DIEP Flap Reconstruction 2016
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Hi Donnar - I did not have your situation, however one thing they don't tell you prior to DIEP is that they take a small piece of rib cartilage (bone?) to get access for the vein re-connection. This caused some shortness of breath for me for a while. Any of you other DIEP ladies know a little more about this?
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Zinny -- ha ha indeed -- final weekend and you are on the other side. I will be at lake this weekend [no internet] so best wishes now.
Stellamaris - there was an animal camera near top that captured prowling cougars more than once! [yes you can chime in again Zinny,!!!]
Donnar25 -- I feel your angst ....my two cents, but I totally get it is a personal decision: I had an 11 hour bmx diep [a few months after chemo] that ended up fabulously great, but my very experienced PS told me later that there had been quite a lot of bleeding on one side as she tried to hook things up, and she had been a bit concerned at one point -- while overall, a very safe surgery with good outcomes, I am not too sure I would be feeling comfortable with your situation of being on blood thinners -- I had been firmly instructed no caffeine, chocolate or red wine [they thin blood] at least 2 weeks prior and 30 days post to maximize good results -- I did even longer [ truly amazed myself
ha ha]. Any way to postpone the surgery for a bit? Your surgeon says it is doable, but maybe not quite ideal.....0 -
Thank you for the info on the rib cartilage Stellamaris. I had seen in some other posts this was mentioned, but didn't realize it was from the sternum area😬 That's sure to be uncomfortable!
Phoebe58 I don't think I'm able to postpone as I'm HER2 + and grade 3, so both indicate this is a very aggressive cancer and they're afraid it will metastasize. They ideally didn't want to wait beyond 3-4 weeks after my last chemo, but decided 5 weeks was okay as long as I came in at the 3 week point after my last chemo to get my 1st Herceptin only infusion... So trying to keep it at bay I guess.... But I guess I could ultimately chose just to do the BMX only and come back later for the DIEP.
I believe their thinking was that they do surgery all the time on people while on Lovenox, they just instruct them to take the shots as usual up until the day before surgery, then none the day of surgery since it is a shorter acting thinner. And I don't know exactly how long before surgery they will pull me off Xarelto and make me start taking the Lovenox shots, but they've mentioned one to two weeks. Either way, little nervous nonetheless and would love to hear that someone else has successfully completed this surgery while being treated for a PE. I know that doesn't mean I'll have the same good result, but would maybe help calm my nerves!😬😋
Thanks all!!
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Donnar, I feel your angst. There is no hands down answer. Your cosmetic result will be far better with an immediate DIEP, assuming all goes well. If you delay, you can go with tissue expanders, but they have their own set of issues.
I would chat with your Breast surgeon about your concerns. They seem to have a better handle on complications than the plastics guys.
As to the piece of rib, yes, they do take out a little chunk to make it easier to access the mammary artery and vein. It can cause soreness, but shouldn't cause shortness of breath. I think that is what made getting back to side sleeping harder.
Not sure I am helping much.
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Do we regenerate the rib cartilage that is taken??
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Phoebe, thanks for mentioning caffeine, red wine and chocolate - no one told me and perhaps that's why my incision is not healing as quickly as it could - I drink coffee every morning and at four and a half weeks, it's still oozing a bit and looks raw in the centre.
I am fed up with trying to sleep on my back - can't wait to sleep on my side again. Also, it's hard to walk any distance so I'm stuck at home. Getting impatient...
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grateful99- if it's still oozing, best to call PS first thing!!
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Cedee, I don't think the rib regenerates, but it is no big deal. There are plenty of muscles and other structures to compensate. Good question for your PS!
Grateful, I agree, ask about the oozing. 4 weeks is too long. Caffiene and wine in moderation shouldn't be affecting your healing. Make sure you are getting plenty of leafy greens and taking a good quality vitamin. That may help healing. Are you getting plenty of protein? Probiotics
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Donnar25- I asked if they needed to group and screen/crossmatch me for the surgery, and they don't, which means they don''t expect much blood loss in spite of the "big" surgery with the BMX and reconstruction. So i would feel more comfortable with that than something like a cardiac surgery ( which my dad had last year on blood thinners and did fine:) )
I will be on a microvascular diet post op, which is no caffeine ( nobody said anything about chocolate!!) as it can cause the blood vessels to constrict and reduce blood flow to those brand new connections… And they suggested reducing caffeine before so as not to have withdrawal. They also suggested eliminating the alcohol in the week before…not sure why.
Also, they are getting me to carb load before surgery- a new thing, apparently. Really interesting. Anyone else asked to drink a carb drink/juice the night before and 3 hours before the OR?
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hey Zinny - delayed lake til tomorrow so catching up -- thanks for reminding me re the blood flow constriction part - I recall that now. PS good chocolate has caffeine
And yes, I was asked to do the carb load at VGH -apple juice before bed and upon waking [I had a 730 surgery] -- apparently it helps keep your BP and blood sugars modulated thru a long surgery, while under anaesthesia... and it doesn't induce nausea like some stronger heavier foods. PS - a few final memories and tips: The 5 days in hospital went surprisingly quickly -- big improvements each day. When the room was initially hot, a sheet was too much at times, so I had a pillowcase across noobs and hips. Biotene mouth spray was sooo soothing and moisturizing. I am not a puker, but I did a little on day 3 morning after re-starting a bit of food and pill form pain meds -- but only the once, and clutched pillow to abdomen - meds were changed back to IV for a day. Use the little gizmo with balls to work on breathing deeply. Day 2 it was tender over sternum [from the rib bit removal] but it fades. Get a back rub if you can. Once you start walking [ok a hunched shufling] you use different muscles which get tired, and you will also flail on your back like a turtle initially, but it gets better. Do regular laps about the unit - more as you progress - my walking improved by a decade a day -starting like a stooped shuffley slow 90, then 80, and so happy to then be what felt like flying around like a 70 year old. Also the night before you use a package of full body chlorhexidine wipes, and you repeat it again at the hospital, and then they put blue goo and a light up your nose, -- weird not painful, and a tad entertaining......all in the name of minimizing infection risk!!! Just remember: All Worth It. Best wishes.
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Thanks cedee and BigSister, I will call on Monday. Yes to protein and probiotics.
I think the doctors in Toronto need to learn something about nutrition and surgery from the doctors in B.C.!
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thanks Phoebe!!
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hi, ladies! I am 16 days away from my surgery. Two weeks from Tuesday. I am Enjoying this memorial day weekend and trying to enjoy myself as much as I can before my activities are limited. You all have been very helpful. I' did not know about no caffeine or alcohol for two weeks prior. I am starting to get nervous. My daughter reminded me this morning that I do not have to do this. I know that, but it is my only option and I want to feel more like me. I just hope it is all worth it and that all goes smoothly. You all have been more help than you will ever know. I am sure I will have tons of questions in a few week
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Thank you so much Zinny!! That makes me feel a so much better knowing what they told you and knowing your father did fine with surgery on thinners too. Are you also on thinners? I see your surgery date is tomorrow!! I will definitely be thinking and praying for your successful surgery and quick recovery🙏
And thank you BigSister, great information and I think I will call my BS and make sure her opinion on risks associated with this are reasonable. Phoebe, so much good information since I really like knowing what to expect as that makes me feel more in control! Even though I've not been given any food or alcohol restrictions yet, or instructions on carb loading to reduce BP issues or nausea issues, I will definitely ask about doing those things as I've had BP and nausea issues with other surgeries that were not nearly as long😰
Smrlvr, I think your surgery is the day before mine, so we're almost on the same countdown! I'm with you in thanking all these ladies for all their wisdom and stories, it's been more help than I can say
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Hi everyone. My implant reconstruction is failing in my radiated side. Thus, I am faced with having to choose a new reconstruction path. During my cancer treatment, I considered DIEP flap. However, I didn't have enough tissue to recon both breasts. We moved forward with implant reconstruction. Now, I have gained weight, but my surgeon is suggesting I still do either LD flap or DIEP on the one side only and leave the implant on the good side.
Has anyone elected to do DIEP on one side with an implant in the other? I just can't imagine how they'd be symmetrical or what it would look like as I age.
Thoughts?
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Patty- it couldn't hurt to get another or even 3 opinions. The first ps wanted me to do lat flap. Come to find out later, that diep is not his speciality. (I talked to 3 different surgeons, they all had differences in their approach
I didn't have a ton of belly tissue, but enough for 2 small breasts. I'm happy I went with diep mainly because I didn't want the deal with muscle being taken from my back or deal with muscle atrophy in new breasts. Also, they can always do fat grafting or possibly implants after diep if you want a bigger size.
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Smrlvr, I am sorry your daughter is not being supportive. She doesn't realize that YOU need to do this. Reconstruction is a terribly personal choice. some are content to be flat; however, I am not one who would be.
In February 2015 I had my BMX with TEs because the OS said I was too small to get 2 breasts with a DIEP. (He was not a a DIEP surgeon, and he couldn't be more wrong.) In my panicked, cancerous state, I believed him and went with his recommendation. Unfortunately, one got infected and had to be removed. Three months later it was reinserted only to get infected again, but this time with sepsis, a life threatening complication.
So there I was last August having endured 4 surgeries and was a complete wreck from the sepsis. I was pretty shaken, yet I hated being flat and hoped for some option.
Thankfully, my family and friends were supportive and embraced my decision for the DIEP. They are also pretty impressed with the results. It helps to have them supporting my desire for breasts and what it takes to get there.
Aside from the long surgery, which you won't even notice!, the DIEP has become fairly routine, and it is so much better than the other options,, IMHO.
I had mine on December 10, 2015 and am now almost 2 months out after Stage 2. My new girls are warm and large with cute little nipples. I maybe done with surgeries and then all that is left is the nipple tattoos.
I would do it again in a heartbeat, but I would insist on DIEP first!
Also, I concur that biotene mouth spray is a life saver from dry mouth
Regarding caffeine and carb load, every doc is different. I had no restrictions other than supplements that can thin the blood or interfere with anesthesia. Just follow the instructions of your guy, and rest easy.
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Smlvlr, I do think your daughter is trying to help by "letting you off the hook." Have a heart to heart with her about your desires and explain to her how she can encourage you.
However, she might not get it, in which case you'll just have to put on a brave face for herand vcome to us for encouragement from your fears!
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Smrlvr: I concur with big sister. The DIEP results are so amazing0
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smrlvr [and anyone with concerns or second thoughts] - I concur tooooo. I am 9 months post diep -- have been so happy and now my scars are very thin lines with only a bit of pink, the surgery [they work, you rest] and recovery [short term] was so do-able, but the best part for me is kinda hard to describe -- I guess the overwhelming feeling of ....relief and calm -- pure and simple, that washed over me when I woke up and looked down to see soft warm feminine mounds under my hospital nightie. Just like master card: priceless
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I am only five weeks post op, so still dealing with some delay in healing but I love my breasts and am so happy that I can now wear normal clothes and bathing suits without worry. I also didn't think I had enough for two breasts and did not want implants, so gained about 10 pounds and it was more than enough for solid B-cups with some left over for future fat injections to even things out. My new breasts are not huge but bigger than what I had before the mastectomies, so I am thrilled.
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I am so thankful for this forum. The information has been priceless. Reading about what other people have gone through and what I can expect has helped make my decision for deip. As we are approaching summer fast, I wonder what everyone thinks about time of year and having their surgery. I was told May/June for my surgery but still no date. Im wondering about putting it off till fall. I just got my pool open and would love to be able to use it lol, but then again I just want this process started.
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taag4, from my recent experience, you will need to be resting a lot and definitely no swimming for I'm not sure how long. At five weeks, I'm still not allowed baths or swimming due to delayed healing. However, since you're in Ontario, be careful about postponing. As you might know there are numerous cuts being done to our medical system. I told my team last spring that I wanted to go away for the summer and they put me at the end of the waiting list. I had hoped to get it done in the fall or early winter, but my doctors were not available then and I had to wait until late April! So my recovery is now getting somewhat in the way of this summer. If it was me, I would take the first date they give you. Who is your plastic surgeon? I do know Dr. Hofer is extremely busy but Dr. Zong and O'Neil seem to be less busy.
By the way, just in case anyone is interested, I had prophylactic mastectomy on my right breast at the same time as DIEP and am truly relieved that I will not need to worry about the other shoe dropping. The two scars are different (left and right breasts) but my peace of mind is definitely worth it.
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My five week update:
Thanks to the advice I received on here, I went to the Plastics Clinic today because about four inches of my abdominal incision was not healing and found out that it could take another three to four weeks! The technician cleaned it out and put on a dressing, Inadine dressing plus Medipore with pad. I ordered 25 of each online from CanMedDirect.ca because my local pharmacy does not stock surgical supplies. Total for about 12 days: $65. The reason for the delayed healing that I was given is that my abdomen was stitched up very tight. I'm guessing that the stitches dissolved before the incision healed completely and that's why the problem. Not sure what could have been done differently except, don't eat and don't move until you are completely healed. Or use stitches that don't dissolve so quickly. All other stitches have healed well but they didn't have the same pressure on them.
Also, I seem to have an infection on the far left end of the incision, and so am on Apo-Cephalex 500 mg. antibiotics for ten days.
I was also advised to shower every day and irrigate the wound after taking the dressing off and before putting on a new dressing. I had been reluctant to shower and only did saline wipes but that was not the correct thing to do.
Still glad I went through the surgery and looking forward to healing well.
Oh, another milestone today - first time I took public transport rather than taxi for my appointment. It involved lots of sitting down whenever possible, but made it!
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So glad that you got some help, Grateful.
Just to tack onto your post, we should move after surgery, but not overdo. It is important to walk everyday, but equally important to not stand up straight too soon. They sent me home with a walker to help me out.
I didn't stand up straight for about 3 weeks. Sleeping propped up in bed with s pillow under my knees was crucial, too.
Showers will get rid of excess germs better, but I don't think your saline washes were bad video think you would be in the same boat no matter what you did.
I hope this son things do their job quickly!
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Thanks, BigSister. Meanwhile, having problems getting the dressings. No one seems to carry them here.
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June, 28th is my date
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Hi Tanya,
How are you doing with the infection? Hope you're feeling better now.
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Well this is crazy. Had a call from pre-op asking me to come in Friday morning, Then found out my information was not sent out to me and that my surgery is Monday morning YIKES!!! Well I guess on the bright side I don't have many days to drive myself nutty thinking about it. Thanks for all your wisdom everyone I guess its time for me to put it to practise. Feel like I have so much to do with no time to do it. Wish me luck
Grateful99- my surgeon is Dr. Douglas Ross. I really like him and have heard a lot of good things about him. I think he was a very good choice.
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taag4, that's great to hear about your surgery happening so quickly. We'll be cheering for you. What hospital will you be at - I'm guessing it's not in Toronto. All the best.
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