DIEP Flap Reconstruction 2017
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Thanks Jeanwash for the weigh-in - I know medics can never provide an exact handbook for any condition - I’m lucky that I’m not getting any sense of concern from mine so fingers crossed all will be well soon. Dunes, thanks for giving me an idea into your timeline, I know each case is different but this has reassured me greatly. Much appreciated
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Encee - I'd also like to hear from people who are further out from DIEP about abdominal tightness, and what can be done to stretch the skin. At 3-1/2 months out, it still pulls on the scar when I arch my back. It feels like the skin doesn't have much more stretch to it.
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Thanks to all who wished me well this week! I haven't felt like logging in. No complications in surgery, spent 2 days in ICU and one in step down- surgery was on Monday and I came home Thursday. For sure it has been hard, harder than the DMX for me because I was nauseated so much until yesterday. Food sounded gross but it is important to get protein for healing. I'm not in pain except occasional drain twitches, have to remember to hunch over, tire easily and look like a truck ran me over. Fortunately we bought an adjustable several weeks before this (I had already wanted one) and it is a life saver for sleeping- head up, knees bent, like you're on your side somewhat. My drains seem to be getting lower really quickly, I know others that have had problems with it. Today I journaled and felt like I could focus to read if I wanted. Part of my plan was to read but not so far. Glad to hear others are doing well, keep it up!
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tnd22 - I hope you cotinue to heal and feel better each day! I too have an adjustable frame for my sleep number bed and it has been a life saver. We've had it for years but it came in extremely handy with my DIEP Flap stage 1 and stage 2 surgeries.
I agree with you needing protein. I find when I cannot get anything else down to eat, I at least drink a Premier protein drink in order to get 30 grams of protein in one shake. Sometimes I mix frozen strawberries with the protein drink in a blender. At least I feel like I'm getting something healthy into my body.
Don't push yourself too soon! Take care
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on the skin tightness questions- it does get better. It just takes time. Don't force it or try to speed it along. I can't remember if it was someone on BCO or Facebook that had their incision open up at around 2 months post surgery. If your abdomen is still hard and has not softened up yet, wait for that to happen. It happened literally overnight for me. It's also very common to feel and look bloated as the day goes on into evening - someone talked about feeling like there is a string around your belly. I just have theories on that one but I find 2 gas-x capsules with each meal helps. Also being mindful of when I feel satisfied when eating vs trying to eat the same amounts as before surgery. I do find that cetaphil lotion helps some with keeping the area along the scar line moisturized and flexible.
On the stretch marks from the harvest tissue question-I'm guessing you did not have a skin sparing mx and will have the skin from the flaps grafted in place to create the breast pocket. I had skin sparing but I have stretch marks on my breasts that I notice more after Surgery if I'm standing at the mirror examining my new breasts. Otherwise I really don't notice them at all.
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I've had skin sparing BMX and had an expander removed during rads because of infection. My PS told me that DIEP might be a better option at this point. Not sure if my skin will still be ok after rads but if so what exactly happens with a DIEP when the skin and nip is intact?
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Thank you Lula - ‘twas I experiencing the “string” sensation - I’m trusting the process but there is a tiny part of me wondering if this is normal so all these responses are like a balm to me. X
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Twills
I had nipple-sparing, skin-sparing mastectomy with immediate LD & implant reconstruction. While my implant had started encapsulating while having chemo, my wall got destroyed by radiotherapy which really did the job on my reconstruction! It probably contributed to my second implant encapsulating, along with my body possibly not liking foreign objects. So my last surgery was my last hooray - My surgeon still kept my nipple but also brought a flap of skin from my abdomen to the underside of my breast - I’m now a C-cup. I hope all this makes sense makes sense and helps
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Encee, thank you for replying, so do you still have an implant? I've just in the last few weeks been told this would most likely be the best option and as I've started to research it and I just don't get it, at least with skin and nipple sparing that is. I've seen descriptions and photos where the skin is replaced but it seems much more uncommon with skin and nip sparing, I know that's becoming more common now so maybe other proceedures are still catching up. I'm also terrified of having to the travel to have this done, I just can't quite wrap my head around the that. I mean, I've had so many followups just with my expanders alone. I suppose I could follow up with my local PS if I went to who he refers me to, if not I would imagine he wouldn't want to get involved. Sorry for the typos and weird spacing, my phone doesn't agree with the applications on this site. TIA for any and all advice!!
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Hi Twills - they got rid of my implant - and they brought up enough fat and tissue to create my own breast; I'll be honest and say I hadn't expect the result at all, so I'm very happy with what they did.
Like you, I fought my demons in going ahead with DIEP - the hospital I had this done is 3 hours drive away; I was in hospital for a week, had to go back for check up 1 week after discharge, then the next check up was 2 weeks after that and then it was 3 weeks between check-up. When my wound broke down at week 3, I had a Public Health Nurse come and do my dressings in between hospital appointments but I'm doing my own now and I haven't had any problems with this.
The DIEP really requires a micro surgeon to do the best procedure (I don't even know if a regular PS would do this - I'm in Ireland and the guy who did my DIEP was decided upon after consulting with 2 other PS before him).
I suppose my decider was that the time invested in this would be worth it for me in the long run - I had to mentally prepare myself for the surgery and recovery afterwards, in addition to having everything and everyone in place for when I got home. So after dwelling on it for 18 months and making the decision to go ahead with it, I had to wait about 6 months to get the call for surgery. I suppose I was terrified that this would be the wrong decision for me or not go well; but despite a few minor issues, I have no regrets.
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encee, I'm more ok with making the decision to have the actual surgery than I am with the travel aspect. The surgeon that my PS has referred me to is 14 hours away. There would be no way I could follow up being that far away. The next closest place that is highly regarded is NOLA, that's over 9 hours away. There are Dr's in FL that do it but are they great at it, who knows. It's very hard to do research, I mean, to know exactly how successful a dr is you'd have to know their statistics and they don't exactly post that anywhere. I even asked my BS how to "research" a Dr and he didn't have an answer either. He said he would send me to Moffit here in Tampa but admitted he didn't know how good the dr was, he just knew she does DIEP. So frustrating
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I can understand where your frustration is coming from - it’s not like there is a register of rated surgeons available to you. I will stop whining at my 3 hour hospital drive - 9 hour and 14 hour - wow
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3 hours is quite the drive as well. Especially while recovering from surgery. This is just par for the course and another "easier said than done" part of the "journey". Thanks for the advice and I'm glad the surgery worked out for you:)
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twills- I had my DIEP done at NOLA (14 hr drive). DIEP is VERY different than all that hassle with expanders and fills and exchange. None of that applies. They'll go in, harvest the tissue from your abdomen, sew that up and place them in the skin flaps you currently have. The only difference with your procedure and mine is that you had the breast tissue removed prior to having the procedure where I had mine done in the same procedure. You're in the hospital for 4 days then released to stay locally until your post op visit (typically 7 days from surgery date). Hopefully drains are pulled then (all but 1 of mine were pulled at post-op visit). Then you're free to travel home after that. I scheduled us to stay in New Orleans an additional 5 days just in case. From a fatigue standpoint I'm glad I did but otherwise I was good to go. They use a combination of disolvable stitches and surgical superglue to close you up. The nurses teach you how to bathe and care for the incisions before you leave the hospital. Any potential issues post-op are handled via phone, email and photos (like a virtual appointment). Most everything can be handled this way quite easily. Comparatively I hear of more problems requiring follow up in person with implants/expanders than I do with any of the natural tissue reconstruction options done and especially fewer with those done at NOLA (the center for restorative breast surgery).
www.breastcenter.com
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thanks Lula73, I had skin and nipple sparing so I wonder if that would/could change anything. I guess if they see skin has lost its integrity they will replace it but do you know if it's possible, if the skin is ok, to just add the fat without the skin?I can't quite imagine that but it sure would be nice.
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I can't remember the user name (or if it was someone on BCO or FB but I know someone else had it done after removal of implants that were put in after skin sparing mx. So yes it has been done. From my understanding, they will use the entire harvested flesh including the skin to create the new breast mound inside the breast pocket. They only remove the skin from the harvested tissue if they have to create the breast pocket. Crazy I know!
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I had DIEP almost four weeks ago and everything has gone very well. I did have a problem with a blocked drain which had to be removed and PS would manually drain weekly. Because of this I did develop a rather large necrosis which he said he will remove in stage 2. Had anyone had experience with necrosis removal?
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Jiffrig, I am glad to hear your surgery went well. I am curious how doctor can tell if it is true necrosis or just hard spots? I am asking because I had hardness on full length of armpit side and underneath. I had read on this site I earlier threads that many had success with massaging the hard spots. I waited about 5 weeks and massaged. It worked! I don't really have hardness or hard spots any more and flap continues to look very healthy. It was really a dramatic change so I am wondering if some hard areas may just be squished fat, pack down or something, but not really dead or necrosis area. Maybe Necrosis has other signs than just hardness..
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Thanks, Jean, I will try that
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If you had rads how long did your Dr recommend you wait to have DIEP? I've been referred to a local Dr at Moffitt, I saw on their website that generally they perform the DIEP 9-12 months after rads are completed. I thought I've read that some Dr's do it muchsooner than that, I known it varies from Dr to Dr but that's the longest wait time I've seen. That's more of the time frame I've seen for placing expander/implants after Rads. More healing time is better I suppose.
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that's a long time! I had radiation and I'm trying to remember when I had 1st recon...hmm...chemobrain says, try again later! Lol
I DO remember it being several months, but know it wasn't a year! Though rad wreaks havoc on your skin. Some docs also will use radiated skin but others will not. (Mine did) I remember pushing it, getting it in as soon as possible but I think it was warm weather, which might make it closer to 9 months. I think you're right about giving your body/skin a chance to heal. Why take a risk, give yourself your best chance, right?
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I had my last rads on December 10 2016 and then recon on May 30 2017 so it was not quite 6 months. I think everything is ok! I'm healing well.
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Hi everyone.
I am a 28 year old female who was diagnosed in February this year with breast cancer. I had a single mastectomy performed and just finished up with my 8th and final round chemo last week. I have a few months left to decide about what kind of reconstruction method I want, and I would just like to hear from others on this topic.
Which method is considered the best? I am very athletic and sporty. I enjoy fitness and compete in triathlons, long distance running & cycling, tennis, water-skiing to name a few. I do not want a procedure that will impact my sporting ability but also don't want a "quick fix" which will result in more surgery/procedures, a few short years down the line.
Please provide advice and personal experience if you have any. I am extremely nervous about the decision and need all the help I can get. Thanks a stack!
Andrea
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Well, since this is the DIEP forum, you'll mostly get people who had that procedure. Read through the threads from this year and previous years - you'll get lots of different accounts. Most seem pretty happy with the outcome, although there are a few that have had a really hard time with infections and pain.
From my experience, having a flap procedure (whether DIEP or some other) is a tradeoff, but one I was satisfied with. I'm not an athlete, but I'm active - hiking and biking. DIEP has a longer recovery than implants or going flat - it would be at least 3 months before you'd be up for any serious running, due to the abdominal incision. I was on a bike after 5 weeks, but just easy flatland rides. Not having to replace implants down the road definitely factored into my decision. I'm looking at one more surgery at 6 months post-DIEP to fix up some small cosmetic things, then hopefully no more ever....
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Twills and Andi - I had DIEP in May and very happy with results. I had recon within 2 weeks of mastectomy; I did not need rads. I think finding a doctor that is well qualified is tougher than it should be. There just doesn't seem to be an easy way to find helpful info. I met with 2 plastic surgeons and they were completely different in their approach. The first one kept asking me if I wanted to go bigger and seemed to be pushing implants. The surgeon I went with explained all the procedures, risks, complications and recovery time in great detail. The majority of his surgeries are recon which was an added bonus. My PS has been just wonderful in making me feel whole again.
I wish you both the best in your decisions. Take care0 -
tnd22 and jiffrig, glad to hear you are both healing nicely. I had my recon May 9 and am feeling pretty good these days. I had PT for 6 weeks to get rid of cording and to help stretch the skin. I would highly recommend PT as I feel so much better. My stomach is only a little tight now and my breast feels very natural. I have full ROM back. The PT gave me lots of stretching exercises which help a great deal too.
I remember in the beginning being told "it takes time" to heal after DIEP. I'm glad I stopped being impatient and focused instead on steady progress.
Wishing you and all others continued healing0 -
I had my diep flap last January. I'm going for stage 2 on Nov. 7th. I'm just wondering what to expect and what kind of clothes I should wear. It's an outpatient surgery. At this point I wear a bra that's kind of like a sports bra. It pulls over my head. It was advertised on Facebook and I decided to try it since I couldn't find one that didn't hurt along my scar line. I liked them so much I ordered 2 more sets. (they came in 3's) Anyway, will I be able to wear them or will I be going braless for a bit? I was told that the new nipples will stand out quite a bit. I keep picturing Madonna boobs with those pointy things. lol
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I had my 2nd surgery on 8/4/17. PS removed my flap and gave me a little lift. I now have a single incision across the middle in both breast. I'm so glad to be rid of the football flaps and my breasts look great.
In addition, he had to do some revision in the abdominal area because I had a large empty cavity where my skin did not reattached to the abdominal wall after my 3/8/17 first DIEP Flap surgery. My stomach really protruded out front even after 6 months from 1st surgery. He inserted biological mesh and he thought it would correct my problem. I've had a very tough time trying to recover from this 2nd surgery.
Now I am not healing again! The skin is still not attaching to abdominal wall and I'm scheduled for a third surgery on 10/20/17. I have another large cavity but this time it is full of gel like tissue and dead cells. This time he is going to stitch my skin down to my abdominal wall using dissolvable quilting sutures every few inches apart. I've heard of this surgery method used in drainless tummy tucks. I certainly hope this works because I’m ready to be done with surgeries.
Has anyone else had to have their skin stitched down to abdominal wall? How did it feel afterwards? Was it successful?
Pa
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I had my pre-op visit Monday. My phase 2 surgery will be here before I know it. Nov. 7th is racing up on me. I can't wait to have it done and be on the mend. It's still hard to believe it's outpatient. For those of you who have had it done. Just how large are my nipples going to be before the swelling goes down?
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Had my DIEP flap separate from the DMX surgery 3 weeks ago and am still recovering. I am tired of this tightness in my abdomen but am sure I'll get used to it or it will loosen up. Starting to feel depressed about the whole thing, that I'll never get speed or agility back. Back on the anastrole after trying exesmestine, which was worse for me. Tired most of the time. My doctor said I would be 5-6 weeks off work, and I don't have a job, but want to start looking as soon as I'm clear. Not sure what my question or complaint is, but wondering if this is typical for recovery- tired, depressed, loss of mobility?
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