Flap breast reconstruction uses your own skin and fat to rebuild the breast after mastectomy. Depending on your anatomy and treatment history, this tissue may come from the abdomen, thighs, buttocks, or lower back. Procedures such as DIEP, PAP, and SIEA flap reconstruction require microsurgery to reconnect the transferred tissue’s blood vessels.
Because flap surgery involves both the chest and a donor site, preparation is more extensive than it is for many outpatient procedures. Knowing what to expect at the New York Group for Plastic Surgery can help you feel organized and more confident as your surgical date approaches.
Several weeks before surgery
Your preparation begins with a comprehensive evaluation. Your plastic surgeon will review your medical history, previous operations, cancer treatment, medications, allergies, and reconstructive goals. A physical examination helps determine whether you have sufficient tissue at a donor site.
You may undergo blood tests, an electrocardiogram, or other preoperative testing based on your health. Imaging may also be used to map the blood vessels supplying the donor tissue, helping your surgeon plan the operation.
Tell your care team about every prescription medication, over-the-counter drug, vitamin, and supplement you use. Some products can affect bleeding, blood pressure, anesthesia, or healing. Never discontinue a medication without instructions from the appropriate clinician.
Nicotine restricts blood flow and can threaten the survival of transferred tissue. If you smoke, vape, or use another nicotine product, you will need to stop before surgery for the period specified by your surgeon.
Preparing your home and support system
You will need reliable help during your initial recovery. Arrange for someone to bring you home when you are discharged and assist with meals, medications, household responsibilities, and childcare.
Place frequently used items at waist or counter height so that you do not have to bend, stretch, or reach overhead. Prepare loose clothing that opens in the front, slip-on shoes, extra pillows, and simple meals. A recliner or supportive pillow arrangement can make sleeping in a slightly elevated position more comfortable.
Your surgeon may also recommend walking regularly before surgery, eating adequate protein, and maintaining good hydration. Do not begin restrictive diets or new supplements without discussing them with your care team.
The final days before flap surgery
Your surgical team will provide instructions covering bathing, medications, arrival time, and when to stop eating and drinking. Follow these directions precisely, even if they differ from general advice you have read elsewhere.
Confirm your transportation and pack only essential hospital items. These may include identification, insurance information, a current medication list, toiletries, non-slip footwear, and comfortable, front-opening clothing for discharge. Leave jewelry, valuables, and body lotions at home unless instructed otherwise.
Contact your surgical team if you develop a fever, respiratory illness, skin infection, or another change in your health. Your safety may require adjusting the surgical plan or date.
What happens when you arrive
After check-in, nurses will review your health information, medications, allergies, and fasting status. You will change into a surgical gown, and an intravenous line will be placed for fluids and medication.
Your surgeon will meet with you, confirm the procedure, answer remaining questions, and mark the operative and donor areas. You will also meet the anesthesia team before receiving general anesthesia.
During surgery, your surgeon removes the planned tissue while preserving its blood vessels. The tissue is transferred to the chest, shaped into a breast mound, and connected to blood vessels using microsurgical techniques. The donor site is then closed and contoured. Flap procedures can take several hours, particularly when both breasts are reconstructed.
Immediately after surgery
You will awaken in a closely monitored recovery setting. Your team will regularly assess the flap’s warmth, color, blood flow, and other signs that the transferred tissue is receiving adequate circulation.
Drains are commonly placed in the breast and donor site to remove excess fluid. Nurses will help manage discomfort and encourage breathing exercises and gentle movement when appropriate. Your hospital stay will depend on your procedure and progress.
At New York Group for Plastic Surgery, board-certified plastic surgeon Dr. Jordan M.S. Jacobs and our team specialize in advanced microsurgical breast reconstruction, including DIEP, SIEA, PAP, DUG, and lumbar perforator flaps. We provide individualized preparation and recovery guidance for patients in New York City, Scarsdale, Greenwich, and beyond.
Contact our practice to discuss your reconstructive options and begin planning for surgery.
