DIEP flap surgery and abdominal strength

If you’re considering breast reconstruction after a mastectomy, you may have heard about DIEP flap surgery. This advanced surgical technique has gained popularity in recent years due to its natural-looking results and potential benefits over other reconstruction methods. However, as with any surgery, it’s essential to understand the potential effects on your body, particularly your abdominal strength.

In this blog post, Sydney Specialist Plastic Surgeon Dr Bish Soliman will explore the relationship between DIEP flap surgery and abdominal strength, as well as provide exercises to help you regain strength during your recovery journey.

What is DIEP Flap Surgery?

DIEP (Deep Inferior Epigastric Perforator) flap surgery is a type of breast reconstruction that uses skin, fat, and blood vessels from your lower abdomen to create a new breast mound. Unlike the more traditional TRAM (Transverse Rectus Abdominis Muscle) flap procedure, DIEP flap surgery preserves the abdominal muscles, resulting in a faster recovery and reduced risk of long-term abdominal weakness.

During the DIEP flap procedure, Dr Soliman carefully selects and removes a portion of skin and fat from your lower abdomen, along with the associated blood vessels. This tissue is then transplanted to your chest and shaped to form a new breast. Dr Soliman reconnects the blood vessels to ensure proper blood supply to the transplanted tissue. The abdominal incision is then closed, typically resulting in a scar that can be hidden beneath most clothing and swimwear.

DIEP flap surgery offers several benefits compared to other breast reconstruction methods. Firstly, it provides a natural look and feel to the reconstructed breast, as the tissue used is from your own body. Additionally, since the abdominal muscles are preserved, patients often experience less post-operative pain and a quicker return to normal activities compared to TRAM flap surgery. However, not everyone is an ideal candidate for DIEP flap surgery. Factors such as previous abdominal surgeries, insufficient abdominal tissue, and certain medical conditions may make other reconstruction options more suitable. Dr Soliman will assess your individual case and discuss the best approach for your unique circumstances.

Effects of DIEP Flap Surgery on Abdominal Strength

One of the most common concerns among patients considering DIEP flap surgery is the potential impact on their abdominal strength. While DIEP flap surgery is designed to preserve the abdominal muscles, it’s essential to understand that some temporary weakness and changes in abdominal function are to be expected following the procedure.

During DIEP flap surgery, Dr Soliman carefully dissects the skin and fat from the abdominal wall, taking care to preserve the underlying muscles. However, the process of separating the tissue from the muscle can lead to some degree of muscle trauma and inflammation. Additionally, the removal of skin and fat from the abdomen can alter the way the muscles contract and function in the short term.

You may experience a feeling of abdominal tightness, weakness, or a reduced ability to perform certain movements, such as sitting up from a lying position, in the initial weeks following surgery. This is a normal part of the healing process and should gradually improve over time.

Several factors can influence the extent and duration of abdominal weakness after DIEP flap surgery. These include:

• Age: Older patients may take longer to regain abdominal strength compared to younger patients.
• Overall health: Patients with pre-existing medical conditions or poor overall health may experience a slower recovery.
• Physical fitness: Patients who were physically active and had good core strength before surgery may find it easier to regain abdominal strength post-surgery.
• Surgical technique: The surgical technique used can play a role in minimising muscle trauma during the procedure.

Most patients can expect to see a gradual return of abdominal strength within 6-12 weeks following DIEP flap surgery. However, it’s important to remember that every patient’s recovery journey is unique, and some may take longer to regain full strength.

In rare cases, patients may experience more prolonged abdominal weakness or develop an abdominal bulge or hernia. These complications can often be managed with additional surgical procedures or specialised physical therapy.

To promote optimal recovery of abdominal strength, it’s crucial to follow Dr Bish Soliman’s post-operative instructions carefully. This may include:

• Wearing an abdominal binder or compression garment to support the muscles and reduce swelling.
• Gradually increasing physical activity as directed by your surgeon.
• Performing specific exercises to target and strengthen the abdominal muscles.
• Maintaining a healthy diet to support tissue healing.Attending follow-up appointments to monitor your progress.

It’s important to remember that while temporary abdominal weakness is a common side effect of DIEP flap surgery, the vast majority of patients are able to regain their pre-operative strength with time and appropriate care.

Exercises to Improve Abdominal Strength after DIEP Flap Surgery

Engaging in a safe and effective exercise program is essential for regaining abdominal strength after DIEP flap surgery. However, it’s essential to approach exercise with caution and under the guidance of Dr Bish Soliman and a qualified physical therapist. Rushing into strenuous activities too soon can lead to complications and setbacks in your recovery.

Before discussing specific exercises, it’s important to emphasise the value of pre-surgery preparation. Patients who engage in regular exercise and maintain a strong core prior to surgery often have an easier time with recovery. If you have time before your scheduled surgery, consider incorporating core-strengthening exercises into your routine, such as planks, bridges, and gentle abdominal crunches. Always consult with Dr Soliman beforehand to ensure these exercises are safe for you.

After surgery, your exercise program should be gradual and progressive, allowing your body adequate time to heal. The following phases provide a general guide to post-surgery exercise, but always defer to Dr Soliman’s specific instructions.

Early Post-Operative Phase (0-4 weeks):

During the initial weeks after surgery, your primary focus should be on rest and recovery. Gentle walking is usually encouraged to promote circulation and prevent complications like blood clots. Avoid any exercises that target the abdominal muscles directly, as your incisions need time to heal.

Some gentle exercises that may be appropriate during this phase include:

• Deep breathing exercises: Take slow, deep breaths to help manage pain and promote relaxation.
• Shoulder rolls and shoulder blade squeezes: Gently roll your shoulders forward and backward, and squeeze your shoulder blades together to maintain mobility in your upper body.
• Ankle pumps and foot circles: While lying down or seated, pump your ankles up and down and make circular motions with your feet to improve circulation in your legs.

Remember to listen to your body and stop any activity that causes pain or discomfort.

Intermediate Phase (4-8 weeks):

As your incisions heal and Dr Soliman gives you the go-ahead, you can begin incorporating more targeted exercises. During this phase, the focus is on gently activating the abdominal muscles and gradually building strength.

Exercises that may be appropriate during this phase include:

• Pelvic tilts: Lie on your back with your knees bent and feet flat on the floor. Gently tilt your pelvis upward, pressing your lower back into the floor, then release.
• Modified plank: Start on your hands and knees, then extend your legs back into a plank position, keeping your knees on the floor. Hold for a few seconds, then release.
• Standing abdominal bracing: Stand with your feet shoulder-width apart and gently draw your belly button in towards your spine, engaging your core muscles. Hold for a few seconds, then release.

Aim for low repetitions and multiple sets, gradually increasing as your strength improves. Remember to breathe normally throughout each exercise and avoid holding your breath.

Late Phase (8+ weeks):

As you continue to heal and your abdominal strength improves, you can begin incorporating more advanced exercises into your routine. However, it’s still essential to progress gradually and avoid overexerting yourself.

Exercises that may be appropriate during this phase include:

• Full plank: Progress from the modified plank to a full plank position, supporting your body on your hands and toes. Hold for 10-15 seconds, then release.
• Bridge: Lie on your back with your knees bent and feet flat on the floor. Lift your hips off the ground, squeezing your glutes and engaging your core. Hold for a few seconds, then lower back down.
• Russian twists: Sit on the floor with your knees bent and feet flat. Lean back slightly, keeping your back straight, and lift your feet off the ground. Hold your hands together in front of your chest and rotate your torso to the left, bringing your hands to the left side of your body. Then, rotate to the right, bringing your hands to the right side of your body. Alternate sides for 10-15 repetitions.

In addition to these specific exercises, it’s important to incorporate abdominal strengthening into your daily life. Simple actions like sitting up straight, engaging your core while walking, and using proper form when lifting objects can all contribute to improved abdominal strength over time.

Tips for Incorporating Exercises into Daily Life

Incorporating abdominal strengthening exercises into your daily routine can help you maintain the progress you’ve made during your recovery and continue to improve your core strength over time. Here are some tips to make exercise a natural part of your day:

1. Start your day with gentle stretches: Before getting out of bed, take a few moments to do some gentle stretches, such as knee-to-chest pulls or pelvic tilts. This can help wake up your abdominal muscles and set a positive tone for the day.
2. Practice good posture: Make a conscious effort to sit and stand with good posture throughout the day. Engage your core muscles by gently drawing your belly button in towards your spine while keeping your shoulders relaxed and your back straight.
3. Take active breaks: If you have a sedentary job or spend long periods sitting, take regular breaks to stand up, stretch, and walk around. Use these breaks as an opportunity to do a few standing abdominal bracing exercises or pelvic tilts.
4. Incorporate exercises into household chores: Many household tasks, such as vacuuming, mopping, or gardening, can engage your core muscles. Be mindful of your posture and engage your abdominals while performing these activities.
5. Make exercise a social activity: Invite a friend or family member to join you for a walk or a gentle yoga class. Having an exercise buddy can help keep you motivated and make physical activity more enjoyable.
6. Set achievable goals: Set small, realistic goals for yourself, such as doing a set of pelvic tilts during each commercial break while watching TV or taking a 10-minute walk after dinner. Celebrate your progress and gradually increase the intensity and duration of your exercises as your strength improves.

FAQs about DIEP Flap Surgery and Abdominal Strength

Can I safely perform abdominal exercises while still having surgical drains in place after DIEP flap surgery?

No, it’s important to avoid any abdominal exercises while your surgical drains are still in place. Engaging in abdominal exercises too soon can put undue stress on your incisions and increase the risk of complications. Wait for Dr Soliman to remove the drains and give you clearance before starting any abdominal exercises.

Will I need to wear a special abdominal support garment after DIEP flap surgery?

In most cases, patients are advised to wear an abdominal binder or compression garment after DIEP flap surgery. These garments help support the abdominal tissues, reduce swelling, and promote proper healing.

Are there any long-term restrictions on abdominal exercises after DIEP flap surgery?

While most patients are able to return to their pre-surgery level of abdominal strength and exercise, it’s important to follow Dr Soliman’s long-term guidelines. Some patients may be advised to avoid certain high-impact or strenuous abdominal exercises, such as weighted crunches or sit-ups, to minimise the risk of abdominal complications.

Can abdominal massage help improve muscle strength after DIEP flap surgery?

Gentle abdominal massage, when performed correctly and with Dr Soliman’s approval, may help reduce scar tissue formation, improve circulation, and promote relaxation of the abdominal muscles. However, it’s crucial to wait until your incisions have fully healed and to follow Dr Soliman’s guidelines for safe and effective massage techniques.

Are there any specific diet recommendations to support abdominal strength recovery after DIEP flap surgery?

Eating a well-balanced diet rich in lean proteins, fruits, vegetables, and whole grains can support your body’s healing process and provide the necessary nutrients for muscle recovery. Staying well-hydrated is also important. Avoid excessive alcohol consumption and limit caffeine intake, as these can interfere with healing. If you have specific dietary concerns, consult with a registered dietitian who can provide personalised recommendations based on your individual needs.

Further Reading about DIEP Flap Surgery with Sydney Specialist Plastic Surgeon Dr Bish Soliman

Read Dr Bish Soliman’s Blog about What Is the Difference between PAP, LAP and DIEP flaps?

Read Dr Bish Soliman’s Blog about BMI over 35 and DIEP Flap Surgery

Read Dr Bish Soliman’s Blog about Returning to Exercise after DIEP Surgery

Read Dr Bish Soliman’s Blog about What to Expect during Recovery after DIEP surgery

Read Dr Bish Soliman’s Blog about Physical Therapy and Rehabilitation after DIEP Flap Surgery

Medical References about DIEP Flap Surgery and Abdominal Strength

A retrospective comparison of abdominal muscle strength following breast reconstruction with a free TRAM or DIEP flap

Abdominal strength after breast reconstruction using a free abdominal flap

A systematic review of abdominal wall function following abdominal flaps for postmastectomy breast reconstruction

Optimizing pedicled transverse rectus abdominis muscle flap breast reconstruction

Function and Strength after Free Abdominally Based Breast Reconstruction: A 10-Year Follow-Up