Not-so-good surprises in DIEP surgery and recovery?
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I don't know whether to laugh or cry...I found out today I can't have DIEP because I don't have enough abdominal fat. TRAM it will be, I guess.
Michelle
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I don't understand? My PS said the only difference between the TRAM and theDIEP was the TRAM used part of your ab muscle as the source of the blood supply and the amount of ab fat required was the same. Are you sure you are speaking to a dedicated microsurgeon who does DIEP flaps all the time? Many PS are not able to do DIEP because they don't have the extra surgeons required or the necessary equipment so they tell you that you don't have enough fat for the DIEP. Just thought you should know before you give up on it.
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I think if you do a TRAM for both breasts you will lose 2 sections of your 6 pack ab muscles putting you at risk for hernias. I think I would get a 2nd opinion.
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@ LuvRVing, you may also want to read about the "stacked DIEP" procedures that is done at NOLA. I think it is done when there is not enough abdo tissue for a normal DIEP. Even if you can't go to NOLA, at least being aware of the procedure might be good?
It does not make any sense to me that you could have a TRAM if you don't have enough tissue for a DIEP as they are very similar procedures (well, free flap muscle-sparing TRAM is).
There are other tissue options also, buttocks for example. Or the latissimus procedure (back flap) although I have known people who had scarring/pulling issues from that.
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Michelle--Yes, contact NOLA (www.breastcenter.com) because the doctors there are pros at getting the fat they need to give you the breast size you want, without the sacrifice of any of your muscles. Many women who've been told they are too thin for flap reconstruction have gone to NOLA and have C and D cup breasts now.0
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I agree with the previous posters, if you can have a TRAM you should be able to have a DIEP and you definitely want the latter.
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I had bl mastectomy with deip and was on the table for 16 hrs. they put cushions under my feet and head, however, I got the most painfull blister on my heels and the back of my head. I am 6 weeks out and still can't put closed toe shoes on. the blisters are almost gone, but my heels are so sensative to walk on..I am also not happy with my breats, they are more saggy than they were before and have huge divet above each breast.
Jane
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Rem9939.. where did you go?? I haven't heard of one unhappy person with the results until now.
Michelle... I went to a PS who doesn't do DIEP and he said I didn;t have enough fat... then I went to Dr allen who said I did have enough for 2 full breasts... the other PS said not enough for even one... so get a second opinion.
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Jane/Rem9939, perhaps after "stage 2" you will be happier - I hope so! I think they can fix the divot with lipo'd fat, and do other sculpting.
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I had surgery at University Hospital of Colorado, had top notch ps, but, I guess I didn't have quite enough fat to make my breast what I had hoped for.. does anyone know how long before they will do stage 2 and fill in the divets??
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rem9939: you should be asking your surgeon these questions. We can talk about our experience, but it won't influence what your PS ends up doing. I'm sure he has a plan for stage 2, etc. Have you talked to him about it?
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I believe stage 2 is normally 3-4 months later??
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rem9939~
Hopefully your surgeon does a stage 2...
I found out after the fact that my surgeon does one surgery only.
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Ang7, my PS said there would not be a stage 2 for me either, but it sounds to me on the forums like that is rather uncommon, but it definitely is good to ask up front about the stages!
I have gotten the impression on these boards though that it is our "right" to continue on until we are happy with the results, so it is probably worth it to look into your insurance and your rights if you are unhappy with the end result rem9939 although hopefully it's too early to worrry and your PS will make things right for you.
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I had a uni- muscle sparing Free Tram. No one in my area did DIEP- wish I had looked further and either gone to NOLA or St. Louis perhaps to find someone who did DIEP. But overall, I am happy with the results of my TRAM 2 years later. Initially, the foob was way too big-at least a cup size larger than the good breast. My first PS said his preferred method of correcting the asymmetry was stick an implant in the good breast!! hell NO! if I wanted an implant in me, well I would have just gotten an implant!
I had radiation to the foob, which ended up shrinking it some- I delayed stage 2 until a year after finishing rads, by then my insurance had changed , so I saw a different PS. He did some lipo to reduce the foob and made my skin island smaller per my request- due to a tumor near the nipple, my skin island was much larger than average. Even with the reduction, its still significantly larger than the areola. I had the fipple done at the same time and had the first round of tattooing a little later. I was much happier with the results after Stage 2, they hang a little differently, but in clothes I am symmetrical. I still have abdominal tightness, I think they took a little too much skin/fat, but it does not keep me from doing anything.
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Alyad,
It's funny how every PS is different. I asked mine about an implant in my healthy breast and she said NO WAY! She said she would suck fat out of my foob to even them up, even though my foob is the size I want my healthy breast to be. I will probably ask her to leave it so I can consider micro-fat grafting in the healthy breast someday maybe. We'll see...just funny how it is the total opposite of what your PS said to you.
2 years later you have abdominal tightness? Oh boy. Could you tell right away that you were going to be tight (like at 6 weeks)? Because I am too tight to sleep on my stomach and just wonder if that will go away.
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I had an SIEA (similar to DIEP) and my abs felt tight for a few months, then back to normal, except extremely flat !! woo hoo !! Glad I got something out of the whole rotten deal of having DCIS.
I had my stage 2 revision at about 6 or 7 months. Working on tattooing now, then I am still deciding on fipple or just tattoo. I am leaning toward fipple.
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Wow, not so good? Well I had a lot of good things happen but here are the surprises.
I had a BMX with immediate TUG (thigh) flap reconstruction on April 5th.
I was in surgery and recovery for 22 hours because of a hematoma. I did not need a transfusion though.
I had tachycardia and they thought I had a blood clot in my lungs. Had CT scan. No clot - just slightly collapsed lungs.
Because I have gastric reflux, they inserted a tube into my stomach which stayed there a couple of days post-op. My throat was really sore and I could only eat soft foods but I think it helped me having bad reflux.
The stitches in my thighs are so very tight and it is difficult to sit on the toilet and move my legs without discomfort. The bicycle (compression) shorts do not help - they make it worse.
I'm quite swollen although less so everyday.
Not so bad, really, is that?
One very positive note: I love my new breasts - even better than the old ones.
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I wanted reconstruction just to fill up a bra, or to go bra-less, I hated the prosthetic! R. mastectomy 9/05, had the other breast removed prophalatically (preventively, did not want the cancer to return in the other breast) the following summer and they did the tram flap. Took stomach tissue, created 36 D's! I used to be 36 A, and I'm 5'7", so I've always been disproportionate but I'm not now! Huge surgery, 8 hours, no complications. Long recovery, slept in a recliner for a week or so. However, I'm glad I did it. They look great in a bra, and bra-less under a shirt. Don't expect them to look like the old ones. The right breast still has the faint football shaped scar, although the left one has no scarring. I had nipples made, asked the surgeon not to make them too big as women do not like erect nipples all the time! Had the ariolas tattooed. I have no feeling in the nipple area, and little in the breasts, and under my arms, and my mid-section. Odd, but ok. I do miss the nipple sensation, but expected that. The cool thing is that I essentially got a tummy tuck out of the deal.
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where did you go for your diep?
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Hi Bella,
A couple things which probably were unique to me, but to keep an eye on:
I sweated terribly the first night or two after the DIEP and of course I just "toughed" it out w/out asking for dry sheets and a gown during the middle of the night.
Had a bad reaction to the pain pump on day 3 and threw up most of the day (Dialudid I believe).
I had my DIEP at Johns Hopkins too Stillhere with Michelle Manahan. She actually DID come in to see me fairly often.
At JH they are now using a SAT machine to check the oxygen levels of the new flap. Ideally they should stay in the high 90's or 100%. Mine kept dropping which is a sign of flap failure. So they came in EVERY hour for the first 24 hours to visibly check it, as well as use a dopler to actually hear the blood rushing through. Everything was fine!
You have to stay hunched over for at least the first week or two until the sutchers are stable, but after that I started to feel pretty normal.
NO ONE told me I would have to be off caffeine for a week after, nor that for 6 weeks no sleeping on my sides. Both of those were toughies!
Best of luck to you, keep us posted!
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Sharon,
I cant even imagine what it would be like to throw up so soon after surgery. I was praying not to sneeze once while I was in there and felt a sneeze coming on. It was enough to just cough to get that phlegm up from the anesthesia.
OUCH!!!!!!!
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pupfoster - it's good to know that Michelle Manahan checked on you often. Did she see you each day you were in the hospital?
I didn't get any special post-op instructions. But, then I only saw the residents for my discharge (and basically everything else in the hospital).
I had my surgery with Gedge Rosson at Johns Hopkins, and he DID NOT see me post-op in the hospital except for once very briefly two days after my surgery. All I saw were a gang of residents who did not care one iota about me - just my "outcome." I was never a person to them - just a teaching tool. It was really hurtful.
I did continue with Dr. Rosson, and I'm glad I did. He really is a superb surgeon, and usually very caring despite his serious lapse during my initial hospitialization.
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Hi ladies, just wondering if they do a cat scan on everyone the day before, and if yes what is this for. My bi DIEP is one month from today. I'm excited.
Are you in ICU after if so how long?
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IowaSue44 - a CT scan is not standard, my ps had to fight the insurance co to approve mine. It is to map out the vessels in the abdomen so the ps's know where to look for your good vessels. It is not a necessary procedure, many very experienced DIEP ps's do not do them, but I was glad to have it done as my ps team was inexperienced relative to those at, say, NOLA.
I was in ICU one night, ps really wanted me to stay in there for 2 nights but I asked to be put in a regular room. The ICU is a noisy place with lots of traffic and I preferred the regular unit (still had hourly checks and had to keep the room at 80 degrees for one day though!).
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Thx xmasdx- maybe they like to do cat scan on the bi diep? I don't think my team is super experienced ( they look so young) I will have 2 PS I went on the Mayo clinic Rocherster, Mn.web page and read up on them. They had their training at big hospitals the lady ps NY and the man at LA .
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Sue,
I went to the Mayo here in Phoenix for my DIEP and have nothing but great things to say about my experience on the DIEP with them.
I did have to have a CT scan before my DIEP. Dr Rebecca said that it was because I had a previous hernia repaired with mesh and she wanted to make sure about the blood flow to that area.
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The first Lady ps I was to have just moved to Mayo Clinic in Phoenix.
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The depression! That surprised me. I had my DIEP on March 29, 2011. It was a delayed uni. I was diagnosed with IBC in October 2010. I had 6 rounds of nasty chemo, radical masectomy and 33 treatments of radiation. I am in remission. I wanted to do the DIEP as soon as they told me I was in remission, but I was too "hot" from the radiation. I am still having trouble sleeping also. I am very sore, itchy and stiff. The doctor still does not want me waring clothes. This was a surprise, also. The fact that there is no bandages over all these stitches and the doctor does not want anything binding on the stitches, so I wear yoga pants and big t-shirts. Not exactly attire you want to wear out. I did sneak out with my husband to a restaurant one afternoon. A casual mexican retaurant -LOL! The doctor said in 2 weeks, I can start wearing clothes!
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momme... what are your stats? Stage? Nodes? etc
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