DIEP Flap Reconstruction 2017
Comments
-
L MICHELLE and lab44,
I can only speak to my own experience. I'm 58 years old, in decent physical shape with no major health issues beyond the breast cancer. I had a bilateral mastectomy with DIEP flap reconstruction on April 4th of this year, so I'm about 10 weeks out. I have been fortunate that I had no major setbacks post surgery(except a collapsed lung in the hospital- but that was easily fixed).
- I have to say I am beyond thrilled with the results. My new breasts look and feel like my originals. Mine sag a bit, but that may be because I told my surgeon I didn't really want a 25 year old's perky breasts. I wanted my 58 year old breasts. I feel more like me that way. (That may change when I have my 2nd stage done. Perky breasts are sounding much better right about now).
I don't have to wear a bra, but I usually do mainly becausr I haven't had the nipple reconstruction yet, and they're a little flat at the front. Running isn't a problem.
The best part of tbe DIEP flap, or any of the other flap ptocedures, is that there isn't a "foreign" object inside my body. It's all my own tissue. That was a big deal for me.
The only advice I would give you is to pick a skilled surgical team (and it is a team effort) and to be realistic about your recovery time. You should plan for 4 to 6 weeks of down time. I say that, even though I was dancing in high heels four weeks out!
Good luck with your decision. Its a big one.
Trish
0 - I have to say I am beyond thrilled with the results. My new breasts look and feel like my originals. Mine sag a bit, but that may be because I told my surgeon I didn't really want a 25 year old's perky breasts. I wanted my 58 year old breasts. I feel more like me that way. (That may change when I have my 2nd stage done. Perky breasts are sounding much better right about now).
-
I second trishylla. I had my DIEP in April 2016 and am also happy with the results. I asked the PS to make mine bigger (I was quite small there) and he did. I can go bra-less if I want to. It's great to be able to wear a swim suit. The PS offered to use some implants as well and I refused because of what I read here. I am very happy with my decision. Just waiting for stage 2 now on July 17 to take care of the dog ears, do a bit of lipo and to make the nipples.
I am considering not doing the tattoos as I hear they fade so have to be redone and I'm not thrilled about having ink injected into my body. Wondering what other options there are.
Also, how soon after the touch up surgery do we get to go home? Will I need help at home?
0 -
Lab and lmichelle. I had bilateral saline implants for a year before and did the Diep. Got them for a Mommy makeover for my 50th. Loved them except the pectoral muscle weirdness when you exercises. Now had my Diep flap may 18 . They r smaller which is ok. And feel fine when I don't look at them. Pecs are back to normal which is also great. However they are still kind of firm and no real projection. They are only minor saggy about the same as the implants were after a year. Feel very natural without touching them.
Stage two surgery for them they may be able to give more projection to them. But they are very round. Sort of like hamburger buns.
Rougher surgery though as you have more areas to heel. Yes you will need 6-8 weeks. Mine had given me 8-12 weeks but if I wasn't getting chemo now then I would have gone back in 6. I am a NP si not that active anyhow.
I really did like my implants. Loved the shape and projection. Felt youngish again. But decided I didn't want anymore surgery in future after this ordeal. They did go "clunk" when I would turn from side to side in bed and they were a 36 c.
Good luck ladies. If u have any other questions I can help with u can either pm me or ask here
0 -
lab44- I didn't have implants but I did have immediate DIEP recon after BMX in Feb.To answer your questions: I am very happy with the DIEP results. They've looked great from the start (minus the stitches of course). They look pretty much the same as the breasts I went to sleep with for the procedure. They are placed a little lower and they are a cup size larger (went from 36c to a 36d). They overfill during stage 1 as they know there will be some necrosis. They will refine for size and shape and lift during stage 2.
I define how they feel in 2 ways: how they feel as a part of your body and how they feel to the touch. At first they felt like 2 foreign blobs on my chest. I think that's from the long acting analgesics they use during surgery,the swelling and the numbness. Now they feel like a part of me and pretty darn close to how the original breasts felt. To the touch (mine or DH's), they are warm and soft. And they move with me. I wear a bra simply to lift them where they're supposed to be. Other than the low placement they are quite perky. I'm pretty confident I will be able to go braless after the lift in stage 2.
Right after surgery they will have you in the bra they want you to wear-soft cup front close. Absolutely no compression. After 4 weeks you can trade out to a non-underwire non-compression bra of your choice. To a great extent the bra is about shaping and supporting the skin covering the transferred tissue. I used a genie style bra starting with week 5 as I needed something with a wider & softer band. At week 12 I switched out to a wireless push-up with a wide soft band from Victoria's Secret.
I will say that the experience level of your surgeon will make a big impact on your outcome. I had mine done at NOLA (traveled there from NC). Make sure to see plenty of before & after pics of that surgeon's work and verify how many per week they do (1 per week is the minimum). Before deciding on NOLA, we compared all the other center's before & after pics to NOLA's as they are pretty much the gold standard for the world. Having the lowest flap failure and infection rates helped a lot too.
I hope this answers some of your questions. Feel free to ask more and/or pm me. Sending you well wishes!
0 -
Lulu I wonder if amount of fat transfer changes plan. I was told I could go braless from the start and they did not put me in surgical bra. I started wearing soft bras about week two. So may depend on size and surgeon. I also had a skin sparing but not nipple sparing
0 -
Tralph-the bra NOLA gives you is in NO way a surgical bra. It is a very basic stretchy soft cup front close bra. I've seen similar in bra departments at Macy's, belk, JCPenney, etc. When I came out of surgery until post-op appt They had me in bras that had the nipple area cut out so they could keep pressure off the nipples. Then at post-op appt they gave me 2 more that did not have the cutouts. It does seem like different centers have different protocols. NOLA definitely stresses no compression and no underwires.
0 -
thank you for all of your responses. How are your scars healing (noticeable)?
0 -
Michele,
I started planning on implants, but after two infections that was out of the question. And I really HATED the expanders for the same reason you do: when I used my arms to lift or do anything, they compressed the things and drove me nuts.
I ended up with a DIEP and am so glad that I did.
I am 5'11" and was about 178 lbs at time of surgery. My doc thought he could give me Bs and I ended up with Cs. Score! They tend to guess on the small side.
6 weeks is a good guesstimate for how long to be out. Some women were back at a desk job in 4 weeks, but the surgery being so extensive really requires time to let your body heal--you will be very tired. I was able to do desk work at 4-5 weeks, but it was much longer till I was back up to snuff. But then I had that sepsis that just about killed me, so I am sure that helped to delay my really getting up to speed quickly.
I am now 1.5 years after my DIEP and finally got around to getting my tattoos. I am so, so happy with the results. My breasts feel like my own tissue. There is still a funky feeling when I use my arms from the scar tissue, but nothing like when I had those expanders in there. The tummy scar is fading and doesn't bother me much. It is nice to have a flat belly!
hth
0 -
Grateful, the touch up surgery (stage 2) was easy. It was done outpatient, so I went home that day. I had fat grafting, nipples, and minor dog ears and incision touch ups. I was doing desk work a couple of days afterward, and I was tired for about a week.
0 -
Lab44, my scars are fading nicely.
Everyone scars differently. When I asked my PS about scars, he answered by finding an old scar on my body, which was just a white line with no raised area. He said that was a good sign that I an a good scar-er. My body doesn't make a bunch of extra scar tissue when it heals.
So, check out some healed scars on your body--you certainly have some? That will give you an idea of where you are headed.
My PS said ittakes at least a year for scars to mature. They keep fading over time. I posted a picture on page 12 of this thread shouting my scars now. (It was taken a couple of weeks before I did my tats.)
One of these days I'll post a picture of my Vinnie's.
0 -
Lula, who was your surgeon at NOLA? I am scheduled for a SGAP Oct 3 with Dr Wise. I had a nipple sparing mastectomy in 2014 with reconstruction and Sientra textured implants. They bother me if I don't wear a bra and I get a burning sensation sometimes followed by a hot flash. I don't have contracture but exercising is not comfortable with the implants. I am afraid my insurance will not cover for removal and certainly not for NOLA. That leaves a huge payment so I keep second guessing myself. Also having textured implants I am concerned with the risk, even though low, of ALCL.
0 -
Hi. I am new to the board. I had my DIEP on March 14 and will have stage 2 on August 9. Is it normal to be exhausted14 weeks post op
0 -
Hi Stillblessed, welcome to the group!
I am so sorry you are struggling with fatigue. Your body has been through a lot.
Can you explain a little about your joueney? Kind of cancer, radiation, chemo, hormones. That can help explain what is going on.
Furthermore, I do recommend taking a good vitamin with methylated Bs. Find one that lists "methylfolate" instead of "folic acid." Pure Encapsulations "ONE" is excellent.
I also expect your vitamin D level is ranked. Get someone to order a blood level. I routinely take 5000 units a day, and my levels are still on the low side.
I would also be sure to take 1000 mg of vitamin C per day. I like solaray's extended release.
0 -
Hi Stillblessed, welcome to the group!
I am so sorry you are struggling with fatigue. Your body has been through a lot.
Can you explain a little about your journey? Kind of cancer, radiation, chemo, hormones. That can help explain what is going on.
Supplement help. I recommend taking a good vitamin with methylated Bs. Find one that lists "methylfolate" instead of "folic acid." Pure Encapsulations "ONE" is excellent.
I also expect your vitamin D level is tanked. Get a doctor to order a blood level. I routinely take 5000 units a day, and my levels are still on the low side.
I would also be sure to take 1000 mg of vitamin C per day. I like solaray's extended release.
Finally, take a good quality probiotic--one that is refrigerated. You can find one at a GNC store. They are a little pricey, but crucial to your health. Since you had an antibiotic during surgery, they killed off your good bacteria.
Your gut is instrumental in helping all other areas of the body. The biome that lives there is like the bees to agarden--nothing does well without them!
0 -
Olaf- my primary was Dr Dellacroce with Dr Wise as the 2nd. Dr Ordoyne did the MX. On the insurance not paying-what did Vickie have to say? Are you having any complications with the implants that would allow coverage? I so wish we were given ALL the recon choices and information when diagnosed. It's a crazy time for sure but I think there are a lot of women out there who are unhappy with TEs, implants, etc and would rather have done something different. Yes Flap surgeries are bigger surgeries with longer recovery time than implants but the satisfaction rate with how they feel, look, and move with you after the fact is very telling. Just my $0.02
0 -
I am on a waiting list for July 6th at UCSF with Dr. Sbitany. Anyone get their DIEP Flap surgery at UCSF?
0 -
Lula,
Thanks for responding. I have a few issues but not sure if they are what TRICARE would call necessary. Vicki couldn't tell me too much but what I gathered it would be tough. I will play up my chronic pain. I was hoping if I have to pay full freight they would help in some kind of installment payments. But Vicki didn't say much. I know she offered another patient free interest for 5 years on what her insurance would not cover.
I totally agree with you that there are not enough choices. I don't think I would have chosen implants!
0 -
BigSister-2
I forgot to ask if insurance paid for your tats by Vinnie? My PS here in Indianapolis said it was covered in his office, but I did not know about Vinnie. Do you mind sharing the costs? I will go to Vinnieeven if it's not covered.
0 -
I am scheduled to have the trams flap surgery in just a few weeks. My doctors have stated that it is up to me whether i have 1 or both sides done. My genetic tests came back beg, i am stage 2 IDC, triple positive but it has not spread to any lymph nodes. Is there anyone who has only done the the surgery to 1 side that wishes they had done both? Why
0 -
Pambc, I don't know yet if insurance will cover it. They gave me a paper with diagnosis codes to send in. I did, but I haven't heard back. But I went into it figuring I would pay out of pocket.
For bilateral it was $800. More than I would have liked to spend, but I decided that I wanted this last part to be perfect. It is permanent and can't be revised, so I decided to get it done right in the first place.
0 -
Thank you, BigSister, I'm glad so hear that. You've been an incredible help here for everyone and I'd like to acknowledge you. You deserve an award!
0 -
Aw, thank you grateful. "Learner" is one of the strengths God granted me, and I love explainingg things in as many ways as needed until it makes sense. I am also a nurse by training, so that background helps immensely.
That training did not prepare me, however, for the wrecking ball called cancer. I was fortunate that my cancer was small and removed completely with the surgery alone. But reconstruction tried to kill me when I had sepsis from an infected expander.
This forum was my lifeline during all of that. Reading about other women's stories and how they managed helped me see I wasn't alone. Some of the tips have been invaluable to me. After all, even a little bit of comfort helps! Mostly, it showed me that there was an end to the tunnel, and I would eventually get there.
One lady said that the DIEP surgery was more of a marathon than a sprint. That helped. I took it one day at a time, knowing I was a little better each day.
0 -
marvelgirl- interesting that your docs are opting for TRAM flap. Tram flap was the gold standard like 20 years ago for natural tissue reconstruction. Today, that's no longer the case. Most surgeons are going with muscle sparing options like DIEP flap, SGAP flap or stacked flapHave they said why TRAM?
As far as doing just 1 vs both there are several things to keep in mind:
1) flap surgery tends to be a 1 shot procedure whether you do both or 1. Once they've done a TRAM or DIEP or SGAP for 1 you can't go back for another round later if needed for the other side. You'd have to use a different harvest site.
2) Symmetry- symmetry is easier doing both at once. Looking at the long term, weight gain and/or loss are the biggest threats to symmetry for a single recon as the tissue thats been transferred has a "memory" and will store fat/lose fat the way it did in its original location. If the other breast isn't a flap, it won't increase/decrease at the same rate and could mean loss of symmetry.
3) odds are you will have to have some surgery done on the other breast anyway for symmetry. So by doing a umx you're really not sparing the other breast from surgery. And if it's going to have surgery anyway why not opt for BMX and use flap recon?
4) did you have genetic testing done? If you're positive for any of the breast cancer related mutations, going ahead and doing both makes a lot of sense
Hope this helps
0 -
marvelgirl - I agree with Lula, you should have both sides done at the same time. Also, I would not do a tram flap because that involves taking muscles from your abdomen area which can cause problems on down the road. It may be that your doctor does not have the skills to do the Diep Flap. Diep Flap does not involve any muscle removal but it does require the doctor to harvest blood vessels from between the muscles and transplant them to the breast with microsurgery. Please make sure you talk to your doctors and tell them you do not want them touching your muscle and ask them if they have a micro surgery Doctor Who will be doing the blood vessel transfer. I had a cousin who did the tram flap several years ago and she cannot pull herself up out of a chair because her abdominal muscles are gone. This is not good and the DIEP flap has been a life saver reconstruction for women.
Also, make sure you find a Doctor Who has done several DIEP flaps, at least one a week, and ask their success rate. List the city and state you're from and maybe someone on this site can give you the recommendation of a good doctor.
Good luck and don't rush until you find the right surgery for you
0 -
I hope this doesn't confuse anyone but there is a modified TRAM procedure that is used when problems are encountered during a DIEP procedure. It is called a muscle sparing TRAM flap. It is very similar to a DIEP. A small piece of muscle about the size of a postage stamp and the blood vesselsis left attached to the fat flap and moved to the chest and is connected using microsurgery just like a DIEP flap. The small piece of muscle taken with the fat pad allows for better blood flow if the DIEP perforators aren't sufficient.
The old TRAM procedure tunneled a strip of muscle and perforators connected to the flap through the abdomen to the chest. That is the procedure that resulted in muscle loss.
I hope this helps.
0 -
Hi all. I am about 4 weeks out from my BMX and DIEP flap. I had neoadjuvant chemo and was not sure if I would need rads, however, 4 nodes came back positive so I will need rads. I was supposed to start about 6 weeks post surgery but I have some skin necrosis on one reconstructed breast (cancer side) so rads will be delayed till skin is healed. Has anyone else encountered this? I'm worried about delaying radiation so long
0 -
Grateful99 I too had Diep with Dr.Hofer and his team April 6. Have discussed stage 2 ( nipple options) with Hofers team. One thing they did say was that 3D tattoos are not covered by Insurance. Normal tattoos or reconstructed nipples are. I personally think the 3D's look great and would eventually like that option, but need to research cost and someone who is excellent at it.
0 -
Hi Beach4, thanks for that information. There is time for the tattoo decision because they don't want to do that until 12 weeks after the touch up surgery and I've been waiting over a year for the touch up. Dr. Hofer is a very busy man. I also read somewhere else that it's possible to make the nipples with a ear lobe graft. I'll be asking about that during my pre-op.
0 -
BigSister-2015 and Beach4
I had Vinnie tats back in 2011 (and they will be going bye bye with the diep...) My insurance company would not pay, even though they were done in a doctor's office (he was working out of a Phila area site for a little while) the reason being he is not a physician or certified with the insurance company, I forget the language. I have an Aetna HMO and I argued up to a hearing, but lost my appeal. (It's ridiculous since tattoos must be far cheaper than surgery I would imagine!!) I also drove to Vinnie's MD shop for touch up that was interesting. Unfortunately no vodka shot for me that day, had to drive.
My PS has a tattoo artist who IS certified and is covered by insurance so I may go that route next time... I would definitely do 3D again it really helps you feel better about looking in the mirror. and honestly I didn't miss the nipple effect since the foob implants were just not breasts.
0 -
By the way, thank you, what you have told me is very inspiring, you seem so upbeat about it all. I did look at your pic it looks really good! It definitely starts to make me feel a bit more confident about what I am about to put myself through. Another question for you, based on your previous weight and height: that sounds fairly slim? I am 5'8" and about 170 lbs, doctor says I don't have enough fat to do diep alone without implants underneath unless I go much smaller. I am a "hamburger bun" C right now. (I really need to find someone who has that combo...) ugg. thanks everyone
Michele
0
