Latissimus Flap Post-OP Instructions
CARE OF SURGICAL INCISION SITE
When you wake from surgery you will be in the recovery room where the nurses will be taking good care of you. You will have a clear plastic dressing (Opsite) over the incision to your back, and a clear Opsite dressing over the breast mound. The transparent dressings will stay on around 5 days. There will be 1-2 drains coming out of the incision in the back, and 1-2 drains coming from the breast mound. Each drain will be connected to a small bulb. These bulbs will resemble a large, opaque egg. When you are discharged from the hospital, you will need to empty each bulb several times a day and keep a record of the drainage emptied from each bulb. You will also need to "milk" the drain several times a day to keep clots from forming in the tubing. When you return from your post-operative visit with Dr. Maguire, you will bring the drainage record with you. When the drainage reaches less than 30 cc's in a 24-hour period, Dr. Maguire will remove that drain in the office. It is not unusual to keep the drains from 7 days to 3 weeks after surgery, depending on the amount of drainage you have. It is important that when you go home you continue to sleep with the head of your bed elevated at 30 to 45 degree angle. You can use 4-5 pillows under your upper body to keep elevated or sleep in a recliner. This will help reduce the amount of swelling to the chest wall.
The day of your surgery is surgery day 0 and you count forward from there. The dressing to the back and breast mound can be removed on day #5 after surgery and you may resume showers at that time. We recommend that you let the water run over your incisions, but do not scrub. Be careful when drying and "pat" your incision dry. Please refrain from putting any ointments, lotions, or powders on the incisions. You will not need to place another dressing over the incision sites once the original dressing is removed. However, the incisions might ooze a little so you may want to keep a bandage over there to protect your clothing. Once the drains are removed you may want to place gauze over the drainage site to keep your clothes from getting stained by draining fluid as well.
After you shower on post-operative day #5, it is recommended that you wear a surgical bra day and night for 2 weeks. Many styles are available for purchase in our office. Placing a thin layer of Neosporin over the incisions will help the final appearance of the scars. Do not submerge yourself in a bath, swimming pool, or hot tub until the incisions are completely healed. This usually takes 3-4 weeks.
PAIN AND DISCOMFORT
At your pre-op appointment you will be given three prescriptions. The first prescription will be a non-steroidal anti- inflammatory drug (Mobic). This medication will help with post-operative swelling and edema. The second prescription is for pain. We recommend that you take the pain medicine as directed. The third prescription is an antibiotic. You may start the antibiotic the evening after your surgery. Be sure to take the antibiotic as directed until the bottle is empty to prevent post-operative infection.
NAUSEA AND VOMITING
A few patients react to the anesthetic after surgery with nausea and vomiting. This usually lasts less than 24 hours and should be treated with lots of fluids and rest. If you have a history of severe post-operative nausea please request a Phenergan prescription.
SWELLING AND BRUISING
Maximum swelling usually occurs at about 3 to 5 days. Most bruising will resolve within 14 days. You can expect your breasts to remain swollen for a minimum of 1 to 2 months. Depending on the amount of swelling that persists, you may want to keep sleeping elevated up to two weeks after surgery. Do not be alarmed if one breast is larger than the other. Your breast will swell asymmetrically.
HOW TO STRIP YOUR DRAINS
When you go home from your surgery, you will keep a record of the amount of drainage coming out of each drain. You will release the suction of the bulb attached to the drain. Record the amount of fluid in the bulb. Then empty the drainage from the bulb into the toilet. Squeeze the bulb flat and replace the cap, this will re-create the suction on the drain in your incision. Carefully with the tube in place at the incision site with your thumb and first finger. Open alcohol prep and wrap it around the tubing and hold it in place with the other thumb and first finger. Slowly work your way down the tubing, holding constant pressure, little by little until you have gone the length of the tubing. This will milk the drain and keep a clot from obstructing the drain. Record the drainage from each drain three times a day. A good way to remember that is to record the drainage when you wake up, mid-day, and before you go to bed at night. Bring this record with you when you have your postoperative visit.
The suture selected by your surgeon is absorbable and does not require removal. Some patients experience discomfort where the suture is tied up. If you experienced this then the knots can be removed two weeks after surgery in clinic.
THE APPEARANCE OF YOUR INCISION
When you remove the dressings and look at your incision for the first time after surgery, do not be alarmed. The incision will be quite wrinkled and puckered, and will look quite ugly. This is exactly what they are supposed to look like. It takes 2-4 months for the incision to heal (inside and outside). The puckering of the incisions will smooth out over several months, but the scar will remain wide and red anywhere from six months to one year after surgery. Once the scar has matured, the redness will go away.
You will need to be off work for a minimum of 4-6 weeks following Latissimus Flap Reconstruction. Do not lift anything heavier than a jug of milk for the first two weeks and nothing over 10 pounds for the next four weeks. If you have small children, do not lift them up, or hold them in your lap for at least 3-4 weeks after your surgery. Take it easy for the first 3-4 weeks following your surgery. We want you to drink plenty of fluids and rest. We do want you up and walking around after surgery, but no exercising. You may start brisk walking around week 4, but absolutely no running. Dr. Maguire will let you know when we can resume a full exercise regimen. This is a big surgery and it takes a minimum of 6-8 weeks for the incision to heal.
The outcome of your surgery may be compromised if you fail to return for any scheduled post-op visit, or fail to follow the pre-and post-operative instructions.
If you have any questions or concerns please contact the office 318-442-5800 during business hours (8 AM to 5 PM) and asked to speak with Dr. Maguire. We look forward to making this journey with you!