DIEP Flap Reconstruction 2016
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SA8PG, Thank you so much for the prayers! I am actually a little nervous this time around. I guess cause it's been so many months with a whirlwind of cancer diagnosis, tests, multiple surgeries. I've allowed myself to fall back into 'normal life'...which is good! ...and Oh, I hope no more drains. I didn't think to ask....I guess I'll find out soon enough ;-)
Taag4 and Jen1...Just a shout out to you both! Hope you are both doing well and with good results! Prayers for a speedy recovery!
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Thanks ladies! @Simplicity - Yes! They are DIEP flaps. Originally the flaps were bigger, and had stretch marks (belly skin after 3 kids), during stage 2, he reduced the flaps significantly
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Huh. They can do that? My stage 2 isn't even scheduled yet. May I askwhat all you had done stage2? I have a boob nose (haha) o remove, a mole to remove, and he has to pull my breasts forward and reshape a bit. Right now I have serious side boob that is insanely hard
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Simplicity, when was your surgery? I didn't see it in the list.
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Hm. Thought I updated that. May 20th, so maybe I havent lol Its been an interesting recovery.
I have 3 as well. 21b, 18g, 15b. Oy. Haha
Not sure if anyone would want to see, but I have been photo documenting..I looked and didn't see a place to put them in your profile?
How are all of the recently recovering ladies feeling today? Past 2 days here have been good. Hurt a bit last night, but the night before and yesterday morning, I was able to stand up straight!!
Had some coffee outside while my dog dogged. Now I am back in my cocoon, about to color. Tried to sleep in my bed the other night. Woke in pain at 3am, carefully turned over, woke at 5 am in pain. So I just went back to my chair hahaHow long are others, if they are able, taking off work for recovery?
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Hi everyone: Can anyone who's had the diep advise me about this--I am thinking of applying for a job as a P.E. teacher which would start about 2 months after my diep surgery. What do you think? How easily did you manage to get around 2 months after surgery?
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Hello ladies, here is my six week update post stage 1 DIEP. My abdomen is in a delayed healing stage. I was doing really well for four weeks except for some oozing and then at five weeks a nurse did some cleaning of the wound and opened it up so now I have a canyon about four inches long. Frustrating. I thought I'd be all healed up by now.
She said there was a danger of infection and in fact a start of one at one end, so I am on antibiotics for ten days. I'm using Inadine dressing covered with gauze and tape and changing it every day. Taking photos every day to see if there is any improvement. Eating lots of protein, taking vitamins, minerals and probiotics (home made sauerkraut). Walking about half an hour daily but still bent over. The breasts seem ok, but now I'm afraid of their incisions opening up so not doing much exercise. I think I strained myself because everything was going so well in the beginning. I think as we get older (I'm 65), the skin is not as elastic and doesn't stretch as well.
I wear a post surgery bra but wondering about buying some new ones - any suggestions? I heard that we're not to wear underwire bras. Are there any other restrictions? I'd love to find one that can double as a bathing suit top. Have any of you found a good one you can recommend?
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rdgc, as you can see from my earlier post, it depends on how well and how quickly you heal.
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Grateful: We all heal at different rates. I am 12 weeks post op (also 65 years old) and I am basically back to normal. I resumed hiking 3 weeks post op (full hike). But I did not do any heavy lifting (still not doing any weights). I was standing straight 2 weeks post op but it took 4 weeks for that really tight, stretched feeling to go away. I needed pillows under my legs at night for about 5 weeks. My tummy is still numb along the incision. It is also still swollen. it stopped oozing at about 7 weeks. At home I really was happy in a medium support sports bra. I am wearing regular bras to work, but I feel it at the end of the day. I think our rate of healing is dependent on many different factors. One thing I know for sure - patience is a virtue that becomes honed to a very fine edge! I got back into knitting to while away all the hours I spent on the couch!
RDGC - Only you can judge how quickly you are likely to heal, based on prior experience, but you should have a plan B in case 8 weeks isn't enough. PE teacher is very strenuous, no? I just have a desk job and I was fine 4 weeks post op. Best wishes to you for a speedy recovery.
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Simplicity - I see you had a mix of TRAM and DIEP? Why did you go that way - not enough for two DIEP? I am curious just in case I ever have to have the left side removed. Does the TRAM feel the same as the DIEP? I am still waiting for stage 2 (reduction on the left) Best wishes and hope your recovery goes smoothly!
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Grateful99, I found that the Bali comfort revolution bra was the most comfortable. I still wear it, it has support but no pressure points and is cut generously at the side and underarm. The Bay carries them. I hope you start feeling better soon!
Myajames, you look incredible! Mine is no where as even, trajectory of diep is lacking and I have a definite shallow area that will be addressed at stage 2. Unfortunately I didn't have enough fat to match my natural breast so it will have to be reduced. But overall I'm very happy. So incredible to wake up from a MX with a breast mound!
Scheduled for stage 2, July 18, providing I don't get bumped for someone needing medical surgery.
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Sometimes they call a DIEP that sacrificed a little muscle to get a better blood supply a muscle sparing tram flap. Although some may argue, the two procedures are essentially the same. My PS and I discussed this quite a bit. (He is a microsurgery geek and loves to explain. Since I am an RN and get the technical talk, he has made it a point to give me all sorts of extra information whenever I ask.)
No matter how careful the surgeon is, when they dig through the muscle to get the blood vessels, muscle will be sacrificed. My PS explained that he would rather take a tiny chunk of muscle and shorten the surgery time than carefully dissect out the blood vessel, still damaging muscle but permitting him to call it a "true" DIEP. Moreover, if he sees a second or third blood vessel in the vicinity, he will grab them aloong with the tiny strip of muscle between them. This gives the flap a better blood supply and reduces the risk of far necrosis.
In my DIEP, my PS found 2 blood vessels in one side and 3 on the other, so I suppose you could say that I don't have a "true" DIEP even though they called it a DIEP. However, the recovery was like a DIEP with no abdominal issues and I don't have any fat necrosis, so I'll take it!
I believe once you have a DIEP, a future Tram flap is not possible because the skin and fat is gone. But there are other places that can be used as donor sites.
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Big Sister, Wow! You absorbed more understanding than I did! Haha
StellaMaris, I didn't have any options with my recon due to the damage from radiation to my skin. From my understanding, the only difference between the two is the use of the muscle. He had told me he may have to take some to assist with blood flow? Or something? Big sister may know haha I tried to feverishly take notes and comprehend but it seems like this info comes at you too quickly sometimes. Anyway, he did end up having to take a bit of muscle for my left side I believe. I am very satisfied, and can't wait for more softening/settling. Right now my left breast (non cancer breast) is sizably larger than my right, and a lot more firm. I meant to request a report from my surgery but forgot
I may call them here in a bit...Thinking of all of our recent surgery patients and hope all are doing well.
3 weeks out today and the past couple days have been great. I can pretty much stand up straight. The areas of necrosis aren't improving as quickly as I'd like, but they aren't getting any worse either. One area of my abdomen is just being an ass
Stubborn in its healing. Necrosis is gross y'all!!0 -
BigSister, so the fat necrosis is from the tram part? I have some but it's not only on the areas where he used muscle...or took or replaced with.
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Jen1-wondering how you are doing, and if you out yet.
Im home from the hospital everything went fantastic. Got out thursday morning, said I was welcome to stay but I couldn't wait to get home, and start to get back to normal. Sent me home with Hydromorph fast and slow acting so I am set for pain, which Ive really had none, other than a drain pulling once in awhile. Waiting for home care to call, not sure why I always have such a problem with them. I have three drain and they are all still in. Funny when the resident was marking me up for surgery, she said you have lots of skin to work with....uhm thank you? Then she said my belly button was not in the middle an they would fix that for me. What is this...... point out traceys flaws before surgery day lol. Anyways I guess I didn't have as much to work with as they thought more skin than fat. But Im really happy with the results. Once my left breast is revised to look the same Im sure Ill be very happy. Would do this again in a heart beat.
myajames- All I can say is wow.
grateful99- I am so sorry you are not healing the way you want. It must be a major concern, consuming every thought. Ill be praying for you, and hope you get it under control soon.
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tag - great to hear you are home and healing well.
Bigsister - thank you for the information - very helpful take care all 0 -
Simplicity, yes, to improve blood flow they need to take a little muscle. Here is why.
DIEP stands for Deep Inferior Epigastric Perforator, which is the name of the blood vessels that come up from deep in the abdomen, inferior (below) the epigastric region (where your stomach is or just below your rib cage). These vessels perforate (go through) the abdominal muscle. It is cool that the name of the muscle indicates location!
In a plain DIEP, they choose one vessel that is feeding the fat and skin that they are taking and dissect down, carefully cutting away the muscle it perforates until they get down to where the vessel is a large enough diameter to use.
That is why women who smoke are not a candidate for this surgery because smoking causes the blood vessels to become smaller such that they cannot be used.
Since blood vessels branch, there are actually many vessels that perforate the muscle. If your doc sees that there is another perforator (small blood vessel) nearby that branches off the same larger vessel that he is going for, it makes sense to preserve both because it will give a better blood supply to the flap.
However, to save them both the doc will have to take a little wedge of muscle as he dissects down to where they merge since he now can't just follow the one. The chunk of muscle they perforated will need to come along for the ride.
We don't miss the muscle. They usually fill in the gap with a little mesh so you don't develop a hernia (where the gut tries to escape through the hole) later.
I am guessing that in your case, since you had so much radiation and the blood supply in the chest was already compromised, he probably figured that you needed all the help that you can get.
So, that is how taking a bit of muscle preserves the blood supply.
I learned all this at my first visit last fall. We were they last appointment of the day and my doc is a self-proclaimed DIEP Geek, so he happily kept answering my questions, complete with hand-drawn diagrams. I think we spent well over an hour and a half with him. I was glad that I had brought a tray of homemade cinnamon rolls with me--bribing office staff is a good way to ensure good help later!
I had let my doc know I was a nurse, so he was free to be pretty technical with me. I had to reexplain it to my husband later because it was too much too fast for him, so don't feel bad that it was too much for you too!
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simplicity-I also ended up having the free tram flap your right it was something to do with the blood flow. Ill know more once I see my surgeon on the 21st. The resident said it basically is the same with some muscle and I haven't noticed any muscle loss so Im really fine with it. Anything that makes recovery quick and easy. Surgery was 9.5 hours. It really is remarkable at what they can do.
Saw my home care yesterday she is going to take one of my drains out today yippy and she said to expect the other in a couple day and the last by the end of the week. Im so looking forward to having a shower.
Slv58-you are scheduled for round two in July, just wondering how long after your first surgery is that? Your also in ontario so our wait times may be similar.
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My surgery is scheduled for this Tuesday. I am getting nervous. The last time I had major surgery, it was for my BMX, and I was scared and beginning my treatment. I had to have the BMX to,take out the C. I have been feeling great and having fun; I almost can't believe I am choosing to go back to healing, drains, and limited activity, especially in the summer. From this forum, I know you ladies have no regret, and I am hoping I will not, either. My PS says only 1% of her flaps fail. I worry about this and other potential complications. Sorry to be such an a worrier. This is getting getting real very fast! I feel i can only vent on this site. You ladies understand
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Hi smrlvr I know how that feels about going back into surgery. I had double mastectomy January 2009. was not going to bother with reconstruction then met some women who had this done and was really impressed. So four months ago went ahead with surgery. I am very pleased with outcome. Drains etc didn't bother me as much as we experienced this before and know what to do. They get removed fairly quickly. Recovery takes time but one step at a time :-) :-) :-) :-)
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Hi beautiful ladies!
I had a BMX on 4/26 and had expanders placed, and just found out that I'll be doing the DIEP reconstruction surgery on 6/30. I'm nervous and scared of all the recovery challenges but determined to get this over with and get to the "new normal" sooner rather than later. I will be checking back in on this board as I get closer to surgery but at least wanted to jump in and say hello and wish all you who are so bravely healing and dealing the very best!
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taag4, I purposely waited until the summer for stage 2 so I wouldn't have to miss work but I could of had it done 5-6 months post surgery. I also had chemo after my diep and put on a good 30 pounds. I knew I wanted to loose the weight prior to stage 2 as I was a good cup size different and originally was planned for a reduction of my natural breast. My breast size always fluctuates with my weight so I knew that once I lost 30 the size difference wouldn't be as great- I was right and am now just having a lift. There will be a bit of size difference as my foob is somewhat flat but I can live with that. I also developed an abdominal muscle bulge because of the surgery, so my surgeon will be going in to try and fix that with some mesh. Oh the fun! I just can't wait till I can get my nipple and then tattooed!
I hope everyone is recovering quickly! I found this surgery was so worth it!
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Smrlvr, I found the DIEP to be less of a challenge than the BMX. I think a lot of it was I knew what I was getting into and the fact that it wasn't for cancer any more--it was for me!
After my BMX with expanders, I endured two infections, one of which tried to kill me. So when I settled on the DIEP, I too was wondering, "Is this really worth it? Am I nuts to keep doing surgery just for cosmetic reasons?" The answer was "YES!" Having been flat for almost a year, I knew that I wanted the reconstruction.
Everything went well for me--my DIEP was successful, and I recovered fairly quickly from the thing. Stage 2 set me back a bit, but I am finally getting back on my feet.
As others have said, I am so glad that I did this and I would do it again in a heartbeat.
Quixhobbit--welcome to our little group! The end of the month will be here before you know it.
Lilyn, wow! You waited a long time. Glad you finally took the plunge.
Slv58--kuddos on the weight loss! That is so hard to do.
For everyone else, happy healing! So glad you girls who had yours done recently are doing well. Here's to getting rid of all those drains. Someday they will just be a distant memory.
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i didn't see a response so ill ask again. Has anyone heard from CarolinaAmy?
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Hi Stellamaris, thank you for your encouragement. I have all these "I wish I did/didn't," thoughts now, and reading your reply, I wish I left the oozing alone to drain and not worry about it. I have to go away in two weeks and it involves a 10 hour flight, so I was planning on being all healed up (it will be nine weeks post surgery by then) and worried what if I can't. And of course, travel insurance is out of the question.
slv58, thank you for the suggestion and photo of the Bali bra. I will be shopping this week, so will check it out.
taag4, congratulations on getting to the other side of the surgery. And I hope you are healing well. Watch those home care nurses, some of them have little or no experience with what we're going through. I had to go to the hospital to get my last drain taken out because the nurse had no idea of what to do and was wiggling it inside my abdomen (ouch!). At the hospital I never even noticed when the nurse took it out.
smrlvr, worry is just part of the process, good luck on Tuesday!
BigSister, thanks for your detailed explanations of DIEP, I'm curious how long did your recovery take post stge 2.
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Quix, looks like I am just a few weeks ahead of you. I will let you know whatnot expect!
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Wow - what a better day today! Straighter, walking better, more energy, no back pain. POD 12 I like you.
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Evening ladies.
Smrlvr, it gets nerve racking close to surgery. I made myself a little corner with a recliner to sleep in with all the necessities, medicine, gauze, tape, coloring books, within reach lol You will be fine
A good, busy weekend here but did too much driving I believe. Abdominal incision bled just a bit Sat night then stopped. Only enough to mark up my brand new jammies, naturally.
Separation looks a tad worse, but I need to take it more easy. Single mom, trying to heal physically, mentally, emotionally, when the opportunity arises.
Hope all have a good night!
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Great to hear Zinny!! Just dont do too much
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Im 6 days past surgery. Two drains gone, one left and I think its going tomorrow. I think Im doing really well. Im wondering if the feeling of the flap will eventually not be so noticeable. Im sure its the swelling and surgery that are really drawing my attention...and the fact that there is actually a boob there,(can't stop looking at it) but did anyone else have the feeling of something attached to your chest and did it go away.
funny story after I got out of surgery and my daughters looked at my chest my one daughter looked and said I think its in the wrong place Its too high up, I said its not wrong it just that my real boob is in the wrong spot. I said thats because of you. Can't wait now for round 2!
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