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There are some surgeries that stay with you long after the patient has left the operating room.
For me, DIEP (Deep Inferior Epigastric Perforator) flap reconstruction is one of them.
Every time I’m assigned to one of these cases, I know it’s going to be a long day. These surgeries can last for many hours and require complete concentration from everyone in the room. But despite how demanding they are, they’re also some of the most rewarding procedures I’ve ever been part of.
These aren’t just operations.
For many women, they’re part of healing after breast cancer and a chance to regain something they thought they had lost.
Being even a small part of that journey is something I never take for granted.
The Morning of a DIEP Procedure
The atmosphere always feels a little different on a DIEP day.
The operating room is calm, but there’s a quiet sense of purpose. Everyone knows the complexity of the procedure, and everyone understands how much it means to the patient.
Before we begin, we gather for our team briefing.
We review the surgical plan, discuss the patient’s needs, check equipment, and make sure everyone understands their role.
I always appreciate these moments because they remind me that surgery is never one person’s job.
It’s a team effort from start to finish.
Preparing the Operating Room
Long before the patient arrives, we’re already preparing.
I carefully arrange the instrument tables, organize the sutures, prepare the retractors, and make sure all the microsurgical instruments are complete.
The venous coupler device is checked.
Every item has its place.
I still remember the first time I prepared for a DIEP procedure. I was nervous that I would forget something important. I checked everything over and over again because I wanted to get it right.
Now, after many cases, I still check everything carefully.
Experience has taught me that good preparation makes the rest of the surgery much smoother.
Working Together as Two Scrub Nurses
One thing I enjoy about DIEP procedures is the teamwork.
Most of the time, there are two scrub nurses working together.
One scrub nurse assists with raising the abdominal flap while the other prepares and assists with the breast reconstruction and the delicate microsurgery where tiny blood vessels are joined together.
Although we’re working in different areas, we’re constantly communicating.
Sometimes it’s just a glance.
Sometimes we already know what the other person needs without saying a word.
It’s a level of teamwork that only develops after spending many hours together in the operating room.
Meeting the Patient
One part of my job that has always stayed with me happens before the surgery even starts.
Collecting the patient.
Many patients are understandably anxious.
Some are quiet.
Some ask lots of questions.
Others simply hold onto a family member’s hand a little tighter before saying goodbye.
I remember one patient who looked terrified as we wheeled her into theatre.
Before she went to sleep, I held her hand for a moment and reassured her that we would take good care of her.
It was only a few seconds, but moments like that remind me that nursing is about so much more than instruments and sterile technique.
Sometimes kindness is just as important.
When the Surgery Begins
Once the patient is asleep, everything changes.
The operating room becomes focused and methodical.
The WHO Surgical Safety Checklist is completed, everyone gowns and gloves, and we begin preparing the sterile field.
Skin preparation and draping may seem routine, but they’re incredibly important.
They’re some of the first steps we take to help reduce the risk of infection and keep our patients safe throughout the procedure.
My Role During a DIEP Procedure
People often ask what scrub nurses actually do during surgery.
The answer is…a little bit of everything.
During a DIEP procedure, my responsibilities can include:
- Preparing and organizing sterile instruments
- Passing instruments throughout the surgery
- Loading ligaclips and sutures
- Assisting with delicate microsurgical instruments
- Holding and protecting the flap when needed
- Performing surgical counts with the circulating nurse
- Monitoring the sterile field throughout the procedure
One memory that still makes me smile is the first time I was trusted to hold the flap.
It wasn’t difficult because it was heavy.
It was difficult because I knew how important it was.
I remember standing there thinking,
“Don’t move.”
My arms became tired, but I didn’t let go.
It was one of those small moments that made me realise how much responsibility comes with this role.
What These Surgeries Have Taught Me
Every DIEP procedure has taught me something.
They’ve taught me patience.
They’ve taught me to slow down when things become stressful.
They’ve taught me that communication isn’t always verbal.
Sometimes your team understands each other through simple eye contact or small gestures.
Most importantly, they’ve reminded me that learning never stops.
Even after years in the operating room, I still learn something new.
That’s one of the reasons I love perioperative nursing.
The Emotional Side of DIEP Reconstruction
People often see surgery as something purely technical.
But being in the operating room has shown me another side.
Many of the women having DIEP reconstruction have already been through so much.
Cancer.
Multiple appointments.
Treatments.
Uncertainty.
This surgery represents another step in their recovery.
Knowing that our team helped make that possible is something I’ll always be proud of.
Some days I leave work physically exhausted.
Other days I leave feeling incredibly grateful that I get to do this job.
Why This Work Means So Much to Me
When I first became interested in operating room nursing, I never imagined how meaningful it would become.
Every surgery reminds me why I chose this career.
I get to help protect patients during one of the most vulnerable moments of their lives.
I get to support an amazing surgical team.
I get to contribute to something that can truly change someone’s life.
Patients may never remember my name.
They’ll probably never know who prepared their instruments or stood quietly beside the surgeon for hours.
And that’s okay.
Knowing I played a small part in their journey is more than enough.
Learn More About DIEP Procedures
If you’d like to learn more about DIEP flap breast reconstruction, the Queen Victoria Hospital NHS Foundation Trust provides an excellent patient-friendly guide explaining how the procedure works and what patients can expect.
You can also explore my other operating room articles, including The Ultimate Guide to Surgical Instruments for Nurses, where I share many of the instruments commonly used in complex procedures like this.
Stay Connected
If you enjoy reading about life in the operating room, scrub nursing, and my experiences as an OR nurse, I’d love for you to join me on this journey.
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SUBSCRIBE HEREThank you for reading and for allowing me to share a small part of what makes operating room nursing so meaningful to me.
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