What breast reconstruction procedure has the easiest recovery?

When considering breast reconstruction, a big concern for many patients is post-operative pain. Many women presume breast reconstruction with implants is the least painful option since the procedure is less invasive and has a shorter operative time than other reconstructive options, but studies have shown this is not the case.

A recent study looked at patients who underwent mastectomy and immediate breast reconstruction with either tissue expanders placed under the chest muscle, or muscle-sparing/preserving abdominal flaps including DIEP flaps. Patient-reported pain levels after surgery were measured, as well as the amount of narcotic drug use. The results showed the implant-based reconstruction patients reported more pain and used more narcotics than the patients who had DIEP flap reconstruction.

Although the DIEP flap procedure is more invasive and takes longer than traditional tissue expander reconstruction, DIEP flap patients experience less pain for a couple of reasons:

• The DIEP flap minimizes muscle trauma and preserves all the patient’s abdominal and chest muscles. Most implant-based breast reconstruction involves placing the implant under the chest (pectoral) muscle. This requires releasing and lifting the muscle off the chest wall to create a pocket for the implant which is painful and adds to the recovery.
• For patients who are not candidates for direct-to-implant procedures, tissue expanders are progressively filled over time to stretch the tissues. This expansion process can be very uncomfortable for some patients.

At PRMA Plastic Surgery, we take extra steps to ensure minimal discomfort and shorter hospital stays for our patients after DIEP flap reconstruction.

In fact, with the implementation of our Enhanced Recovery after Surgery (ERAS) protocol, patients rarely need narcotics to control pain levels after surgery. Patients actually begin the protocol the morning BEFORE surgery to ensure a baseline level of pain control is already in place at the time surgery begins. Our surgeons then inject very long-acting local anesthetic at the time of surgery (known as “blocks”) at each surgical site to ensure an excellent level of pain control is achieved before the patient even awakens from surgery. These “blocks” have dramatically improved and minimized abdominal discomfort after DIEP flap surgery.

Most PRMA patients are able to maintain extremely good pain control post-operatively with non-narcotic drug combinations including Celebrex and extra-strength Tylenol. Several other oral pain medication options are also available for those who cannot tolerate these first line choices.

The Enhanced Recovery Protocol also includes a specially-formulated carbohydrate drink which the patient takes before surgery. This helps the body process anesthesia quicker, decreases post-operative nausea, and also optimizes healing. The formula decreases nausea by increasing gastric motility. This allows patients to tolerate solid food earlier after surgery and also decreases the risk of constipation. Not having to depend on narcotics for pain control decreases the tendency for constipation even further.

All these improvements in recovery mean patients are up out of bed much earlier after surgery and are also ready to go home sooner; our Enhanced Recovery Protocol has decreased patient hospital stay after DIEP flap surgery to just three nights.

“I was up and walking laps the day after my surgery,” shares PRMA DIEP flap patient Sherry. “I was really worried about my recovery because opioids make me very sick, but there were never any issues since I was able to easily control my discomfort using the prescribed Celebrex and Tylenol.” 

Author: Dr. Minas Chrysopoulo & Courtney Floyd