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Is your DIEP breast hard or soft?

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[Deleted User]
[Deleted User] Member Posts: 4
edited June 2014 in Breast Reconstruction

I know that I have had some complications that make my case not the norm, but was wondering how hard or soft anyone's DIEP breasts are......I had a unilateral on 10/24 -- had a hematoma and infection, and although part of my breast is soft, I have a hard area on the right side -- don't know what it is.....and hoping it will soften up once I have finished healing.....(I still have an open wound from the infection which is being packed daily)

I see the PS again on Tuesday so will see what he says, but I am starting to become discouraged.   The whole point of this surgery was to end up with a softer, more natural feeling "breast" --  and instead mine has had problems and is often painful and uncomfortable.    I have not given up on getting a result, just starting to get depressed that everything is taking so long...the wound has become a little smaller since it was opened due to the infection, but it is still fairly deep (5cm) -- and I feel like I have weeks left of daily nurse visits!

Michelle

Comments

  • October
    October Member Posts: 1
    edited December 2007
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    Hi Michelle,

    I had bilateral DIEP almost 7 weeks ago. Have been very fortunate with recovery. The breast mounds are soft, although there are some firm areas along the scar lines.

    It sounds like the worst parts of your complications are past and you can look forward to a good result in the future. It probably seems like things are taking forever and it is only natural to feel discouraged, but just think of how much you have overcome.

    I hope things get easier for you.

    Sara

  • hope_m
    hope_m Member Posts: 24
    edited December 2007
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    Dear Michelle,

    It is normal to have some hard areas due to fat necrosis or even scar tissue.  Sometimes they can be broken up in a revision surgery.  I believe that they do that with the liposuction canula.  My DIEP breast had some hardness along the outer side and it was improved with revision and with time, but I still have hardness underneath the flap (due to the previous recon attempt with implant reconstruction and radiation).

    Best of luck with the healing process.  Try to hang in there!

    Hope M. 

  • LisaSDCA
    LisaSDCA Member Posts: 178
    edited December 2007
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    Hi Michele -

    I have followed your ups and downs with your DIEP and know that you have had some real rough going. My surgery was about a month ahead of you. I had immediate postoperative (while I was in the hospital) dermolysis on both breasts which is not that unusual, but also meant dressing changes and wound care for weeks - no, months -  on end. My PS had told me it was going to get worse before it got better. Well, bits of it did.

    At one point, the left breast had what I called "my black hole" because it seemed bottomless. It was about the size of a cherry, I'd guess. Part of the areas on both breasts (below the flaps - the flaps were never a problem) were just raw and oozing and f'ugly. But they g r a d u a l l y got smaller. The black hole began to fill in - in fact it disappeared before some of the just plain raw spots on the other breast did - go figure! I only last week was able to stop keeping a dressing on my right breast. Both are now smooth, but still red, as though they were burned, but that is fading towards pink daily.

    I had my surgery on Sept. 25th - both of my breasts are soft and feel just like my breasts (just rather less the victims of gravity Cool). However, I did develop a 'lump' about a month ago near the right axilla. This was my cancer breast so it had to be watched. When it did not go away, we did a punch biopsy - benign fat necrosis. It was during the ultrasound prior to that biopsy that we discovered a large seroma underneath the transferred tissue. He drained nearly 80cc! No wonder that breast was feeling tight and achey. Last week he drained another 100cc and I have an app't on Tues. to go at it again. That area does feel a little firmer, but not hard.

    All to say that healing from this complex surgery is not linear. A few women have it go 'textbook' but most of us have a bit of an adventure, even in a successful surgery. Over time, your body will heal, things will settle in, and your breast will no longer feel like the enemy.

    Patience, faith, good eating (protein), plenty of sleep - and that "little smaller" that you have noticed will keep progressing.

    Good luck!
    Lisa

  • BethNY
    BethNY Member Posts: 74
    edited March 2008
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    how long ago was you surgery? I didn't have any complications so my breasts started to get soft around week 5-6.  By the 8th week they were softer.

    It was at about a year after that they just felt completely real, like they had always been there-- same bounce and jiggle and they felt warmer to the touch as well.

    just hang in there.  It will get better.

    whether you're dealing with necrosis, or wound healing--it's a long and stressful process.

    But with wound healing-- constant care, and eating a great diet full of lean protien and calcium your body will fix itself-- it just takes time.

    With fat necrosis, they can sometimes soften up-- if it remains painful, it might be something you would need to have removed.

    Also, gentle massage is great for flap breasts and implants.  It help break up scar tissue.

    I hope everything starts to soften for you soon---

  • Unicorn128
    Unicorn128 Member Posts: 1
    edited December 2007
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    My surgery was mid Sept. I had bilateral and to date my mounds are quite hard and have constant discomfort. My PS said it will get better.

    I have started Physical Therapy and it seems to help with muscles and the tightness.

    Hope all goes well.

  • SandyinSoCal
    SandyinSoCal Member Posts: 559
    edited December 2007
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    Michelle, I had a large hard area on one breast, and my former ps said that it was probably fatty necrosis and would resolve, but could take up to a year.  He said that it would leave a large void if he were to remove it, and that he would not do that.  During stage II (with a different ps), that area was broken up with some liposuction.  The area still has some firmness, but it is much better than it was, and has none of the swelling and ache I felt before.   I'm actually having a second stage II surgery since I needed so much revision (breasts and abdomen both completely re-opened) after stage I, so there's a chance it will be even better after the next round.

  • TammyLou
    TammyLou Member Posts: 12
    edited December 2007
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    I had a do-over.

    My original IGAP reconstruction did not work out.  The circulation was intact immediately after the surgery, but the entire flap turned cold and purple several hours later.  With intensive treatment (blood thinners), it finally "pinked up" two or three days later.

    It is a rare occurance (2% or so), but flap failures do happen.

    I had 5 holes in my chest.  3 small, 2 large (bigger than golf ball).  After 385 days of packing, swabbing, dipping, etc., followed by debridement and a wound vac...I was left with a very hard mass on my left chest.

    My plastic surgeon said it could not be salvaged, that it would not soften.

    My best understanding is that the flaps usually do soften (within 6 months or so).  I just happened to have a particularly difficult time with my initial reconstruction.

    On 3 Oct, I had MS-Free Trams (bi-laterally)...a do-over. 

    I suspect that the hardness / softness of the flap is dependent on the blood supply.  A robust blood supply usually results in a soft breast mound.  (The MS-Free Trams have been soft from day one, and if anything, they are softer now...2.5 months later.)

    If the reconstruction "takes", your body will improve the blood supply to the tissues over time.  (You'll develop new blood vessels, etc. to "feed" the tissues).

    If the tissue is scar, then no new blood supply will develop.

    The hard mass on my chest after my first reconstruction attempt was alot like a horse hoof / hockey puck. 

    Most people do not have this experience.

    Most of the time, the wounds heal and the reconstruction can be salvaged.

    Generally speaking, the hole(s) will heal by secondary intention (your body will "fill-in" with new, viable tissue).

    Tammy Lou

  • TammyLou
    TammyLou Member Posts: 12
    edited December 2007
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    "Tammy,

    I don't believe my DIEP flap is a failed flap

     M"

    Me, neither..speaking as someone who has had a failed flap.

    I think you are going to heal, and your reconstruction is very correctable.

    During revisions, the ps can revise the scar.

    Your body will fill in the "hole" with new, fresh tissue.

    I think that it is possible for the surgeon to make some adjustments to the hard spot later...right now, the hole has to heal.

    I believe that you will have a good outcome...you are just going to have to deal with the craps right now.

    My sympathies.

    Tammy Lou

  • TammyLou
    TammyLou Member Posts: 12
    edited December 2007
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    I don't think that revisions will increase the risk of lymphadema.

    I am having them soon...got batwings / dog ears around my left arm pit.

    There is documentation that reconstruction does not increase the risk of lymphadema.

    I know that this is bothering you...I can dig it.

    Believe me.

    http://i41.photobucket.com/albums/e284/i5am5ladyt/blisteredthunder.jpg

    http://i41.photobucket.com/albums/e284/i5am5ladyt/july2006thunder.jpg 

    http://i41.photobucket.com/albums/e284/i5am5ladyt/IMG011.jpg

    http://i41.photobucket.com/albums/e284/i5am5ladyt/IMG004.jpg

    http://i41.photobucket.com/albums/e284/i5am5ladyt/IMG010-1.jpg

    http://i41.photobucket.com/albums/e284/i5am5ladyt/091.jpg

    Your flap can be salvaged.

    Revisions can take a "mediocre" flap and produce beautiful results.

    I do know what a drag it can be when the results are less than perfect. 

    It is so disappointing...in part, because the reconstruction has been "built up" as a "positive" in this crappy deal.

    And, I think it is difficult mentally to have an open wound on your chest. 

    After 385 days and a major surgery plus wound vac, the holes in my chest finally closed. 

    The "do-over."

    http://i41.photobucket.com/albums/e284/i5am5ladyt/002-2.jpg

    I had a boatload of rads (10+ fixed, matted lymph nodes), reconstruction #1, major debridement, reconstruction #2...so far, no sign of lymphadema.

    I submit, madam, that you have not had every complication possible. 

    I didn't want to be the "winner"...:)

    Get well soon.

    Please keep us posted.

    Tammy Lou

  • TammyLou
    TammyLou Member Posts: 12
    edited December 2007
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    I had an IGAP in June 2006...it did not work out.

    The holes in my chest had to heal before I could try again.  Not purty.

    In October 2007, I had bi-lateral ms-free trams.  (Not my first choice, but it is what it is.)

    Tammy Lou

  • TammyLou
    TammyLou Member Posts: 12
    edited December 2007
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    Hang in there, M.

    I know it is demoralizing and frustrating and crazy-makin'...but, I really believe that (in 6 months or so) your ps is going to be able to fix it (revisions).

    Gentle hugs.

    Tammy Lou

  • TammyLou
    TammyLou Member Posts: 12
    edited December 2007
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    You could be right.

    But, I can hope whatever I want to.  :)

    Get well soon.

    Tammy Lou

  • SandyinSoCal
    SandyinSoCal Member Posts: 559
    edited December 2007
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    Michelle, I also had a very hard area on one of my diep flaps, and Dr. DellaCroce addressed it a few weeks ago.   I have heard that he breaks them up with a small lipo cannula.  My original surgeon had told me that the hardness was likely fatty necrosis, and that if he tried to remove it, a large divot would remain.  He said it might become soft after a year or more and that massaging it would help.   I was having lymphatic drainage massages  three times a week, and after some sessions, the area would be very tender and swelling around it would increase.  This would also happen once in a while when I would try to wear a normal bra for a day.   Anyway, I am happy to report that while I can still feel some firmness in that region, to a large degree the hardness is gone.  I return to NOLA in about six weeks, and I'm sure that Dr. D will work on it some more if he thinks it's necessary.  I'm ending up basically having two stage II surgeries because there were changes that required that my skin be stretched quite a bit and he didn't want to risk wound dehiscence.  I agreed to take multiple steps to achieve a better end result cosmetically.  Since the area where the lump was is adjacent to my incision, he can do more breaking up of that area if he thinks it's necessary. 

    Don't worry!  You are still early in the healing process and changes will continue for many more months.  If the hardness persists, it can be addressed down the road.

  • lynn717
    lynn717 Member Posts: 2
    edited December 2007
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    I had unilateral DIEP in Nov 2005

    At first the whole top of the flap was hard and it took about a year to soften

    Now I do not feel any hard areas

    I am now wondering, due to the weight of the flap, if this right side will droop before the breast on the left 

    Will need a support bra on one side!

    (funny, I feel guilty for even worrying about that, a few years ago, all I wanted was a mound of any kind! 

  • SandyinSoCal
    SandyinSoCal Member Posts: 559
    edited December 2007
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    Michelle, what is strange about the hard area I had is that it did not move like a lump---it felt like it was attached to my ribs/chest.  I thought that a large part of the flap had died.  I almost lost the same flap 7 days post-op---it turned bluish and cold.  I hadn't been put in a bra or told to wear one, but once I put one on, the flap warmed up and survived.  My ps said that it had "venous congestion" and was healing slower than the other side.  Finally at about three months out, he said it was probably necrosis.  I was reading some posts on the FORCE board (www.facingourrisk.org) tonight, and a couple of ladies had this, and it resolved without any noticeable size change to the breast, but it took a long time.  

    I understand your feelings about having complications.  I had an undetected seroma in my abdomen that scar tissue started growing around, and that had to be removed last month, so more than a foot of my abdominal incision was re-opened. and cleaned out.  It had reached the point where I could hardly walk, and could not sit upright at the table to eat a meal.  On top of the seroma, my sutures were forming granulomas and I had hard lumps all across my belly.  One of them opened and I had a hole that drained for two months.  In addition, Dr. DellaCroce said that my DIEP flaps had slipped down, and he had to completely re-do them on the inside.    Thankfully, he was able to address all of these issues, and I am doing much better now, but I did lose a few months and have to start over again with insurance deductibles and out-of-pocket expenses, which is not what I was expecting.  My original ps had told me that even if he had to be in the O.R. with me on New Year's Eve, he'd finish me up in 2007.  Unfortunately, complications got in the way of that plan.  He wanted to wait until they resolved on their own, but the pseudobursa in my abdomen had to be removed surgically---they don't just go away.  I'm hoping to be all done by summer now.

  • Claire
    Claire Member Posts: 1
    edited December 2007
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    Hi: Can't physiotherapists break down scar tissue with massage? Maybe it will soften up over time. Ask your PS about self-massage. I had DIEP flap done in Oct 06. I healed well and I am pleased with the result. I am so sorry that you have to endure these problems. Reconstruction should be the icing on the cake! My recontructed breast is a little firmer than my natural one. PS said that fat tissue from abdomen is more dense. I do have some hard spots, probably scar tissue, on the edges of the flap where she sewed it on. I have gotten them to soften up by massaging. My PS recommened a gentle massage around the edges. The reconstructed breast felt firmer when I first had it done than now.

  • dcrutche
    dcrutche Member Posts: 2
    edited January 2008
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    Hi, I saw this thread and wanted to let you know that I too had fat necrosis which was removed during the second surgery. Your PC doesn't sound terribly empathetic. It is very difficult waiting for the second surgery. The best thing I can say to you right now is that in the long term, you will be much happier with the DIEP surgery. The surgery itself and the recovery and revisions are a real pain, but I will be a year out from having unilateral DIEP in February and I am very pleased with the results.

  • LisaSDCA
    LisaSDCA Member Posts: 178
    edited January 2008
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    Ah - Michelle

    Sounds like you have a bit of an undetected seroma going on in there, too! You should call his office next week and let him know of this relief you got after fluid drainage. See if - no, TELL him you need to have the breast checked by ultrasound for a seroma. See my post above from 12/15 that my breast was holding ~100cc's of fluid two+ months after surgery.

    I am so glad you had something good happen and that your breast feels softer. Seromas will often refill several times before they resolve, but draining them is no big deal.

    Onward!

    Lisa

  • KerryyrreK
    KerryyrreK Member Posts: 1
    edited January 2008
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    Hi "M",

    I had bilateral DIEP on Aug 31, 2007. 

    My recovery has not gone as planned.

    I had to be rushed into the OR on 9/1 as the circulation on the outside of my left flap had been compromised.  They were able to fix it, but I later developed a large area of fat necrosis in the same area. 

    I would say that at least the outer half of my left breast is extremely hard from the necrosis.  I am having to wait on the revision as they found some invasive BC in the mastectomy pathology, and I am undergoing chemo. 

    I have been told that the fat necrosis might soften up, but I have little hope that such a large area will change much.

    I am extremely upset about the results.  I had to travel a long way and spend lots of money and invest a lot of physical and emotional cost as well.  I will now end up with exactly what I didn't want.   I opted for bilateral diep for symmetry, natural feel and natural aging.  It is clear that lefty will never age gracefully, will never feel normal, and will eventually be mismatched with righty! 

    They "look" ok now, but the hard area is uncomfortable and makes it hard to sleep any way but flat on my back.

    Ok, enough of that complaining.  I have to have faith that the cancer is gone and that is the most important thing.

    Hugs,

    Kerry