Has anyone had experience with the use of silicone im plants after reconstruction done with diep flap surgery...it is being suggested as the results have not been so satisfactory...
would love to hear from anyone who has gone this route...
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Ruthy Joined: Mar 2009 Posts: 40 |
Nov 21, 2009 08:35 pm
Ruthy wrote:
Hello, I have not personally had this done. Take a look at Dr. Spiegels website in Houston. She has a great website with pics of her reconstructions. Some of them have had implants added to their dieps and they look great. Hope this helps and good luck with your reconstruction. Ruthy |
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abbadoodles… Joined: Jun 2007 Posts: 2,536 |
Nov 21, 2009 08:54 pm
abbadoodles wrote:
Yes, I have one after MS free TRAM,similar to DIEP. Has improved results without problem. Actually, I would have been happy with implant alone if it had worked but, after rads, wasn't working. Tina
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rdumap Joined: Nov 2009 Posts: 6 |
Nov 22, 2009 01:45 am
rdumap wrote:
Thanks so much for yur answer...why did you have the implants ..was reconstruction not done first?? what kind of implant was used ?? Would love to hear more detail, also about decision to do this, recovery and any down sides?? Thanks so much |
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chinablue Joined: Jul 2009 Posts: 312 |
Nov 22, 2009 10:09 am
chinablue wrote:
My ps is recommending an implant to help with the shape of my breast. I had immediate diep reconstruction on my right breast after a mastectomy in August. I am currently a D cup (original left breast) and a B cup (diep breast). My diep breast is a little flat and my ps is thinking an implant will help with protrusion. The plan is to lift the original breast this summer and put the implant in the diep breast March 2011 a year after the completion of radiation. If anyone has experience or further information, I would greatly appreciate reading it. Here is what I found out the following so far: Placing an implant under a DIEP flap (under the pectoral muscle to be precise) to enhance the DIEP reconstruction is fairly common. Usually the surgeon will re-open one of the previous incisions to place the implant. Recovery is usually straight forward and fairly quick, a few days to a couple of weeks depending on what else is being done. There are a few more things you need to know however.In my opinion, you should not put too large an implant under a DIEP flap reconstruction, particularly in the context of radiation. The blood supply keeping the DIEP flap alive is usually connected to the internal mammary blood vessels running by the side of your sternum (breast bone). These connections can be damaged during the implant placement if too large an implant is placed. Placing a small implant is straight forward. Placing a large implant (as would be required in your case to increase your breast size by 2 cup sizes) is a riskier proposition, especially since you have had radiation to the DIEP breast. Radiation usually causes increased firmness of the chest/breast skin and muscles and can prevent the usual stretching of the tissues over the implant, something we rely on and need for the implant to fit. The lack of elasticity in the breast can also cause compression from the implant on the blood supply to the flap. While in the vast majority of cases the DIEP flap still survives even if the pedicle is damaged (because of other blood vessels growing in to the flap over time), it is possible to kill the DIEP flap several months out from the initial DIEP flap procedure. This is rare however. While the plan your surgeon has may be very reasonable for your particular case (it's difficult to say without examining you), you could consider settling for a C cup instead of a D cup, making the natural breast 1 cup size smaller and placing a smaller implant in your DIEP breast to increase it by 1 cup size instead of 2. In terms of the PRMA approach, we have transitioned away from implants and are using them less and less often. We prefer to enhance our reconstructions with fat instead. Fat is liposuctioned from another part of the patient's body, prepared and injected into and around the DIEP flap to enhance shape, contour and size as needed. This is not free of issues either though.... fat grafting can lead to fat necrosis (small areas of hardening) and can cause calcifications on mammograms. Radiologists are becoming increasingly more familiar with this technique though and most are able to tell these fatty calcifications from "bad" calcifications associated with cancer. We have not had any issues with our patients. The benefit of fat over an implant is that it is natural, improves radiation damage and avoids the issue of capsular contracture (hardening around the implant) which can be a long-term problem with breast implants, especially in the context of radiation. I hope this isn't info overload. I think these are important issues for women in your position to consider. Good luck. Dr C _________________ Minas T Chrysopoulo, MD Plastic, Reconstructive & Microsurgical Associates (PRMA) Tel: (800) 692-5565 Placing an implant under a DIEP flap (under the pectoral muscle to be precise) to enhance the DIEP reconstruction is fairly common. Usually the surgeon will re-open one of the previous incisions to place the implant. Recovery is usually straight forward and fairly quick, a few days to a couple of weeks depending on what else is being done. There are a few more things you need to know however.In my opinion, you should not put too large an implant under a DIEP flap reconstruction, particularly in the context of radiation. The blood supply keeping the DIEP flap alive is usually connected to the internal mammary blood vessels running by the side of your sternum (breast bone). These connections can be damaged during the implant placement if too large an implant is placed. Placing a small implant is straight forward. Placing a large implant (as would be required in your case to increase your breast size by 2 cup sizes) is a riskier proposition, especially since you have had radiation to the DIEP breast. Radiation usually causes increased firmness of the chest/breast skin and muscles and can prevent the usual stretching of the tissues over the implant, something we rely on and need for the implant to fit. The lack of elasticity in the breast can also cause compression from the implant on the blood supply to the flap. While in the vast majority of cases the DIEP flap still survives even if the pedicle is damaged (because of other blood vessels growing in to the flap over time), it is possible to kill the DIEP flap several months out from the initial DIEP flap procedure. This is rare however. While the plan your surgeon has may be very reasonable for your particular case (it's difficult to say without examining you), you could consider settling for a C cup instead of a D cup, making the natural breast 1 cup size smaller and placing a smaller implant in your DIEP breast to increase it by 1 cup size instead of 2. In terms of the PRMA approach, we have transitioned away from implants and are using them less and less often. We prefer to enhance our reconstructions with fat instead. Fat is liposuctioned from another part of the patient's body, prepared and injected into and around the DIEP flap to enhance shape, contour and size as needed. This is not free of issues either though.... fat grafting can lead to fat necrosis (small areas of hardening) and can cause calcifications on mammograms. Radiologists are becoming increasingly more familiar with this technique though and most are able to tell these fatty calcifications from "bad" calcifications associated with cancer. We have not had any issues with our patients. The benefit of fat over an implant is that it is natural, improves radiation damage and avoids the issue of capsular contracture (hardening around the implant) which can be a long-term problem with breast implants, especially in the context of radiation. I hope this isn't info overload. I think these are important issues for women in your position to consider. Good luck. Dr C _________________ Minas T Chrysopoulo, MD Plastic, Reconstructive & Microsurgical Associates (PRMA) Tel: (800) 692-5565 Diagnosis: 7/7/2009, IDC, 3cm, Stage IIIa, Grade 3, 4/24 nodes, ER-/PR-, HER2- |
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