Rehabilitation for DIEP Reconstruction
by Jennifer Unterreiner, DPT, OCS, CLT
A Deep Inferior Epigastric Artery Perforator, or DIEP, flap is a common type of reconstruction done with patients following a mastectomy. This procedure can be done either in two steps with expander placement done concurrently with the mastectomy and the final flap reconstruction done after other treatment is completed, or done all as one surgery at the same time as the mastectomy. Initially, the most complicated part of recovery is the presence of multiple sets of drains that are usually in place for the first 1-2 weeks to manage the swelling and residual fluid from surgery. After the drains are removed, it typically becomes much easier to complete normal daily activities, however limitations regarding lifting and reaching are usually still in place for the first 4-6 weeks post-surgery, depending on your surgeon’s preference and protocol.
Post-operatively, it's very common to have shoulder mobility limitations and stiffness, pulling and stretching in the pectoral muscles in the front of the chest that make it difficult to do everyday tasks like reaching overhead, washing hair or getting dressed. It's also likely that you'll feel soreness or a constantly hunched over feeling in your mid or low back as a result of increased pulling across your abdomen at the graft site when trying to stand fully upright. The good news is that with physical therapy, many post-operative issues can be addressed and resolved.
Butterfly Stretch (10-15 reps x 5-10 sec holds, 2-3 times/day)
Initially, the focus of your rehabilitation should be on regaining range of motion in your shoulders. Stretches, such as the butterfly stretch, are performed to improve flexibility in the pectoral muscles, which when stiff, can limit your ability to reach overhead.
Seated Swiss Ball Roll-Outs (10-15 reps x forward, diagonal left, diagonal right, 2-3 times/day)
These roll-outs are a great exercise that can be performed early on in the rehab process. They're not only a great way to stretch the shoulder and improve range of motion, but can also improve mobility in your thoracic spine or mid back. Due to the forward rounded posture patients typically find themselves in post-surgery, it's important to move into the reverse by using the arm and support of the ball to drive the motion.
Scapular Squeezes (20 reps x 10 sec holds, 2-3 times/day)
As both your mobility and range of motion improve, we want to ensure that you have enough strength in the muscles responsible for supporting your posture in order to avoid a hunched back that's common immediately following surgery. Scapular squeezes are a great way to help initiate the strengthening process. This exercise is performed sitting with your arms supported in your lap with palms facing upward. From that position, squeeze your shoulder blades together and down as if trying to pinch something between them. To increase the difficulty, perform this while standing and using a resistance band. Maintaining the scapular squeeze, pull the band apart while keeping your elbows glued to your sides.
The important thing to remember with this rehabilitation is that it's going to take at least 4-6 months to rebuild the mobility, strength and endurance necessary to completely return to the activities you did prior to surgery. If you feel like you need more help and guidance to navigate the lengthy rehab process, talk to your surgeon or reach out to a physical therapist to discuss your options and ways to decrease your discomfort and improve your function.