Topic: Overweight but "not enough tissue" for DIEP...bummed

Hi Hotsyta,

I didn't have enough abdominal fat for DIEP either but I had plenty of fat in my upper and lower buttocks.  I had SGAP on January 14, 2008.  SGAP is the same procedure as DIEP but they used the fat from my upper buttock.  I'm very happy with the look and feel of my breasts and I had very little pain during recovery.  Not all ps are experienced at this procedure so they won't tell you that it is available.  If you would like more information on it you'll find pictures and detailed info on WWW.DIEPFLAP.COM.

Best of luck with  your decision making.

Hi Ta,

  I wanted a DIEP too.  I didnt have enough tissue for 2 Cs.   So different scenario.  But I was still very  dissappointed to find out what I wanted - I couldnt do.   Then you have to start over & rethink it all.

I am having a BL mastectomy with Immediate Reconstruction (expanders) Next week.   Im ok with that.  Only took me a few days to switch gears.    And at this point I am relieved that I wont have the extra pain from the Belly Incision & all that healing to deal with too.  ( I had a Lumpectomy 6 weeks ago- Thats why I am pretty confident that my Immediate Reconstruction will go off without a hitch)  So I cant help you on that question.  Someone should be able to.

A 2nd Opinion is good.  But I bet you will get the same answer...and if you dont...You still need to be comfortable going with the decision to do one...Even though one recommends not- He may have very good reasons- like the ones you brought up.

Pam

I dont know about all that girl---,my BMI was 24, so I did not have alot to take either.  My ps even joked and said we are going to suck you dry.  He did, but was able to create a fantastic boob!  I only had a unilateral.  He said that if I wanted to do both, he could, but they would be small.  I would get a second opinion too.  Good luck

I can't comment on the flap surgery Ta but I can tell you my experience with radiated implants.  First of all, a little history... I was diagnosed Jan/07, IDC, triple neg, 4.5 cm tumor in left breast with no apparent node involvement (clinically, PET/CT and MRI).  I had neo adjuvant chemo then a bilateral mastectomy with SNB.  I had immediate reconstruction with silicone implants using Alloderm.  the SNB was negative intraoperatively but three nodes came back with micromets 2 weeks after surgery.  I went on to a full axillary node dissection and all were negative.  In any case, I sought several opinions about radiation therapy and adjuvant chemotherapy.  The docs at a local University hospital did recommend I do both in light of the neoadjuvant chemo, the likelihood that the nodes were 'more' positive pre-chemo or there were more positive nodes...  yada yada... I do go on.  What I meant to tell you is that the radiation has not significantly affected my implant.  I was noticing a slight tightening of the prophy side before radiation and the implant didn't seem to be seated symetrically.  That hasn't changed.  I have a slight ripple on the underside of the cancer boob.  I've decided to go back into surgery for a revision ... larger and high profile implants, to see if that will correct the problem.  I could just as easily live with these breasts the way they are but I want bigger.  I don't think it's a given that radiation will muck up your implant even though it often does.

Good luck to you.

When I was going through treatments, surgery was the one that scared me the most.  It's a good thing people don't typically die of fright because I wouldn't be here today if that were true.  Even so, I distinctly remember the day I requested the information packet from the doctors in New Orleans.  I had peace in my heart.  Then in June my local surgeon and onc were really scaring me to pieces when I said I wanted a diep in the next state.  They must be arrogant aholes because they appear to have scared me for no reason other than their bruised egos.  I had many ocasions before and since to feel very very very glad that I travelled to get my surgery. 

If you have a nagging little voice telling you to get another surgeon, I urge you to listen.   

I have Kaiser insurance and they are notorious for not paying for stuff. Colleen you had all of your dx done with photos? Does this mean that almost everyone will be a candidate? I am 20 lbs heavier, a smallish 18 and about 1/4 inch shorter. I guess it can't hurt to send some pics yeah? I'm gonna give it a shot!! I feel so down about asking Kaiser for ANOTHER referral, and I know I shouldn't feel that way, but part of me feels like I may be making a big deal just because this is such a difficult process and I really just want it to be over with. Implants are much easier to recover from....ol' flip floppy me, can't make up my mind..

Ta

I think I read here somewhere that this is a kaiser in southern CA that does DIEP. You may want to search the archives for that, or maybe someone else will pop in with the info.

Anne

Hi

I have kaiser and I have just been diagnosed with IDC. Who do you recommend at Kaiser ? She has not scheduled me to see a plastic surgeon. She thinks a lumpectomy will be fine. Can you tell me if you had an MRI. I have had a lump for a while but they missed it and I think it has spread as I have a lot of pain in my back but they do not want to do an MRI.

Hi, this is my first post on this site,  I would get a 2^nd opinion since they are making me a D breast and I am only about 15 lbs overweight. I will have a mastectomy in the next 1-3 weeks depending on several issues.  He is he told me to go home and eat!!!  I am 5'3 and now weigh 133lbs.  This is my heaviest weight (without baby) ever.  My age is 47 and in the last 1-2 years I started getting the tire around my lower ab, flabby arms etc....(there is a reason for everything)  He said I almost have enough for a D cup breast so go home and gain weight.  I am only about 10-15 pounds over what I have averaged most of my life.  When I am thinner I am a B cup, when I gained weight in my mid 30's I went to a C cup. It was fine with me.  I do not think I am a D cup maybe a small C.  What concerns is my bust seems to go up and down according to my weight.  I took my measurements yesterday so I can kind of track what every thing is. I was 39 - 29 - 38,  I had not measured in years I think 20 yrs ago I was a 34-24-34.  I am not athletic nor lots of just m  body type.  I am scared about making all the decisions but would like to have reconstruction immediately it will save most of my skin. He said an one implant would not be a good match for me. This is so overwhelming! I am in a Houston suburb.  Have a great holiday I will be checking back later or tomorrow.    

This is my first post on this site. My Godmother has breast cancer which was the reason I started researching all this. Unfortunately it turns out her cancer is too advanced for an immediate breast reconstruction. The DIEP flap certainly seems like the way to go but she'll have to wait until all her cancer treatment is completed, including radiation.

Have you heard of PRMA plastic surgery in San Antonio, TX?

Four plastic surgeons. All are apparently very experienced in DIEP flap breast reconstruction. They've performed over 2000 DIEP flaps and have a very high success rate (over 99%). I've heard from a handful of their patients. All had great things to say about the practice. They've had patients from all over the US and even from abroad.

Good news for us is that they accept insurance and unlike most of the other practices we spoke to they DO NOT balance bill.

They have a nice article on their website about finding a DIEP flap surgeon and what questions to ask.

I found this article particularly useful when I started researching docs. I didn't realize so few plastic surgeons perform DIEP breast reconstruction, yet alone routinely.

hi Keryl, I think it is pretty hard to tell by yourself. I thought I had plenty, but my ps told me I barely had enough fat for one B breast.  seeems I had very little fat just under the belly skin but above the ab muscle.  that is the fat that they use in a tram or diep.  I had some extra fat under the ab muscle, but that is not in the right place, even tho it gave me a tummy pooch.  if you can grab some squishy tummy, that is a good sign!  best, and have brownie, can't hurt...Pat

ok, well, it is squishy and on top of muscle, so that is a good sign, but realize only the expert can tell. I have 2 more weeks until my PS consult and I cant stand waiting. Funny to say "eat" as I just started an excercise and diet routine thinking that I could lose some weight before my surgery as I will be laid up and I read about people gaining. I like the brownie idea better. I will stick with the xercse though. Thanks.

That's cool. I just hired a trainer also, we meet every TH and it is nice to have the support. she is awesome and does a lot of recoveries as well as rigorus training. This is the longest two weeks of it-- I need to settle on a plan and get on with it - that is me. 

I think I am going with the let mast.; immediate recon of some sort, and then we'll see.... I trust my medical team but its a bit hazzy.

Keryl, when I had my uni-diep, I ended up losing about 20% of my new breast to a circulation problem.  my ps offered to compensate by putting an implant behind the new breast tissue.  I don't see why a surgeon could not combine an implant--especially if you already have one--with the diep or tram for women who are short on ab fat.  the ab fat would surely be thick enough to cover the implant nicely, sort of like a lat-flap does.  now that I re-read your first post, I see that this is what you were asking about.  seems very do-able to me.  my ps even put in an expander under my diep when I had the complication fixed.  I just think that most women who have dieps or trams are not offered the option of combining it with an implant, or don't want an implant, but my ps did offer it to me, so it must work. I  had delayed reconstruction, so I would have had to do the expander first, but I would think that with immediate recon., you would not need to do that part.  and if you were willing to go smaller, perhaps you could have the implants removed and just go with the diep on one side.  btw, I later decided to reduce my natural side with lipo and had the expander removed, and I match very well.  best...