DIEP Flap Reconstruction 2017
Comments
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Hi all. I am three days out from stage 2 diep surgery and am still very swollen. The pain is manageable. I feel a bit beaten up. I finally get to shower today. Hurrah. I am taking arnica for the swelling. For others who have had stage 2, how long were you taking pain medication and when did the swelling subside? Thank yo
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Welcome houmom. Now that you have made this difficult decision, I hope we can help you through this process. It is not easy but I believe it is the best way to repair your body. Keep us updated.
HUG
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Hello! I am on the other side! yay!
Monday 12/4 arrived (for what my Doc's called Stage 2 of the DIEP, which was the actual flap transfer, after the Delay of Flap surgery 11/20). It was supposed to be about 5 hours in surgery and it ended up being 8.5...! There were a number of things that came up, some scar tissue around the designated Preforator, from my C-section 20 years ago, some congestion in the flap which was concerning... plus: a change of plan to NO IMPLANTS, ALL FLAP!!! so awesome!
I was in-patient 3 nights, they kept me a day longer than they thought, in order to monitor the congested flap. I came home yesterday, with NO DRAINS! I had had a drain for 14 days already, and at the pre-op last Friday they told me I would have 1 -3 drains for 1 - 3 weeks. So this was a total surprise!
My pain is not too bad, mainly managed by tylenol and a few tramadol. I will probably stay on the tramadol for the night's sleep for a few days longer. I am kinda hunched over but that's not too painful and already getting better.
I am thinking of putting together some pics. I will post next week when the hubby goes back to work maybe
I am so glad to be on the other side!Peace,
Michele
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LMichele-so glad to hear you’re doing well!!!
Suburbs-what all did you have done for your stage 2?
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LMIchelle, good for you. No implants was the best surprise to wake up too. Continued speedy recovery.
Lula73, my "punch list" is about 10 posts back. I can't comment on results as I am still swollen and bruised. The original bandages are now off and I have bandaids, steri-strips and gauze with tape on various spots. Removing the bandages after 3 days to shower was not fun with bleeding from sutures, but finally having a shower was a definitereason to celebrate.
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LMichele and Suburbs, I hope recovery from your recent surgery is still going well.
Anyone have (or scheduled to have) bilateral reconstruction
using both DIEP and PAP, or even just extended DIEP?
If so, are you happy
with the results?
What PS preformed your surgeries?
Do you have any long term nerve problems?
Do you think you would have preferred SGAP instead?
Dr. Joshua Levine is suggesting a "four flap" reconstruction with PAPs (both thighs) and an extended DIEP for me. I was hoping for SGAP (both buttocks), since I'm 5'6" 130 lbs, hold more fat in my buttocks, and I thought it would be less painful sitting (compared to PAPs). But he prefers and preforms mostly PAP and DIEP. I really like him and his staff. I just don't know how I feel about the extended DIEP and PAPs -- especially the scars. At least SGAP scars can be hidden.0 -
Hi Outdoorsy. Thank you for your kind thoughts. I am getting better everyday, off the narcotic pain meds, and planning a small outing on my treadmill today : )
As for surgery, your situation is not standard or routine so my best advice would be to urge you very strongly to seek more than one opinion and at a large facility that does many flaps. Best wishes in your decision making.0 -
Suburbs, It's good to hear that you're off the narcotics and getting more exercise in! That's great! Who did you have preform your surgeries? I'll be checking with a couple more places this week about reconstruction options (tissue, not implants), hopefully Dr. Massey and the docs at NOLA, but it depends on if they're willing to work with my insurance.
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hi outdoorsy- I second suburbs advice. Seek another opinion especially NOLA. I had DIEP at NOLA and would recommend them to anyone wanting to do natural tissue recon-the docs there are artists as much as they are surgeons. My guess would be NOLA would likely do a stacked flap (SGAP & DIEP) for you since you're on the thin side. Look at each doc's before & afters and make sure that's what you want to look like (not what you’d be ok with looking like considering you had breast cancer). Hope that makes sense. Compare the pics from Levine & NOLA. If cost is doable from both centers, go with the one that provides the best looking result even if its the more expensive option. You are worth it.
Here's a link to a talk Dr Dellacroce from NOLA did at an international Breast recon conference for surgeons. He discusses stacked flaps starting at 12:48 into the talk and he addresses PAP flaps in particular at the start of this part of the presentation. He then shows a case study of a thin woman who had a botched recon somewhere else that he repaired with a stacked flap.
https://m.youtube.com/watch?v=lGmoI21Tfbc
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outdoorsy-here's the link for NOLA's website and access to before & after photos:
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Lula73, Thank you for the information. I actually found the video you linked in a different post you posted to. It's a very good video! And that's part of the reason why I would like to go with SGAP (instead of PAP), if possible. I would love to be able to go to NOLA! I left a message for Vickie from NOLA to call me regarding costs. I know that they are out of network for me. Hopefully, I'll get a return call tomorrow. Have you run across a post discussing general costs for tissue transfer surgeries at NOLA? I know it probably depends on where tissue is taken from, etc. but was just trying to get an idea of what I might be facing.
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outdoorsy- cost depends on what your insurance will pay even though out of network. Where do you live? Are there any in network docs who do DIEP & SGAP within 25 miles of your house? Within 50 miles of your house? I ask because if not you may qualify for out of area coverage which increases your reimbursement rate (usually to 100% of reasonable & customary or what they would’ve paid a local in network doc to do it.) keep us posted on what Vickie says
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I live in Delaware, and, no, there are no flap surgeons within 25 miles of my house. There are none in my state! If you want to read my post titled No Flap Surgeons in My State, Out-of-Network Coverage, it explains my situation - which is a bit different than most here on the forum. I thought long and hard about whether I really wanted to write that post, but I decided to do it in hopes that it might help others in similar situations.
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Thanks jbdayton.
Hopefully I will be getting my surgery date tomorrow. I'm anxious to get moving, but I'm also starting to worry more about the scars. Are they going to fade over time, or will I always have very visible lines when wearing something that will show my decollete?
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houmom- are you doing BMX with delayed flap somewhere else or immediate flap during same surgery as BMX? Will it be skin and/or nipple sparing? If skin/nipple sparing, your décolleté should be just fine. They try to keep the incision lines from nipple down to chest and in the inframammary line. If the nipples have to go they typically just follow the outline of the areola and then down to chest. Make sure you've looked at your doc's Before & afters for where he placed the incisions and how they healed. How they heal depends on the patient's skin as much as the surgeon's Technique. Also look at this pics and be sure you’re happy with having those results for yourself and not that you’d be happy with it considering youve had BC and it could be much worse than that so yeah I’m ok with it (but inside really not). Where are you having it done?
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I feel good! DIEP and OOPH surgery was 12/8 and I’ll be discharged tomorrow. I have 6 drains— 4 chest and 2 abdominal. I’m off the pain ball and just on Tylenol and Motrin. Everyone is different so if you need the pain meds don’t feel bad about taking them. I brought my Home Depot apron (only $.99) with me for the drains and the doctors and nurses loved it. A bit harder to use with the gown but it worked. Day after surgery I was in a chair. Next day walking with walker. Next day showering in a seat and walking unassisted. That’s the regimen at Hospital at Pennsylvania. They want you up and moving!
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I was aT UPenn in July, Rhodes 1, the medical staff was amazing. So glad you are doing well!
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faith walker-so glad it went well and you’re feeling good!
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Faithwalker22, you go. Excellent news. You are a trooper. I spent a few days on Silverstein 12 earlier this year. The nursing staff at that hospital is stellar. I had my revision at Pennsylvania Hospital last week. Again, the nurses were tremendous. I am happy to hear you had a good experience. Good luck shedding those drains just as quickly.
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Lula the plan is immediate recon right now, but that might change based on the CT results I just got back. My tumors are too close to the nipple to spare so they are going. The PS said he was going to cut pretty high up. I was not expecting that tbh. I’m having it done at Memorial Hermann in Houston. My oncology team is with MD Anderson though.
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suburbs, what is the revision like? I didn't even know there was a "revision" until I saw my PS last week (six weeks postop) and she made some comment about revision and I said what is that? She said "you didn't think I was going to leave your breast like that did you?" I was so stunned I didn't even think to ask more about it. It won't be for another year anyway because I still have chemo and then radiation and she we have to wait until six months after radiation. Is it surgery? Do you do it in the clinic? I'm so confused. Right now my right breast feels quite large compared to left breast. Itdefinitely does not match my left breast. It seems like it's throwing my back out of alignment. Did anybody else experience that?
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Hi everyone, I'm pretty new here. Hi uburbs, what is the revision like? I didn't even know there was a "revision" until I saw my PS last week (six weeks postop) and she made some comment about revision and I said what is that? She said "you didn't think I was going to leave your breast like that did you?" I was so stunned I didn't even think to ask more about it. It won't be for another year anyway because I still have chemo and then radiation and she we have to wait until six months after radiation. Is it surgery? Do you do it in the clinic? I'm so confused. Right now my right breast feels quite large compared to left breast. Itdefinitely does not match my left breast. It seems like it's throwing my back out of alignment. Did anybody else experience that?
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Hi Laura, that is part of what they will "fix".
Make them match up basically. I am in your same boat, right side mastectomy. Currently just a uni, lol Didn't do immediate recon. I am fairly certain, as off as they are ...trust me. Its better than just one...the only part I regret. lol You can get a prostetic prescription from your doctor. If its a huge differnece...which I am assuming it is if your back is in pain you can get partial prosthetics. It might help balance things out for comfort until you go in for stage 2. 0 -
Houmom- did he show you pics of his typical lat flap patient’s results? I would definitely want to see those similar to what his plan is for you. Looks like they go in anteriorly for lat flap (outer side of the breast). Easily hidden in a bra or bathing suit and no scars on décolleté. Maybe he meant high up on your back... I’d want to know for sure exactly what he means well before I went for pre-op. If you don’t like what he has to show you, you can always get a 2nd opinion. PRMA is in Houston I believe and they have a good reputation for flap recon..
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Lula he is doing DIEP, that's why I was kind of confused when he started talking about the lines on the chest. He showed me lots of phtots, none of them had these lines he was talking about so I assumed they just healed really well.
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hi Laura644. I did chemo first and had a double with immediate recon and did not have radiation because my nodes were negative and there was no cancer found in my post surgery pathology.
It's normal that the reconstructed breast is larger as the surgeons expect some loss of tissue. The revision is generally out patient. Typical revisions are nipples if they were removed, dog ears/wings on side of hips or under arms, filling in dents or spots to create better symmetry.
It was nothing compared to stage 1. It's been a week and I was off narcotic pain killers on Sunday. In post op I was in a lot of pain but they gave me a shot. After that it was very manageable. I alternated between Motrin and Percocet and now it's Tylenol and Motrin alternately as needed. I took it very easy for the first few days. I'm very swollen so I can't comment on results.
I had round the clock care from my sister and our BFF so I took it very easy. It was not absolutely necessary but did keep my spirits up. I am covered with gauze and tape still and can't wear a bra. Again, a walk in the park compared to that first surgery.
Welcome to the group and best wishes for a speedy recovery
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houmom- I’m sorry, I swear I saw something about using the lat dorsi in one of your posts somewhere-must be losing my mind. So on the high up for DIEP with just skin sparing BMX, I would think only as high as the top of your nipple with a few extra mm to get clear margins. Even when they just do MX with no recon the incision is usually right across the horizontal midline of the breast and not high up. When he said high up did he show you in anyway what he meant (ie on a drawing, using marker or just his hands as he did the exam, etc)? If nothing else I’d call and clarify. Who is doing the surgery?
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Congrats Faith walker, I am glad you are on this side! Hope the drains don't have to stay too long!
mccmom I was on Rhodes 1 last week, felt like my home for 3 days and bonus I had an ivy league view
my new boobs are getting soft and jiggly it is so amazing compared to the ugly implants. I'm sorry. I know most of you are no doubt grieving your breasts. I was there not so long ago... my condolences, it sucks....
Off the pain meds completely as of yesterday, including ibu and tylenol. Going to get my bully button stitches out this thursday I wonder if I will be released to drive...? it's probably a pipe dream but maybe I will be able to go pick up my daughter from college end of next week...?
best,
michele
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Lula I am going to meet with the PS again before surgery so I will clarify. Thanks for the suggestion.
New forks in the road today - newly observed 5cm (!) mass in the other breast, not seen on any previous imaging but seen on the MRI. Issues with the meds I take for ulcerative colitis also being blood thinners. Lung nodule and a liver lesion. The two existing tumors have grown, and a new one was spotted. I am now stage 2.
I was supposed to have my sentinel node biopsy done Thursday with BMX end of next week but now the SN will be Monday, BMX remains unscheduled.
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oh houmom, I am sorry!
I keep trying to plan recon and one thing after the other seems to come up. Having a new lump looked at tomorrow myself. Deep breath, one day at a time. 0
