainable.

Your body will provide important feedback as you transition back into exercising after DIEP surgery. Pay close attention to how you feel during and after physical activity. If you experience pain, discomfort, or unusual fatigue, it might be a sign that you are overdoing it or that certain exercises are not suitable for you at this stage. It’s important to start with gentle activities and gradually increase the intensity and duration as your strength and endurance build.

Types of Exercises to Avoid Initially

In the early stages of your recovery from DIEP surgery, it’s essential to avoid high-impact activities that can place excessive stress on your body. Exercises such as running, jumping, or any activities involving sudden, jarring movements should be postponed until you have sufficiently healed. These types of exercises can strain the surgical sites and increase the risk of complications, such as opening wounds or causing internal damage. Instead, focus on low-impact activities that promote gentle movement and allow you to gradually rebuild your strength and endurance without risking injury.

Core-Intensive Workouts

Core-intensive workouts, such as sit-ups, crunches, and other abdominal exercises, should be avoided during the initial stages of recovery. These exercises can place significant strain on the abdominal area, which is particularly vulnerable following DIEP surgery. Engaging in core-intensive workouts too soon can impede the healing process and potentially lead to complications. It’s important to give your abdominal muscles ample time to heal before introducing exercises that target this area.

Heavy Lifting

Heavy lifting is another activity that should be avoided during the early phase of your recovery. Lifting heavy objects can place undue stress on both the reconstructed breast and the abdominal donor site. This can result in complications such as wound reopening, increased pain, and delayed healing. As a general rule, avoid lifting anything heavier than 2-5 kg for at least six weeks following your surgery. When you do begin lifting objects again, start with light weights and gradually increase as you regain strength and confidence in your ability to handle more strenuous tasks.

Gentle Exercises to Begin With

  • Walking: Walking is one of the most beneficial and safest exercises to start with after DIEP surgery. It promotes blood circulation, reduces the risk of blood clots, and helps maintain cardiovascular health without placing undue stress on your body. Start with short, slow walks around your home or neighbourhood, gradually increasing the distance and pace as you feel more comfortable. Aim to walk for at least 10-15 minutes a few times a day, slowly building up to longer durations.
  • Gentle Stretching and Flexibility Exercises: Incorporating gentle stretching and flexibility exercises into your routine can help improve your range of motion and prevent stiffness. Focus on stretches that target the areas around your surgical sites without causing pain or discomfort. Simple movements, such as shoulder rolls, neck stretches, and gentle arm raises, can be beneficial. Always perform these exercises slowly and carefully, stopping if you experience any discomfort.
  • Breathing Exercises for Relaxation: Breathing exercises can be incredibly helpful during your recovery. Deep breathing helps to relax your body, reduce stress, and improve oxygen flow, which aids in healing. Try diaphragmatic breathing, where you inhale deeply through your nose, allowing your abdomen to rise, and exhale slowly through your mouth. This type of breathing can be done several times a day and is particularly useful if you feel anxious or tense.

Gradually Increasing Intensity

  • Introducing Light Cardio: Once you feel comfortable with walking and gentle stretching, you can begin to incorporate light cardio exercises. Activities such as stationary cycling or using an elliptical machine are good options that provide cardiovascular benefits without high impact. Start with short sessions, around 10-15 minutes, and gradually increase the duration as you build stamina and strength. Always ensure that these activities do not cause pain or discomfort in your surgical areas.
  • Building Up Endurance Safely: Building up your endurance is an essential part of your recovery, but it should be done gradually to avoid overexertion. Focus on increasing the duration and intensity of your exercises slowly. For example, add a few minutes to your walks or cardio sessions each week. Pay attention to your body’s signals, and take rest days as needed to allow your body to recover. Consistency is key, but so is listening to your body and progressing at a manageable pace.
  • Monitoring Your Body’s Response: As you increase your exercise intensity, it’s important to monitor your body’s response. Keep an eye out for signs of overexertion, such as increased pain, swelling, or fatigue. If you notice any of these signs, reduce the intensity or take a break from exercise. Maintaining a balance between activity and rest will help ensure a steady and safe recovery. Keeping a journal to track your exercises and how you feel can be a useful tool to monitor progress and identify any issues early.

Strength Training After DIEP Surgery

  • When to Introduce Strength Training: Strength training is an important aspect of a well-rounded fitness routine, but it should be approached with caution after DIEP surgery. Generally, it’s advisable to wait at least six weeks before introducing any strength training exercises. Always consult with Dr Soliman to determine the appropriate timing based on your individual recovery. Starting with bodyweight exercises can be a gentle way to reintroduce strength training without the risk of lifting heavy weights.
  • Safe Exercises for the Upper Body: When you are ready to start strength training, focus on safe exercises that target the upper body without putting too much strain on the surgical areas. Exercises such as bicep curls, triceps extensions, and shoulder presses with light weights or resistance bands can be effective. Begin with light resistance and gradually increase as your strength improves. Ensure that you use proper form to avoid injury and stop any exercise that causes pain or discomfort.

Gradual progression is essential when reintroducing strength training after surgery. Start with light weights and perform a small number of repetitions. As your strength and endurance improve, you can slowly increase the weight and the number of repetitions. Avoid rushing the process, as overloading your muscles too soon can lead to setbacks.

Core Rehabilitation and Strengthening

Rebuilding core strength is a component of your recovery after DIEP surgery. The core muscles, including the abdominals, back, and pelvic muscles, play a vital role in maintaining posture, balance, and overall body stability. After surgery, these muscles may be weakened or strained, particularly if tissue was taken from the abdominal area. Strengthening your core can help alleviate discomfort, improve mobility, and enhance your overall functional ability.

Safe Core Exercises to Begin With

When beginning core strengthening exercises, it’s important to start with gentle, low-impact movements that engage the core muscles without causing strain. Here are some safe exercises to consider:

  • Pelvic Tilts: Lie on your back with your knees bent and feet flat on the floor. Gently tilt your pelvis towards your ribcage, flattening your lower back against the floor. Hold for a few seconds and then release. Repeat this movement 10-15 times.
  • Abdominal Draw-In: While lying on your back with knees bent, gently draw your navel towards your spine without lifting your hips off the floor. This engages the deep abdominal muscles. Hold for a few seconds and then relax. Repeat 10-15 times.
  • Heel Slides: Lie on your back with knees bent. Slowly slide one heel along the floor until your leg is extended, then slide it back to the starting position. Alternate legs and repeat 10 times on each side.
  • Knee-to-Chest Stretch: Lie on your back and gently pull one knee towards your chest, holding for a few seconds before releasing. Alternate legs and repeat 10 times on each side. This helps to gently stretch and engage the core muscles.

Always perform these exercises slowly and with control, focusing on your breathing and maintaining proper form.

Avoiding Strain on the Surgical Area

It’s essential to avoid exercises that place excessive strain on the surgical areas, particularly the abdominal muscles. Here are some exercises to avoid in the early stages of recovery:

  • Sit-Ups and Crunches: These traditional core exercises put significant pressure on the abdominal area and can hinder healing.
  • Leg Raises: Lifting both legs off the ground can strain the lower abdomen and should be avoided until your core is stronger.
  • Twisting Movements: Any exercises that involve twisting at the waist, such as Russian twists, should be avoided as they can stress the surgical sites.
  • Heavy Resistance Exercises: Using heavy weights or resistance bands for core exercises can also place undue stress on the abdominal muscles and should be avoided initially.

Flexibility and Mobility Exercises

  • Stretching for Improved Mobility: Incorporating stretching exercises into your recovery routine can greatly enhance your flexibility and mobility. Stretching helps to lengthen muscles, improve circulation, and reduce stiffness, which is especially important after surgery. Start with gentle, controlled stretches that target major muscle groups without causing pain or discomfort. Key areas to focus on include the shoulders, neck, back, and legs. Perform each stretch slowly and hold it for 20-30 seconds, ensuring you feel a gentle pull but not pain. Regular stretching can help you regain movement and prevent muscle tightness as you heal.
  • Yoga and Pilates for Gentle Flexibility: Yoga and Pilates are excellent choices for gentle flexibility and mobility exercises post-surgery. These practices emphasise controlled movements, deep breathing, and alignment, making them suitable for gradual recovery. Start with beginner-level classes or routines that are designed specifically for post-surgery rehabilitation. Gentle yoga poses, such as Child’s Pose, Cat-Cow, and Downward Dog, can help stretch and strengthen without placing too much strain on your body. Pilates focuses on core strength and stability, with exercises like pelvic tilts and leg slides being particularly beneficial.

FAQs about Returning to Exercise after DIEP Surgery

How soon can I start gentle activities like stretching and walking after DIEP surgery?

  • While the exact timeline can vary, most patients can begin very gentle activities like light stretching and short walks within the first week after surgery. The key is to start slowly and listen to your body. Begin with short walks around your home and light stretching that does not put any strain on your surgical sites. These activities can help improve circulation and reduce the risk of complications such as blood clots.

What are the signs that I might be doing too much too soon in my exercise routine?

  • It’s important to pay attention to your body’s signals as you resume physical activity after DIEP surgery. Signs that you might be overdoing it include increased pain, swelling, redness around the surgical sites, excessive fatigue, or a feeling of heaviness in your chest or abdomen. If you experience any of these symptoms, it’s crucial to reduce the intensity or duration of your exercise and consult your plastic surgeon. Overexertion can delay healing and increase the risk of complications, so it’s essential to progress at a pace that feels right for you.

Can I do water-based exercises like swimming after DIEP surgery?

  • Water-based exercises such as swimming and water aerobics can be beneficial for low-impact exercise, but they should only be introduced once your surgical wounds are fully healed and your surgeon has given the go-ahead. Usually, this is around 6-8 weeks post-surgery. Swimming can help improve cardiovascular fitness and muscle tone without putting undue stress on your body. However, ensure that you avoid vigorous strokes and movements initially, and gradually build up your strength and endurance.

Are there specific clothing recommendations for exercising after DIEP surgery?

  • Wearing the right clothing during exercise can enhance comfort and support your recovery. It is recommended to wear a supportive sports bra that offers good coverage without compressing the surgical area too tightly. For abdominal support, you might consider wearing a compression garment as advised by your surgeon. Loose, breathable clothing can also help reduce irritation and allow for a greater range of motion. Avoid any clothing that is too tight or restrictive, especially around the chest and abdomen.

How can I stay motivated to exercise during my recovery from DIEP surgery?

  • Staying motivated during recovery can be challenging, but setting small, achievable goals can help keep you on track. Keeping a journal to document your progress and celebrate milestones, no matter how small, can be encouraging. Joining a support group with others who have undergone similar procedures can provide a sense of community and shared experience. Additionally, incorporating enjoyable activities, such as listening to music or walking in nature, can make exercise feel less like a chore and more like a rewarding part of your day.

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

Medical References about DIEP Surgery

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

Do your Research

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