Recovering From DIEP Flap Reconstruction
Dr. Berfin Mahmut
What to Expect and How Physical Therapy Can Help
by Berfin Mahmut, PT, DPT, CLT-LANA, OnCS
If you have chosen DIEP flap reconstruction after breast cancer surgery, you may have spent a lot of time preparing for the procedure itself: What will the surgery involve? How will my reconstructed breast look and feel? How long will I be in the hospital?
But there is another important part of the process that deserves attention: how your body will move and function as you recover.
DIEP flap reconstruction is a major surgery that involves taking skin and fat from the lower abdomen and transferring it to the chest to reconstruct the breast. Because both the chest and abdomen are healing, your body may feel different for a while. You may notice changes in your posture, mobility, strength, and ability to perform everyday activities.
And while recovery takes time, you do not have to navigate these changes alone.
What Can I Expect After DIEP Flap Surgery?
The first few days and weeks after surgery are often focused on healing, managing discomfort, caring for your incisions and drains, and gradually getting up and moving. Early mobility is an important part of recovery, and patients are generally encouraged to begin walking and gradually increase their activity as medically appropriate.
But getting back to your normal movement may take some time.
Your shoulders may feel stiff.
After breast surgery, it is common to experience limited shoulder movement. You may notice difficulty reaching overhead, reaching behind your back, putting on a shirt, washing your hair, or performing other everyday tasks.
Some of this may be related to the breast surgery itself, while additional procedures such as sentinel lymph node biopsy or axillary lymph node dissection can also affect shoulder mobility.
You may instinctively protect the surgical area by keeping your arms close to your body. While this can feel comfortable initially, prolonged guarding can contribute to stiffness and difficulty returning to your normal movement.
Your abdomen may feel tight.
Your lower abdomen has undergone a significant surgical procedure. Even though the DIEP flap preserves the abdominal muscle, the abdominal incision and healing tissues can create a sensation of tightness or pulling. You may notice this when standing upright, walking, getting out of bed, reaching, or changing positions. It can take time for the tissues around the abdomen to become more comfortable with movement again.
You may have difficulty standing completely upright.
In the early stages of recovery, standing fully upright may feel uncomfortable or restricted. You may naturally walk or stand with your trunk slightly bent forward to protect the abdomen. This can be a normal protective response during early healing. As your surgeon clears you for increased movement, gradually restoring an upright posture becomes an important part of returning to normal function.
Everyday movements may feel surprisingly difficult.
Getting out of bed, getting up from a chair, rolling over, getting dressed, walking longer distances, or getting in and out of a car can require more effort than you expect. You may also notice weakness through your core and upper body. Even when the abdominal muscle itself has been preserved, surgery, pain, reduced activity, and changes in movement patterns can temporarily affect how efficiently your core works. Research and clinical experience support the role of rehabilitation in helping patients recover strength and function after breast reconstruction.
Start With Mobility
One of the most important things to remember during recovery is that more is not always better.
Your body has just undergone major surgery. The goal early on is not to push through discomfort or quickly return to your previous exercise routine. The goal is to gradually restore comfortable movement while respecting the healing process.
Once your surgeon has cleared you for movement, gentle mobility exercises can help you gradually regain flexibility and confidence. Depending on your individual surgery and restrictions, rehabilitation may include:
- Gentle shoulder range-of-motion exercises
- Chest and upper-body mobility
- Gentle abdominal and trunk mobility
- Postural exercises
- Walking and gradual increases in activity
- Breathing exercises
- Functional movement such as bed mobility and sit-to-stand
- Gentle stretching as healing allows
The exact timing and range of movement should be individualized. There is no single exercise timeline that applies to everyone, particularly because surgical techniques, additional procedures, healing, complications, and surgeon-specific restrictions can vary.
Your surgeon’s instructions should always guide when and how you progress.
Then, Gradually Build Strength
Once your tissues have healed appropriately and your medical team has cleared you for strengthening, the focus can gradually shift from simply moving comfortably to rebuilding strength and endurance. This may include progressive strengthening of the core, shoulders, arms, back, hips, and legs.
Strengthening is important not just for exercise, but for everyday life. Your core helps you transfer between positions, get out of bed, stand, walk, lift, and carry. Your upper body helps you reach, push, pull, dress, and perform household activities.
Rather than thinking of strengthening as something you have to “get back to” after recovery, think of it as part of rebuilding your confidence in what your body can do.
Progress should be gradual and individualized. Your physical therapist can help determine when you are ready to progress an exercise, increase resistance, or return to more demanding activities.
Where Does Oncology Physical Therapy Fit In?
This is where an oncology physical therapist can become an important part of your recovery.
You do not have to wait until you have a major problem before seeking rehabilitation. An oncology physical therapist understands how breast cancer surgery, reconstruction, lymph node procedures, radiation, chemotherapy, hormonal therapy, and other cancer treatments can affect movement and function.
After DIEP flap reconstruction, your therapist can assess your shoulder mobility, posture, scar and tissue mobility, core and upper body strength, pain, tightness, swelling and lymphatic concerns, walking, and ability to perform everyday activities. From there, your rehabilitation plan can be tailored to your body, your surgery, your healing, and your goals.
Hands-on care can be part of rehabilitation.
Depending on your stage of healing and medical clearance, physical therapy may include hands-on techniques to help address areas of restriction or discomfort. This can include gentle soft-tissue techniques, scar and tissue mobility once the incisions are appropriately healed, and techniques to address areas of tightness or restricted movement.
For patients experiencing swelling or lymphatic concerns, an oncology or lymphedema-trained physical therapist can also assess the area and determine whether lymphatic techniques, compression, exercise, or other strategies may be appropriate.
Exercise is another important part of recovery.
Your physical therapist can guide you through the progression from gentle mobility to strengthening and eventually to the activities that matter most to you. That might mean getting out of bed independently, standing upright comfortably, reaching overhead, returning to work, picking up your child, going for longer walks, returning to pilates, yoga, strength training, or another form of exercise, or simply feeling comfortable and confident in your body again.
Your Recovery Is More Than Healing an Incision
DIEP flap reconstruction can be an important part of your breast cancer journey, but recovery is about more than the surgical site.
It is about being able to move through your day with less restriction, rebuilding strength, feeling comfortable in your body again and returning to the activities and routines that make you feel like yourself.
If you are recovering from DIEP flap reconstruction, remember that you do not need to rush your recovery, but you also do not have to accept ongoing limitations as something you simply have to live with.
Once you are medically cleared, the right rehabilitation approach can help you gradually restore mobility, rebuild strength, and regain confidence in your body.
And if something does not feel right, bring it up with your medical team. New or worsening swelling, redness, drainage, significant pain, fever, changes in the reconstructed breast, or other concerning symptoms should be evaluated by your surgical team rather than assumed to be part of normal recovery.
Healing takes time. Rehabilitation can help you make the most of that time.
Berfin Mahmut is a Doctor of Physical Therapy, a certified lymphedema therapist, and a cancer exercise specialist focused on cancer rehabilitation at Mount Sinai in New York, NY. She is also the founder of Pour Cancer Rehabilitation, a dedicated practice offering in-home breast cancer rehabilitation throughout NYC and online cancer exercise coaching to clients worldwide.
