Flap Reconstruction - ICU or TICU
Once you arrive in the ICU or TICU on the fourth floor, you will be connected to a cardiac monitor, automatic blood pressure cuff, and continuous oxygen monitoring. A heating pad will be applied to your chest to keep your breast reconstruction warm and to help promote blood circulation.
Depending on your surgery, you will have either a lower abdominal incision (DIEP flap) or upper thigh/groin incisions (TUG flap) with suction drains coming from this area, known as your "donor site." You will also have drains coming from your breast reconstruction. For more information on drains, see Appendix B.
Depending on your Surgeon, you may also have a "pain pump" (local anesthetic catheter) from your abdominal incision to minimize the pain. You will also wear compression leg stockings ("TEDS") and have sequential compression devices ("SCDs") on your legs to promote circulation and prevent blood clot formation.
If you have flap reconstruction, you can expect to have your vital signs taken every one to two hours on the first night after surgery. In addition, your breast flap will be checked every hour for color and warmth. During these flap checks, the Nurse will listen to the Doppler signal. You can expect to be frequently interrupted through the first night! The number one priority of your entire team (Surgeons and Nursing team) is to have the best surgical outcomes.
You can expect to be gently turned by the Nurse for a slight tilt from side to side every couple of hours. The purpose of turning and changing position is to promote lung expansion and prevent any skin breakdown from lying in one position too long. During the first night you will also be encouraged to begin your post-op breathing exercises and leg exercises (see Appendix A).
It is important for the first 24 hours after Microsurgery (a flap) that you have nothing to eat or drink (this is known as "NPO"). This is to ensure that if there is a concern with the circulation of your flap on the first night, you can return to surgery immediately without a period of fasting before. This is known as a "take-back" to the operating room, which occurs rarely.
You will be hydrated with IV fluids for the first few days until the Nurses feel you are taking enough fluids on your own. Cool swabs to wet your mouth and lips will be provided during the first night of fasting after surgery.
You will be allowed to eat and drink the morning after surgery if there are no concerns with your flap circulation. Coffee and teat are allowed; you may wish to start with clear fluids and advance your diet as you become hungrier.
You will also be on bed rest for the first 24 hours to five days after flap surgery. Your surgeon will give you specific instructions. You will eventually be allowed to sit up in bed and to control the bed position yourself. Nurses will be managing your position for the first night.
One of the complications of postoperative anesthesia is nausea. Please be assured if you are feeling nauseated, appropriate medications will be ordered by your Surgeon and administered by your Nurse.
In the ICU/TICU, the Nurses work 12-hour shifts. At the change of shift, the oncoming Nurse and off-going Nurse will both examine your breast together to ensure both Nurses are in agreement with the appearance and circulation of the flap.
The ICU/TICU is flexible regarding visiting hours. However, family cannot stay the night in the ICU. Prior arrangements should be made for lodging for family members. Once transferred to the TICU, arrangements can be made for one person to spend the night with you, if desired.
Implant Reconstruction - Third Floor, Med/Surg Unit
If you have had an implant for reconstruction, many of the details above will also apply on the third floor Med/Surg Unit. You will be given supplemental oxygen, anti-nausea medication, and will likely have a Foley catheter the first night.
However, you will not be attached to a cardiac monitor, you will not have hourly breast checks, and you will be allowed to eat and drink the first night of surgery.
You will also be allowed to get out of bed, and sit in the chair if you like. The bladder catheter can be removed at your request the first night if you wish to use the bathroom with the Nurses' help.