Many women who want to have their breast reconstructed in the most “natural” way possible will choose autologous reconstruction. This method uses their own tissue, as opposed to implant reconstruction. The multiple surgical sites required for autologous reconstruction may leave you uncertain about recovery following the procedure. This is completely normal. We hope that by including some basic information about recovering after autologous reconstruction, we can help calm some of your worries.
This article will discuss basic recovery times, limitations, and surgical requirements for the different types of autologous reconstruction. If you are not familiar with the different types of autologous reconstruction (such as TRAM, DIEP, SIEA, SGAP, LD, IGAP, TUG and PAP flaps), feel free to look over our autologous breast reconstruction overview post.
As with our post about implant breast reconstruction recovery, we cannot provide you with specific details regarding your individual recovery. Your physician will provide you with detailed recovery instructions after your surgery that will be more specific. Those instructions should be followed carefully. We seek only to give you a general idea of recovery after autologous breast reconstruction.
Recovering in the Hospital
Immediately following your breast reconstruction surgery, you will be moved to a recovery room at the hospital. Recovering in the hospital is relatively the same for all autologous reconstruction techniques. Nurses and physicians will closely monitor your blood pressure, heart rate, and body temperature to ensure you are not suffering from any complications. They will also check the incision sites to make sure they are properly healing. Many women feel pain or nausea after the procedure. If you experience this, tell your nurse or physician. They can often prescribe medication to make you more comfortable.
You may be kept at the hospital for three to five days. The actual length depends on the specific reconstruction procedure and how well you are healing. Any complications or problems may result in longer hospital stays. On average, women who have had any type of TRAM, DIEP, or SIEA flap procedure are kept in the hospital for five days. SGAP, LD, and IGAP procedures have average stays of four days, while TUG and PAP flap procedures typically keep women in the hospital for three days.
Recovering at Home
Once you are sent home from the hospital, you will have a significant recovery period. Depending on the technique, it will take anywhere from four to eight weeks to recover. Ultimately, however, it may take up to a year before the tissue is completely healed and the scars begin to fade.
General Recovery Care for Autologous Reconstruction
Part of your recovery at home will involve properly caring for stitches, dressings, and surgical drains. Proper recovery care following autologous reconstruction is largely the same as recovery care after a mastectomy or implant reconstruction.
You will want to get plenty of rest, take any prescribed pain medication as per your physician’s instructions, and do simple arm exercises regularly. Having friends and family around during your recovery can be a great help. It will give you the time you need to rest and heal, but things will still get done around the house.
If you have surgical drains in place, you cannot be fully submerged in water. Until the drains are removed, you can take sponge baths and, if your physician approves it, may be able to take showers.
Abdominal Procedure Recovery
TRAM, DIEP, and SIEA flap procedures take roughly six to eight weeks to heal. It is common for women who have immediate abdominal autologous reconstruction to feel worse than women who have a mastectomy alone. They may also have a longer recovery time. This is because abdominal reconstruction requires surgery at two areas on the body: the stomach and chest. After any of these procedures, you will likely have incisions on your lower abdomen, breast, and around the belly button. You will need to carefully care for these incisions while they heal at home. Additionally, you will likely have drains in the reconstructed breast and donor site that will need to cared for.
Strenuous sports, heavy lifting, and sexual activity must be avoided for at least six weeks after a SIEA, TRAM, or DIEP procedure. You will likely experience some pain or difficulty when sitting down, standing from a sitting position, or getting in and out of bed. These activities can be especially difficult following a TRAM flap procedure, because part of the abdominal muscle is removed along with the tissue. Fortunately, there are ways you can compensate for your inability to use your abdomen in these situations. A physical therapist or your physician can teach you to use other muscles instead.
Your physician will also provide you with stretching exercises that you can perform to stimulate healing. He or she can give you a timeline for when you can begin normal activities. Beyond that, your physician may suggest that you wear a compression girdle during your recovery to reduce any problems around the donor site.
Buttocks Procedure Recovery
Similar to abdominal procedures, IGAP and SGAP flaps take roughly six to eight weeks to heal. Your physician may suggest wearing a compression girdle during the healing time to assist with the process. Most autologous reconstruction procedures that take tissue from the buttocks result in anywhere from two to four surgery sites on the lower buttocks and chest. This means you will have multiple incisions and sites that must be cared for during recovery.
Since these procedures involve taking tissue from the buttocks, sitting down is normally uncomfortable for at least a week. Additionally, tight jeans and tops may be uncomfortable. Instead, try wearing loose clothing for a few weeks to prevent any unnecessary pressure being placed on the surgical sites. Most sexual activity, heavy lifting, and strenuous sports should be avoided for around six weeks following IGAP and SGAP procedures.
Thigh Procedure Recovery
Both TUG and PAP flap procedures take from the thigh and have shorter recovery times than abdominal and buttocks procedures. You will recover from thigh flap procedures in around four weeks, but you will still have up to four different incisions to care for during your recovery time. Furthermore, your physician may have you wear a compression girdle for up to eight weeks. Likewise, abstain from strenuous sports and sexual activity for at least four weeks.
Due to the more unusual location of TUG and PAP incisions, recovering can feel a bit strange. These procedures take tissue from the upper thigh. While you are allowed to walk during recovery, any movements that spread the legs or flex the hips must be avoided. This is especially important for women who have had TUG flap reconstruction. Ultimately, women who have had a PAP flap procedure often have to pay closer attention to healing around the thighs, because they are more prone to having healing problems at the site where the donor tissue was taken.
Latissimus Dorsi Procedure Recovery
Latissimus dorsi flap procedures also have a shorter recovery time of around four weeks. They share most of the same considerations as the previously discussed procedures, including caring for multiple incisions and avoiding strenuous activities. However, they do have a few unique recovery requirements.
Since latissimus dorsi procedures remove tissue from the back, you will need to have help caring for the incisions along your back. You will struggle to reach the site on your own and it is important that general care is not skipped. Additionally, many women must participate in brief physical therapy after the procedure. The procedure takes tissue from the shoulder area of the back, and many women find that their range of motion is weaker after surgery. Physical therapy will help you maintain and strengthen your shoulder’s range of motion and prevent any long-term movement problems.
Hybrid Procedure Recovery
In addition to the single site procedures discussed above, there are three multi-component or “hybrid” autologous reconstruction procedures: stacked DIEP, body lift perforator, and stacked GAP flap. All three procedures take between six and eight weeks to heal and many physicians recommend wearing a compression girdle after all three.
Otherwise, most hybrid procedures have similar recovery experiences to the flap procedures that take from their respective donor sites. Stacked GAP reconstruction takes tissue from the buttocks, so recovery is similar to what we discussed in the “Buttocks Procedures” section. Meanwhile, stacked DIEP flaps take from the abdomen, and body lift perforator flap procedures take from the abdomen and hip. Their recovery processes are similar to that of regular abdominal procedures.
Recovering After Fat Grafting
Unlike other autologous breast reconstruction procedures, fat grafting does not require major surgery. However, there are still some common things you can expect following a fat grafting procedure.
Following the surgery, you will likely have mild to moderate bruising and swelling in the breast and the tissue donor site. You may experience some slight discomfort at the donor site, but there is often very little in the way of discomfort around the reconstructed breast or breasts. Fortunately, most swelling and discomfort is easily minimized with a compression garment.
For at least two weeks after the procedure do not compress the reconstructed breast(s). Avoid activities that place direct pressure on the breast, and do not sleep on your stomach during this time. Compressing the reconstructed breast may cause the body to reabsorb a larger amount of the transferred fat cells. This will cause the reconstructed breast to shrink in size and could result in an undesirable appearance.
In general, you should be able to return to work within a week. Most women with a sedentary job can return to work within three to five days. However, those with jobs that require more movement may need to wait for an entire week.
Many women find that they have trouble accepting their reconstructed breast as their own. This is common after both implant and autologous breast reconstruction. It is especially common among women who have delayed reconstruction.
Time is really the only requirement for emotionally recovering from autologous reconstruction. Recovering from gaining a new breast is largely similar to the emotional recovery involved after losing a breast. You will likely experience a myriad of emotions during this time. Fortunately, there is no need to go through the process alone. Finding a support group or going to see a counselor can be hugely helpful for women as they recover emotionally from their autologous reconstruction.
Do not condemn yourself to struggling alone. Please reach out to others.