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Post-Operative Abdominal Flap

If you have not yet had your surgery, you may want to begin by reading the Preparing for Surgery section for TRAM flap and other abdominal flap reconstruction. If you have taken the time to prepare for surgery, all that will be left to do is rest and heal. In this section you will find tips to help you recover, and learn about how surgery might affect you. It is important to remember that everyone is different, and we all heal at our own pace. What works for some, may not work for others. We hope this section will serve as a helpful guide for you.

In the Hospital

Upon waking up from surgery, you may be confused as you awaken from anesthesia. Others may feel sharp and alert as soon as their breathing tube is removed. If you have never had surgery with a breathing tube, it is important to remember not to fight it when the doctor takes it out, and take a nice deep breath once it is removed. Your throat may feel raw and you may have trouble speaking at first, but this will wear off soon. If you feel any nausea, do not be afraid. You will be surrounded by a team of doctors and nurses that will take care of you, no matter what may arise.

Once in the recovery room, you will have strong pain medication, and you will probably sleep a lot. You will have compression sleeves on your legs that help with circulation. You will also be given an incentive spirometer, which is a breathing device that helps you expand your lungs. Nurses will check on you often, especially if you have had microsurgery, to make sure the blood supply to the flap is not compromised. You will probably be visited by a pain management specialist to help make you as comfortable as possible. A computerized pain medicine pump may be attached to your IV that allows you to receive pain medicine at the touch of a button. The drains will usually be secured together to make it easier to monitor your drain outputs. Most patients will have two drains for each reconstructed breast and two drains in the abdomen. The nurses will care for your drains, and during that time you will learn how to care for them yourself.

The day after surgery, you will be helped out of bed into a chair. A catheter in the bladder from the operation will drain continue to drain urine so you will not have to go to the bathroom by yourself yet. This catheter will be removed when you are more comfortable and mobile, usually by the second or third day after surgery. You will have more pain in the abdomen than in the breasts. If you are having a sentinel lymph node biopsy, or other nodes removed, you may feel sore, especially if the drains exit from under your arms. Most of the breast area will feel numb. You will be slightly hunched over, and you may have feelings of tightness and discomfort in your abdominal area. Getting in and out of bed is usually the hardest part in the beginning. You won't have the benefit of a hospital bed once you get home, so it's helpful to have someone give you support. From a reclining position, with your feet as close to the floor as possible, your caretaker should place their right hand on your lower back, and hold your left arm or hand in their left hand. On the count of three, you want to get up, using their hand on your back for a little push. If you try this, and do it too slowly, you will feel pulling on your abdomen. After a few tries you will find what works best for you. You have to will yourself to get up, and walk in the hall, or in your hospital room. The sooner you can do this, the sooner you can get out of the hospital. Many people think they should stay in the hospital longer, but this is unnecessary. You will heal and rest much more comfortably in your own home.

Recovery at Home

Upon discharge from the hospital, your nurses and doctor will go over what you need to do at home. You will be given a prescription for pain medication, and an antibiotic. Please refer to Preparing for Surgery for tips about the car, and what to wear home. When you get home you will need plenty of rest. Be sure to stay hydrated. The sooner you can stop taking the narcotic pain pills and switch to Tylenol, the easier your recovery will be. Some women have an easier time in the beginning than others. You may be too tired to shower during the first week, but if your surgeon gives you permission, and you feel up to it, you can shower with the help of a caregiver. If you have a deep tub, you may have problems climbing over it. You will need to pin all of your drains either to a Velcro drain belt, or you may be given something in the hospital like a gauze necklace to support the drains around your neck. It may help if you have a shower stool (you can get them in most drug stores) so you can sit down in the shower, and someone can help you wash. Alternatively, you may buy (or obtain from the hospital) packs of disposable wash cloths. As the drains come out, it will be much easier to shower.

You will most likely see your surgeon weekly until the last drain has been removed. You cannot rush removing the drains; as bothersome as they may be, they are essential to proper wound healing. Generally once an individual drain produces less than 20 to 30 cc's in a 24 hour period, your surgeon will remove it. In most patients, the drain removal does not hurt.

Resuming Activity

During this time, it is important that every day, little by little, you start to stand up straight. By the third week, you should no longer be hunched over. Do not be afraid to stand up straight; it is normal to feel tightness in your abdomen. The sooner you are standing up straight, the sooner you will be able to admire your new breasts in the mirror. Flap breasts may feel hard at first, but with every week that passes, the swelling will subside, and the breast will get softer and softer. Early after surgery, you do not need a bra, but if you feel you need something, many women recommend shelf bra camisoles, that are soft. You don't want anything that compresses the reconstructed breast too tightly, and you don't want underwire bras that may irritate your healing scar. You will notice changes in the breasts especially over the first eight weeks. Keep in mind that during the second surgery, your surgeon will address any areas of aesthetic concerns you may have.

The abdominal discomfort you experience should begin to subside once the drains are removed. Sleeping will become more comfortable, however, it may take time before you are able to sleep on you stomach. Some women find that getting a prescription from their surgeon to attend physical therapy helps them get back into normal activities more quickly. It is important to find a physical therapist that has experience with breast cancer patients. You do not want a physical therapist that deals only with sports injuries.

Within four to eight weeks you should be back to most of your normal activities. You will still have some tightness in your abdomen. This is completely normal and can last for a few months. It is important to listen to your body. While you may feel fine driving and doing household chores, it may require a little more time before getting back to advanced Yoga or Pilates classes.

Intimacy

Many women have asked when it is okay to resume sexual activity. Physically, it is safe once your drains are removed, and you feel up to it. Emotionally, it will take as much time as you need. Some women feel uneasy about not having nipples. If this is the case, wearing a camisole may make you more comfortable. The general concern is wondering how your partner will feel. If you are comfortable and confident with the process of reconstruction, you can ease any concerns your partner may have. The most common concern partners may have, is that they will hurt you if they touch you the wrong way. It is helpful to communicate, and be receptive to what your partner is saying. If you find yourself having a hard time emotionally, it may be helpful to talk with other women who have already had reconstruction, or to seek help from a counselor.

The important thing to remember is that every day is better than the one before. The pain you feel in the hospital will soon become a distant memory. The scars will fade over time, and once you have completed the final stages of reconstruction, you will regain a sense of wholeness that will truly help you to move beyond cancer.