DIEP Flap Reconstruction 2017
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there are several Facebook sites for Breast recon and some get as specific as type of recon and/or different centers for recon. I know there’s one for women looking into recon at the center for recstorative Breast Surgery in New Orleans (NOLA on the BCO threads) and/or the center in Charleston with Dr Massey & Dr Craige. We discuss the good, the bad, the ugly and the fabulousin a range of topics from the docs to the different types of recon, the hospital, side effects, complications, etc.
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Thank you, that would be helpful and more accurate in that type of forum. I'm looking to go to either Dr Klein in Orlando or Moffitt in Tampa. I've seen online review type posts for both but they seem to be a love him or hate him type thing, that's typical I think for a reviews type thing. Mostly love so I guess that's some indication. Thanks:)
My first consultis tomorrow with Klien in Orlando.
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I had my consult with Dr Klein in Orlando, he used to be at Moffitt in Tampa. I liked him a lot, he doesn't give the warm fuzzies but neither do I, lol. He's a bit soft spoken and to the point which I like. He didn't even come across arrogant but it's still early lol. He said if I choose a bilateral DIEP to not lose any weight before the surgery and if I feel too small afterward or don't like the shape or projection we could add an implant. I of course would rather not but I like the idea of having the choice. Sheesh, it's a lot to take in.
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I had a unilateral DIEP in late September. Love the resulting tummy tuck. Initially, the new breast was very full and round. Now it has lost its shape and size, which was expected.
The area had been radiated last year. With the resulting tissue damage the fact that a DIEP can only take you so far, my surgeon has told me that the size of implant that he can put in will be limited to around 100cc. I was hoping for more. He's hoping to bring it close to the size of the other (unaffected breast). Before we consider an implant, he will remove some fat from my "muffin top" area via liposuction and inject it into the new breast area this coming February. A few months after that, we'll see where things are at.
Has anyone else had the same experience related to not being able to get the size you want? I'm ok to play it safe but it seems like others don't seem to have the same limitations even though they too have had a mastectomy and radiation.
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jewel- sometimes the limitations you speak of are due to the patient's body. But sometimes the limitations are due to the surgeon- his experience/expertise with DIEP and/or stacked flap recon, his experience/expertise in the full gamut (vs just a select few) of the DIEP revision options, and his comfort level with performing them. Do you feel like he is listening to you and making your goal his goal or is he just looking at things and trying to figure out how to make you bigger (a more vague goal)? And then maybe he'll try to talk you into a reduction on the other side to match if the bigger option chosen isn’t big enough? Is he on your game plan or his own? I think more questions about his plan need to be asked. He needs to be on your game plan.
Certainly implants are used in conjunction with DIEP but it's usually when the patient is really thin. If there is a large difference between where the DIEP breast is now and where the original breast is, would a stacked flap make more sense to gain the needed volume (especially before he starts lipo on the muffin top that he may need for a stack)? Perhaps it's time for a 2nd opinion before anything else is done?
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Infreyred, I haven't been checking in here as often so I'm late responding. I've heard good things about Dr. Joshua Levine but didn't see him. I had a lengthy failure with tissue expander using a different doc in Manhattan. I have since had a wonderful experience with Dr. Korn in Long Island. He is with Israeli & Feingold. They all do amazing work. They specialize in autologous breast recon. They also have a great therapist on staff who holds groups for patients & another for their spouses! They get what an ordeal this is.
They also take insurance. My NYC doc "accepted out of network insurance payments" and then aggressively billed ME the difference. Happy to say it is not like that with Dr. Korn's office.
I did the TUG flap using my thighs and I'm thrilled! There are fewer of us & not as much posted so that's why I'm on this DIEP thread. I'm 1 week past my 2nd stage (nipple, fat grafting & scar revision) and feeling great! So thankful to be where I am. Also so very thankful for all that I have learned here from all that you women have shared. It helped me to feel less alone.
Wishing you & everyone reading & posting here good luck & good health.
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Had my Phase 2 reconstruction yesterday. Everything went well. Took fat for grafting from abdomen and pelvis. Revision to left breast lift to fix shape. Right breast nipple reconstruction. Been sore and sleepy yesterday and today. Happy that Phase is over.
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Rsteadman - Congratulations on (hopefully) the last stage in your journey! Can I ask what post-surgery restrictions and self-care needs you have? Do you have drains? Restrictions on lifting arms, etc? I'm scheduled for Phase 2 in mid-December and am a bit nervous about it. Unlike the DIEP where I had a chance to ask a ton of questions, scheduling Phase 2 seems more like choosing a meal at In-N-Out-Burger. Yes, I'll take No. 2 with the breast lift and dog ear removal, no nipples please....
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Rlsteadman, congratulations on getting through your phase 2 surgery. Wishing you a speedy recovery. Thanks for sharing and any updates on progress are most appreciated when you feel up to posting.
Aquilegia, I agree with your point that stage 2 consults get less attention for sure. I am a bit crazy when it comes to getting the most out of a consult. My stage 2 is in December. I made a checklist of revisions on a big piece of paper with a sharpie and added to columns for checking the box yes or no and reviewed it with my surgeon. I'll bring a copy to pre-op testing and day of surgery. Your description of the process was a good one. Like you, I am full of anxiety.
In general, I find much less information to research on stage 2. The DIEP reconstruction is a long haul. I really appreciate all the feedback being posted here.0 -
aquilegia- I just had stage 2 DIEP done 2 week’s ago. The doc should examine you and make a list of things he thinks need done in stage 2 but you should have a list too. Whatever is on your list that the doc doesn’t mention you should bring up and discuss. Overall it’s a much “lighter” surgery than stage 1. Much more moveability when you wake up. My restrictions were no arms above head or side sleeping for 2 weeks, no lifting more than 5lbs for 4 weeks, wear girdle they supplied for 2 weeks round the clock then may switch to spanx round the clock or stay in girdle for another 4 weeks, no underwire bra and stay in bra they supplied for 4 weeks. Shower daily letting soapy suds run over incisions (no rubbing).
Hope this helps
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I took my list of changes from my previous visit to make sure the surgeon had them all the day of surgery. I had nipple reconstruction on my right breast and will have it tattooed at a later date. He fat grafted some close to my armpit where there was a divot from where the fat pad was removed. They took all my lymph nodes and it looked bad. I was nervous about getting lymphedema but seems good so far. Then left breast needed further revisions. He lifted it higher and fat grafted under the breast where the incision was. Also needed lypo in the pelvic area. It looks better but is still swollen. He took fat from my upper abdomen for grafting also. It’s hard to tell how much because I’m swollen. I got on the bath scale and was shocked that it’s higher than before surgery. Hopefully it will go down as the swelling goes down. I have more range of motion than after the first surgery. No drains this time. I am really sore from the lypo. I have a 10 pound weight restriction for 2-3 weeks. Wearing an abdominal binder and I’m not sure how long. Can shower but no rubbing of nipple. Wearing my zip front post mastectomy sport bra. No side sleeping.
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tnd22, jbdayton, and Lula: Thank you so much for your suggestions. Since my last post, I have been at PS each week. Each time more stitches removed from other areas. My body is unable to absorb them. I have severe anemia and asthma. It is now week 6th. I do think bra was cutting the incisions under my breast so I am now using a maxi pad under bra
Absent my healing issues, Stage 2 was much easier than initial DIEP. RIsteadman the list is so important because even on the day of surgery you need to describe all procedures a couple of times. You may be nervous so it is great idea!
I hope all are resting this Sunday.
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Twills,
I might start my own thread next week... and post some pics. I will be having a combo small implant and DIEP on top so you can check with me and see how that goes....
Michele
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agualegia, just to respond to your nov 5 question on breast lift...
I had breast lift and small reduction on good breast and fat grafting on Diep breast. The gory details are not really gory at all. The lift breast has the incision at base inframammory fold and vertical to nipple and stitching around the nipple when it was repositioned. The doctor took most of the reduction tissue out from lower pole and then repositioned nipple so it sits naturally. He also made some pocket, stitching around to side under arm to keep fat positioned upward. The breast initially looked a bit square at the base due to tight stitches. But a few weeks now and pretty well rounded. My breasts now are high up without bra and naturally shaped. The doctor will mark you up and measure so everything looks proper.
I too was really worried about working on the good breast, but the lift is so nice. I can walk around without a bra and they are position equally. If I did nothing else I am happy with the look. But I might have one more fat grafting at the upper pole of the lifted breast so it isfuller.
The best news of all for me was the clear pathology report after examination of the removed breast tissue.
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Wish me luck!
I am going in tomorrow for the "Stage 1 of Stage 1". The main DIEP is still 12/4. Tomorrow I am having outpatient surgery during which my surgeon will snip all the blood veins supplying the donor site, except for 2, one on each side. This is a new technique my surgeon has developed the last few months I think I will be about the 20th patient! It's not supposed to be very painful but they say to expect drains for two weeks.
I have to take a shower tonight with antiseptic solution. and wake up at 4 a.m to drink 32 oz of Gatorade and take a boat load of ibuprofen and acetaminophen. Surgery 7:15 a.m.
Being ready after a long wait, and very excited to be getting rid of the implants, does not preclude being quite nervous!!!!!
Michele
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LMichelle, good luck with your surgery. I hope everything goes like clockwork. Keep us posted. All the best
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Good luck LMichele! Let us know how it goes. Very curious about this method.
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Best wishes LMichele! I look forward to hearing about this new method as well.
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LMichele - please keep us posted! I wish you well during this first surgery. I wonder if this new method reduces the lengthy surgery time. Very interesting
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I did it'! Well, two plastic surgeons, my breast surgeon, the anesthesiologist, and all the other people who were in and out of the room did it! Double MX with immediate Diep Flap reconstruction completed on November 13th 2017. 10 hour surgery, no post anesthesia problems, perfect in all ways. I am one week today out of surgery and I am certainly not at 100%, sleeping lots, still need a pain regime of tylenol, ibuprophen, and an occasional "hard stuff" medication when going to bed for a longer nap or bedtime.
the hospital there was pain and tightness that i did expect, good control. Excellent doctors and nurses at UW Hospital, Madison! I am having some skin necrosis, one of my drains pulled out as I turned to get out of bed yesterday morning (OUCH) but a call assured me this was not major, just care for the drain insert site as I care for the rest of myself. I like my new breasts--lots of work to be done in healing. No one explained how much bruising would be normal, how much oozing from the stitched site would be normal, my abdominal incision is PERFECT. Healing easily as is the naval site. So glad I decided to do this, I am certain it was the best possible decision, in every way. PLAN for a lot of rest, you won't have much choice, the body just says rest, and you have to.
The pictures at the side are of me last summer with my two new granddaughters, the second is me with my daughters 25 years ago, and YAY, last week, November 8, my daughter had a new baby girl! Two daughters, and now five wonderful granddaughters. Life is amazing......My recovery goal is to hold new little sweet baby as soon as possible, it is very hard when she visits and I can't hold her at all....and to get back to my job as I did get the promotion I applied for and it will be waiting for me next month.
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p.s. after I read what I just wrote, I believe if I feel ungrateful or don't appreciate my life, I better read what I wrote here, the last months have been amazing.
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Yay StarlitMomMom!! Glad to hear you are doing well. I am sure it is a relief to be on other side of surgery. Take it easy and rest. Happy healing
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Thanks to everyone that responded on my request for Stage 2 information. I wasn't offered a consult for Stage 2 after my Stage 1 6-week post-op visit, so your information is very helpful.
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Great news starlitmom! Congratulations on the babies and on feeling well!!!
I had my outpatient portion of DIEP yesterday. The procedure was about an hour and 1/4. I wasn't given a pain prescription but the nurse in Post op gave me 2 percocets, which was nice for a good day of sleeping. The pain was actually minimal and has gone down alot today. I am down to taking one tylenol or ibuprophen, alternating, one every 3 hours. May not even need tomorrow. The tummy is kind of swollen and I have one drain. The fluid output went up today, sadly. I really hope it goes down. so I can get the drain out. because I have to go to work next week drain or no drain!
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I am still reading....there is so much info on this thread! So...if this is already discussed my apoligies ahead of time. I am trying to decide between a uni expander/implant and DIEP. I am really nervious with a the implants just cause they are not "natural". But the logistics of DIEP at a hospital 6 hours away is another predicament all together.
So far my questions are: (Some are sillyI know!)
1. What does a DIEP breast feel like? Any feedback from someone that has felt both? lol
2. Would I be able to stay in a hotel near the hospital by myself for several days after DIEP? The doctor wants me to stay within an hour of the hospital for several days following discharge.
3. Skilly waist, fat hips/legs still? Did you even out afterwards? lol
4. How soon would I be able to exercise, running specifically?
5. I see all these "follow up" surgery for fat graphing, lipo on the tummy ect....was this all covered by insurance's in the US?
TIA!!!!
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I am 8 days out from Stage 2 of Breast Reconstruction and feeling discouraged. Stomach and pelvic area were the donor site for the fat grafting. Stomach area still having some pain when standing from seated position. I feel swollen and stomach is itchy. Nipple reconstruction is doing good. Weight gain of 3 pounds after surgery. Thought weight would go down not up. Was I overly optimistic that this surgery would be easier than Stage 1?0
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On Oct 31 I had an SGAP on my right breast. And 3 days later a stacked DIEP on my left. The great Dr. Massey in Charleston SC worked for 22 hours to give me back 2 soft warm breasts. I have had no complications because she takes every precaution before and after surgery to avoid blood clots, infection and swelling. I am able to contact her personal cell 24 hours a day if anything should arise. I am at the end of recovery and plan to go back to work Dec. 1st.
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Hi rlsteadman. Arnica Montana and Bromelain have recently helped a great deal with swelling. Both were recommended for pre and post surgery.
Stage 2 is still a surgery under anesthesia so it seems like a serious business. I am trying to keep my expectations about recovery time pessimistic. Then when it's not as bad as I had imagined, I will congratulate myself on my good fortune. Whatever works. I'm a bucket of anxiety.
Maybe your expectations about stage 2 were optimistic and they helped you to have the courage to take the next step. It's normal to be discouraged after surgery in my opinion just from the physical restrictions. Hope you feel better soon.0 -
Rlsteadman- do they have you in a girdle? If not that could be part of the issue. I’m in one for 6 weeks. Weight gain is likely fluid. It will come off gradually over 4-6 weeks. Girdle also helps reduce fluid retention (at least in the area it covers).
SCGirl-do glad you’re doing well and like your results so far!
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Greeneyes-where are you having your DIEP done again? I know you mention 6 hours away... I'll do my best to answer your questions based on my experience:
1. What does a DIEP breast feel like?
It feels just like real breasts. From the “inside” they felt like 2 blobs sitting on my chest at first. Over time as I healed they felt like me. After stage 2 I couldn't believe how much more they felt like me (i think i was only about 75-80% feeling like me before stage 2 Surgery). After stage 1 they were a little heavy as they were about 1-2 cup sizes larger. Now I'm my old size. From the “outside” (ie husband/boyfriend/me) touching them no significant difference from before. They are warm and soft & they move with me like the originals did. The only drawback (and this is true no matter the type of recon) is that theres no sexual stimulation feelings. But I can deal with that. I still have a lot of feeling in the skin of my breasts though-just no nipple sensation. But the nipples do respond to stimulation and cold
2. Would I be able to stay in a hotel near the hospital by myself for several days after DIEP? The doctor wants me to stay within an hour of the hospital for several days following discharge.
No you can't stay by yourself. You need to have someone with you-husband/boyfriend/Mom/friend/hired CNA/someone. You'll need help getting out of and into bed, help showering, help with drain/incision care, help with meals, etc. you'll likely be pretty out of it when you do take your pain meds too. You have to be accompanied by someone all the way home too. And you likely will still need a little help once you get home as well.
3. Skilly waist, fat hips/legs still? Did you even out afterwards?
After stage 1 my tummy was VERY flat, but waist seemed very short and I kind of went straight down and then out at the hips-that nice hourglass curve had lost a lot of its curve and was more angular. Depending on your dr, that should get fixed in stage 2. I just did stage 2 on 11/2 and my hips, thighs, rear and tummy all look fabulous-I'm awed every time I take this girdle off to have a shower. (I'm in the girdle for 6 weeks.) I say depending on your dr about stage 2 as there are some docs that refuse to focus on correcting/tweaking anything other than the breasts after stage 1. Definitely ask your dr about his plan for stage 2 and correcting these areas. If you're going to NOLA no worries-it's standard part of stage 2 for them.
4. How soon would I be able to exercise, running specifically?
About 6 weeks. Although I will say I tried at about 12 weeks (I'm a rower) and had to give up. It just hurt the abdominal area too much and it would get worse for a couple days after-it was different than just being “rusty" from not having done it for a while. My abdomen feels completely different after stage 2 so I will give it a try again likely after Christmas. With that being said, there are many women who resume running around 6-12 week's post DIEP. Make sure to get a very supportive sports bra-supportive not smooshed/compressed.
5. I see all these "follow up" surgery for fat graphing, lipo on the tummy ect....was this all covered by insurance's in the US?
Yes it is covered by insurance provided your PS codes it correctly and uses the right terms. Typically this happens in stage 2 but sometimes more than 1 stage 2 is necessary. Fat grafting is very common to help fill in divots especially on the upper poles. They have to get the fat from somewhere so that's where lipo comes in. Recontouring hips, thighs, tummy even rear to make you look symmetrical again is important too. They also do scar revision, reduction & lift during stage 2. Again not all docs will do it though-definitely ask. Here's a link to a page on BCO that discusses insurance coverage intricacies-it's after the middle section with all the questions to ask your PS and Ins co.
http://www.breastcancer.org/treatment/surgery/reconstruction/paying-for
Let us know if you have more questions!
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