DIEP Flap Reconstruction 2017
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I am here! Surgery completed 3 hours ago... 7 hours for surgeons ... 5 mins for me. Everything looks beautiful, minus the stitches. The team is fantastic. Had blessing of a few great residents surgeons working with Dr. Alghoul. They all are great. It is a high relief but honestly just amazed, impressed and grateful. Even in ICU looking out my window lake view to Lake Michigan..
Thank you everyone for your encouragement! And Trishlya for getting me off google in wee hours of morning and cdv, Tpralph, mmcmom... and everyones well wishes and positive energy.
I am not in pain. I have local pain flow thing that just numbs local area. I haven't needed the IV pain really but I will tonight if needed. Tomorrow when I move around I will probably need more. For now just thankful for doctors, nurses, technicians. Happy to be alive. Thank God for all of you!
Will give another update late
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Wonderful that all went smoothly, jeanwash! Rest well and listen to your nurses. Hope you are home in your own bed soon.
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You're welcome, sweetie! Glad everything went so well. Take it easy, and let your nurses take care of your every need. It only lasts a couple of days, so enjoy it while you can.
Happy healing and warm, gentle hugs.
Trish
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Hi everyone. My DIEP is scheduled for the end of October so starting to prepare myself, home, family, etc. I am on Tamoxifen. Did any of you have to stop tamoxifen for a period of time prior to surgery. I believe it can predispose to blood clots. Also wondering about being able to travel after surgery. Would like to travel to see my mom on her 75 birthday a month after surgery. Any thoughts or suggestions greatly appreciated. I have been reading this thread for a long time in anticipation of surgery. Kelly
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Katjavdm, I traveled (10 hour flight + 4 hour taxi ride), two months after my DIEP, but I had complications with the abdominal incision not healing properly. And I only had a carry on with wheels with me, since we're not allowed to lift anything. How far would you need to travel?
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Katjadvm- I can't answer your question about Tamoxifen but I will say that I scheduled my DIEP to give me 8 weeks to recover from it before I traveled- we are leaving for Vancouver on August 4- my brother is getting married and I didn't want to miss the wedding. And, I'll say that I really do feel greatly improved after 8 weeks, so traveling on a plane for a long trip seems doable- even with my aged parents, my four year old, and my anxiety ridden DH. I did buy travelers insurance just in case. Good luck to you!0
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jeanwash- here's to the road to recovery! Hope it's smooth!
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Thanks Lula for your information. Like I said the medical team did not give me any foreseeable options to work with. I gather info thru internet. No thanks, I only want to reconstruct the left side and then maybe a lift on the right. The less invasive the better. What concerns me is the article below. It may not be recent but creditable
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Jeanwash congrats for it to be over. Now onward with healing!
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Houston- Thanks for sharing the link. I deal with studying clinical trial studies on an almost daily basis. This was very interesting reading, but all is observation as they really can't do controlled clinical trials on this. Observational trials have so many variables that cannot be controlled and are considered interesting but not considered reliable and/or credible by the medical community. The last paragraph of the conclusion is one of the most important:
"In conclusion, our study indicates that reconstructive breast cancer surgery constitutes an independent stimulating event on the growth of micrometastases leading to accelerated relapse rates. The effect is similar to that observed after primary breast cancer surgery. Importantly, this does not translate into worse long-term disease-free survival. Our results may provide indirect evidence that immediate reconstruction would be more beneficial than delayed as this obviates one possible growth stimulating event. Still, randomized trials assessing this question are not ethically or practically feasible. Further studies are ongoing and will shed more light on tumor biological mechanisms behind the observed phenomenon."
Thoughts on the conclusion:
First sentence - this is only 1 study/article
Second sentence - similar effect to primary BC surgery - no one is opting to not have surgery for BC over this
Third sentence - this does not translate into worse long-term disease-free survival - seems to contradict first sentence
Fourth sentence - may provide indirect evidence...possible growth stimulating event - may and possible
Fifth sentence - randomized trials...not ethically or practically feasible - no controlled trials have been done or will be done
Sixth sentence - studies are ongoing and will shed more light...behind the observed phenomenon - more observational studies are being conducted and possible in vitro studies on the potential mechanism as well as animal studies (rats and mice likely) and note the words 'observed phenomenon'
I hope this helps break it down for you a little better. There may be something to this and there may not be. No one can say for sure. At this point and time with all the data that is available to us, delayed recon has not been proven by this study or any other to carry higher risk of relapse/recurrence.
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hi there....just chiming in regarding mesh. I'm having a very hard time finding people with mesh from DIEP !! I had two separate layers of Prolene mesh used with my Stage 1 because the abs were extremely dissected to access the artery. I was so bummed to learn this....I did not want any foreign bodies, but no going back now! (My surgeon also left in the monitoring wires, but is removing them at Stage 2 per my request). I'm so paranoid about foreign bodies that I didn't even allow the titanium chip placement during my biopsy! You can imagine my distress. My family has a complex history of auto-immune disease, so I didn't want to aggravate my system!
Anyway, I'm a martial artist, and I simply cannot get that mesh area to feel right or work properly. A sit-up is a joke, but I can compensate other motion with stronger muscles, like my obliques. I'm still uncomfortable with a small cough, eight months later, I'm 43 and highly concerned about my future active lifestyle!
I'm going to ask if the mesh can be removed at Stage 2 since the muscles should be healed? Before adhesions set in as the years pass...I'm doubtful though.
I just read a NIH paper about using a dermal graft instead of mesh...that sounds so much better!!! They can use the wasted skin from the flap...
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Huston and Lula, here is another sentence from the report that is encouraging:
"Both increased and reduced risk of recurrence was reported after delayed breast reconstruction" (Introduction bottom of second paragraph).
Also, later on in the study report:
"(Fig. 6, red line) revealing that, in spite of the balanced initial prognostic factors, matched control patients display worse prognosis than reconstructed patients."
And:
"The reason underlying the similar or relatively better long-term outcome of reconstructed patients is presently undetermined."
Here is another report that concludes reconstruction increases chances of long term survival:
"In a large cohort with invasive breast cancer followed over 20 years, there is no evidence that breast reconstruction is associated with worse survival outcomes compared with mastectomy alone."
https://www.ncbi.nlm.nih.gov/pubmed/25719710/
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Jubird, I was dismayed to be told in June that my surgeon had used mesh for some reason in my abdomen. I had very specifically talked to him about this and was assured it would not be necessary. I completely understand things change when they get in there and they have to do what is necessary, but he never told my husband or me that mesh was used until my 3 month follow up when I asked about the bulging on my right side and he said, as he and the nurse walked out of the room, "probably something to do with with the mesh or a hernia. I'll check that when we go back in for stage 2." They walked into another room and I was late to get back to work so i had to leave. I tried calling to talk to the nurse but no one returned my calls. I was just told that the surgeon is now working from a different facility only one day a week now (no explanation about why or what this means for future surgery.) I'm going to ask about removing it when I talk to him finally because I do not want any foreign bodies in me if at all possible. Thanks for mentioning that because I hadn't thought about it being something temporary possibly. Fingers crossed it can come out.
I wonder nowif all the trouble the nurse had getting one of my abdominal drains out (it was "caught" on something on the right side and she had to tug and pull on it until she finally went and got the surgeon from another room to yank it out. Quite scary when happening and freaked me out.) had something to do with it getting hung up on the mesh. The other side drain slipped out painlessly and effortlessly and the left side of my abdomen is lovely and flat.
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Can anyone explain to me if there is a medical reason for reconstructed nipples? I really don't think I want them , thought I am doing the DEIP in Sept. Since I won't be breastfeeding and my nipples never felt much anyway, I won't be missing them. Then I have to worry about them showing through clothes. I was never that attached to my breasts and don't really even think I need tats. Anyone else feel that way?
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no medical reason for nipple recon. Many women on the boards who got them say they tend to flatten out with time. I was able to do nipple sparing bmx but if I had to lose them I would've opted for 3D tattoos in a very pale pinkfrom Vinnie. Like you I was never that attached to my breasts either but for me it's a visual thing.
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I'm 2 weeks out, been walking mostly around house outside, want to walk more. My PS said to walk, any suggestions on a walking routine?
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also, starting to feel "zings" in the left breast, I'm assuming this is the nerves. Any thoughts
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mmcmom: zings are normal it is your nerves regenerating. I walk every evening for 30 minutes. at 4 weeks I added another 30 minutes in the day time 5 x per week. we have a dog that needs walking so it makes it easy. I did not hold the lease though in cased he started pulling.
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mmcmom, Start slowly, you don't want to open up your incisions. Two weeks is early after major abdominal surgery. My incision opened up after three weeks and it was caused by my eagerness to be active too soon. That's when the dissolvable stitches dissolved and there was nothing holding me together. Be very careful and use a compression belt.
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I am afraid of the incisions, so I really want to take it slow, I'm thinking 10 minutes if I can do it.
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mmcmom, plan your route with places to sit down along the way, if you can. Yes, 5-10 minutes sounds reasonable especially if you wear the binder. Pay attention to how your abdomen feels and don't increase the duration of your walk too quickly. Time yourself around the house first before you venture out. Be patient!
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I am so impatient!! It is really hard for me to just sit still, but I know In the long run it's for the best. Luckily, the weather is gorgeous today and I can sit outside and get some much needed vitamin d.
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Question...How long till the abdominal pain goes away? I guess what I'm asking is how long until I can stand up "straight" and walk around with no pain?
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I'm almost at 9 weeks and I don't have ab pain anymore. Except when I was at physical therapy and I tried to do a plank for 10 seconds. Ouch!
Speaking of physical therapy, everyone should get range of motion back! My PS would not have given me a script on his own if I hadn't asked. So please dont hesitate to get what you need. And what you need is to go back to full range of motion, right?
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mmcmom - I was walking around the hospital on day 3 and around the block after a week back home. I borrowed a rolling walker for the first week, then used a cane for another week - mostly because I'm prone to lower back pain anyway and walking bent over was painful. Also, the abdominal binder actually wore blisters on my stomach until I figured out to wear a camisole underneath it! But it's really a good idea to walk as much as you're comfortable with - it'll help prevent blood clots in your legs.
I never had any pain from the actual incision - just from the drain tube points and from wearing the binder. At 8 weeks I get itching and irritation where my pants waist rubs on the incision, but no pain.
The breast pain may get worse for a while around week 3-4 from accounts I've read online, then diminish, and that was my experience. At week 8 my breast pain is gone except where the cartilage was removed - that is very painful at times..
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pretty sure I was fully upright about week 5 without any pain. Back to work at week 9 (I walk, get in and out of the car and lift a lot of the workday) and had pain by the time I got home. Crawled into my recliner and rested to start all over again the next day. It takes time and in this instance time is your friend :-)
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My Day 5 update...
After 3 nights in hospital I was released yesterday. Pain has not been bad. Took one pain pill for ride home and one last night. It has 19 hours since my last pain pill and am doing quite well. I have been back and forth to bathroom by myself about 10 times and walking around house after each bathroom run. I find the back strain the most uncomfortable so I use a cane and have chairs strategically placed around the house for short breaks. I have a post op visit with my doctor on Wednesday .. basically day 7. The ride is pretty long so will probably take a pain pill for the ride out. But for now I think I am done with pain pills. The pain I have is more like 2 or 3 and not a problem.
The Dr did say they found an even better situated vein sitting on top of the muscle so they did not have to touch muscle at all to get to it. Probably why pain level is low. It also helps that I sleep on the recliner so I have quite a bit of independence getting around.
The 3 drains on my body are quite distracting, uncomfortable and all around a pain to navigate. I have then safety pinned to a lanyard I took to the hospital with me. Will have to throw a party when they are removed!
My new breast on the other hand looks fantastic. Both in shape and how healthy it looks. Thank you Dr Alghoul!! Grateful for his attention to detail and for the overall wonderful care I received at Northwestern Univ hospital.
I will post after my post op visit. Still can't believe I went through with it. But very glad that I did..
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that's great news, jeanwash!
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Hello fellow DIEPs, I haven't posted for a while. Back at work and still getting infusions so I'm wiped out most days. Happy to see those that had surgery around the same time as me doing so well and the newbies on the healing path.
mmcmom - I remember being impatient as well. It was tough not to be at my normal pace. I think you're doing great so far; take it slow and add 5 more minutes a day. Tpralph and grateful99 are right...don't over do it. I'm 10 weeks out from surgery and I'm walking 3 miles almost every day. I had to slowly work up to that; my body objected when I pushed it so a little at a time works best.
jeanwash - great job on your recovery! You're making excellent progress after just 5 days. The drains are a pain but I got used to them after the first week and they weren't so bothersome. Getting them out is definitely a cause for celebration! I'm happy to hear you're pleased with the results, that's the best feeling after everything you've been through. I am very happy with my results too, I have a wonderful and talented surgeon. I recently had my annual with my OB GYN and she raved about the quality of my DIEP and reconstructed breast 😊
Sending prayers for continued healing for all and best wishes to all those with upcoming surgeries. Take care everyone!0 -
I totally forgot to ask....at 10 weeks recovery my stomach is still very tight. Is that typical? Lula73 I see you're in pain at the end of the work day and sometimes I feel that way too. I'm assuming that it will take time to completely get back to our "before surgery" routines. I'm struggling though with the stomach tightness though and wondering when that goes away.
I start PT for slight cording under my left arm this Thursday so maybe they can give me some tips on the stomach. I just can't get comfortable yet - sitting, standing or laying down. Not painful, just uncomfortable.
Any thoughts or suggestions?0
