DIEP Flap Reconstruction 2017
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Houmom, hi, hope you are doing okay besides not standing up straight! that takes a while! You can't stand up too too much when you are still recovering, but I did go to my husband's christmas party at day 11, I never thought I would but i wanted to go for at least an hour and I found out the more you stand up the straighter you get. When I went back to work at 4 weeks, I realized that sitting at a desk was harder than standing up. Even a half hour of sitting would make me feel all crunched up again. I am now at 6 weeks out and it is really getting easier.
I wonder if I should go on 2018 thread. I am not done!
Just getting over an interesting 2 weeks in which I had a negative reaction to the adhesive glue on the incisions. I guess whatever remained at about 4 weeks, was just too too much for my system. It was very inflamed and throbby and itchy all over.
Got fat necrosis in one side, anyone have any experience with that?? Dr. is so casual about everything, no problem he can fix it... but it is really bumming me out and I am having a hard time finding info. I am massaging like crazy and all it seem to do is make me sore.
Michele
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Any one who has had the Stage 2 and is done, know if they ever reduce the flap breast recon at all? and if so is that done by lipo? (I should really research how lipo works I don't understand how it doesn't create a hole...?)
One side, left, is soft and fine, and of course it's the bigger one. The right Is a fair amount smaller. That side had a scare, the blood was flowing in faster than out I think, at first? They monitored me hourly for 2 days and everything seemed fine. After a week or two it became apparent (to me) there is a pretty large hard lump on top part. Even if that part re-absorbs or gets broken up by a lipo needle, that side will still be smaller. Maybe I would just have the larger side reduced.I kind of don't care too much about which size I just hope to wind up even, after all this time and surgery.
thank you.
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well all went well today at the plastic surgeon. Surgery is on for May 18th. Super excited. 16 weeks and counting. Surgery being done at Moffitt cancer center in Tampa by doctor Paul smith. Wonderful doctor
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LMichelle, I had stage 2 a month ago after 6 months. My best advice would be to wait a bit and see where things land. I had several tweaks done and for the most part I am happy with the results. I have been having physical therapy by a seasoned professional who specializes in lymphedema. She has seen many patients with the flap surgery. Her advice has been very helpful and made me be patient. It's really tough waiting. I want to get back to my normal activity level and am hampered by a wound on my abdominal sutures that has proven to be very pesky. Nothing compares to some others and their difficulties. You may not believe it but it sounds like you are doing really well. Hang in there.
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LMichele- the necrosis will be broken up during stage 2 typically with the lipo cannula. And yes they can reduce the flap breast. They can take care of the side boob and dog ears at your hips as well as car revisions. They make you bigger in stage 1 because that tissue is most likely to survive and stay vs trying to make you bigger using fat grafting which tends to get reabsorbed. The PA estimated I was a cup and a half bigger than when I started this process. Dr reduced, lifted, broke up some necrosis, got rid of side boob, took care of dog ears, straightened my belly button (mine is oval and it was tilted after stage 1), lipoed hips and smoothed transition from waist to hips to thighs, and used that fat to fill in upper poles of both breasts. As far as symmetry, talk with your dr about what option you’d like and what would be best in their opinion.
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Lula thank you for that great breakdown of stage 2 - did you go home with drains? After stage 1 I find myself not wanting to have any more surgery, but I know I probably need to get over it.
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Hi friends,
This is my first post. Last week I was diagnosed with DCIS Stage 0 grade 2 and atypical ductal hyperplasia, L breast. I also had ADH in my right breast in 2016 with a lumpectomy. Because of my high breast cancer risk (37% before the DCIS diagnosis) and having the option of avoiding aromatase inhibitors and radiation with a BMX, I met with a PS yesterday at Stanford and am planning to have a BMX with DIEP. He also offered me the option of DIEP with implants in case there is not enough fat in my abdomen to make my breasts the size they are now, or if I want to go up in size. If there is not enough fat to make them the size they are now he would put the fat in there and then add a thin implant, under the fat but on top of the chest wall. He also said I could add fat later but some of it might get absorbed, or it might not take. Have any of you done DIEP with implants? I am a bit concerned about the implant needing to be replaced -- I am 58. Or any other complications of implants. Thanks.
I am having a lumpectomy Monday then will schedule the BMX with DIEP to be in about 6 weeks or so. The doctors at Stanford are telling me my breast cancer risk will drop to 1% with the BMX, which is great. Question: How long did it take after your BMX with DIEP to feel "back to normal" in terms of your energy, range of motion, and pain? Thanks!
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Hi houmom. I had lipo for the dog ears, hips and under arms and a hard lump of necrosis at the top of my right breast. That lump was perfectly symmetrical with my port lump. The sutures at the lipo spots and a line of sutures the mirrored those of my port as well as those from newly constructed nipples were all healed within a month. There were no drains. The surgery lasted an hour and 45 minutes but would have been shorter except for cleaning a pesky wound site on the abdomen line where I had an abscess and an infection. I had doubts about stage 2 but in retrospect am glad that I did it. Recovery has been a walk in the park in comparison to stage 1.
CyberCathy, welcome and good luck with your surgery. It sounds like you have a good plan. My surgery was an immediate recon after BMX and after chemo first. The first month was tough. I had a lot of help. Then every day got better. It's been 7 months. I am still not 100% back to normal but I would attribute that to the chemo mostly. By avoiding chemo, I would imagine your recovery would be easier. Adding an implant is less common but it's done successfully. And you may not need the implant. If the implant worries you, you might discuss with your team. Also, ask questions about post surgery monitoring. It might be nice to avoid any screening afterwards if you skipped implants. Good luck getting a plan together that makes you comfortable
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Thanks suburbs!
CyberCathy my plastic surgeon offered me the option to add implants to my DIEP but I was happy to be going much smaller. It is still an option down the line for me, it did not have to be done all at once.
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houmom- I had 2 drains. As it was only 1 night in the hospital I did go home with them. Both were removed at my post op visit a few days later. Stage 2 Surgery is nothing like stage 1-much easier and far less pain.
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Hello All,
I had unilateral mastectomy with immediate DIEP flap reconstruction in August of 2017. I wish someone would have a book or a blog of the monthly..'what to possibly expect' so that when things happen I am not just sitting and worrying or wondering. I cannot always seem to find my answers because most people only communicate when they have had horrible experiences.
I am hoping to ask a couple of questions and if this has been done and the answers are within this thread of 41 pages, my apologies.
I did have lots of issues after the surgery as my onco surgeon was fairly aggressive and I had some necrosis (nothing that went completely black...dark blues, lots of seeping from the skin and peeling). Anyway, I have some redness below the flap now and hoping that will shrink in time. I have not had the stage 2 surgeries yet. But, I was told I might have to leave the lower part of the breast below the flap the way it is because trying to remove the scar tissue would make for a really irregular shape.
Here are my questions:
Last night and today I have some cramping going on above the reconstruction - feels like along the route the drain had been in and soreness near the one lymph node that was removed. It has had moments here and there of some pain from nerves regenerating but this also feels like I am puffier - maybe some fluid retention but looking at it I cannot see it is puffy - just feels it. Can we still get inflammation these many months out? Is cramping just nerves regenerating?
Second question, due to the amazing 'footprint' that the plastic surgeon made of the reconstructed breast, we are really just looking at some fat graphting for my right breast (no cancer in that breast). Initially we thought I would need a lift to the right breast but the two really share the exact same outline and look, aside from the reconstructed breast being fuller near the top. Has anyone had this process? Any thoughts on that?
If I didn't make sense on something, please let me know. Sorry for the long read.
Thanks!
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Hi! just wanted to check in. I am 6weeks post surgery. I am still doing well! The incisions have all healed and my new breasts are still nice and warm. They are not as swollen or tender as however there is still some tenderness.
I think it was about week 4 I was able to stand up straight and around the same time I was able to lay in the bed. 😊💃🏽💃🏽 I still had to put a pillow beneath my knees to release a bit of tension but for the most part I was flat. What a wonderful feeling to be in a bed and not in a chair! For those of you who have recently undergone surgery, keep the faith! It gets better. It really does.
Trhbfc- regarding cramping, I was told some cramping is common. However you had your surgery almost 5 months ago so I'm not certain if that is still expected. Are you able to shoot a message to your nurse practitioner or doctor and ask?
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trhfbc2017, swelling can last for a long time. If you are not going for regular physical therapy, you might consider it with a seasoned expert in lymphedema. I have the same swelling but not cramping.
Faithwalker, glad to hear everything is going pretty well. It is fabulous to sleep in a proper bed. I spent a month on the couch before and after surgery. A pain free night of sleep is a slice of heaven. Good for you.
Wishing you both aspeedy recovery.
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Faithwalker and Suburbs, thanks for the replies. I had been in physical therapy because I also managed to get frozen shoulder and have been keeping up most of the exercises at home. I am trying to chalk it up to a stressful night a couple nights ago when I kept waking up in a fetal position (which was super uncomfortable) but will definitely send a message over to the doctor on Monday if it keeps up.
Faithwalker - I remember I had a couple failed attempts to get back into the bed. My husband bought me a lift chair so I slept in that for a couple of months but when I was able to get into my own bed - such a great feeling. Did the pillow under the knees too and have found that squished under my feet at the bottom of the bed now so I guess it is time to lose that. LOL
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My stomach incision is feeling weird this evening at the far ends, it feels like the tape is pulling on it or something. I’m not sure if it’s because I’ve been able to eat more normally in the last couple of days after not eating much since surgery last week. It’s driving me crazy.
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I am 6 months after my DIEP surgery. I can feel a ridge or lump in the upper and inner part of my reconstructed breast. I think it’s normal but does anyone else feel anything where the breast meets the chest? I am healing well after Stage 2 but a sports bra still bothers the lower incision. Thanks!0
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Rlsteadman, I had a large lump at the top of one breast. It was equidistant and matched perfectly the lump from my port on the other side. My breast surgeon looked at it about 8 weeks after my surgery. The plastic surgeon happened to be in the office and was called in as well. The spot was immediately checked out by ultrasound. It was deemed to be fat necrosis. The breast surgeon said to have it removed and be subject to pathology during stage two which was to be 4 months later. The plastic surgeon warned me there would be a line of stitches and scarring. It was removed during stage 2 and confirmed to be fat necrosis with no cancer cells. You might consider having your breast surgeon check it out. All the best
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Pain where rib cartilage was removed: 7 months after DIEP, I still have on-and-off mild pain in the divot near my sternum where the PS removed rib cartilage to access the blood vessel. A nerve gets irritated by breast movement, temperature changes, etc. Fat grafting over the sunken area helped for a month, but most of the fat was resorbed and the pain came back. Has anyone experienced this, and did you figure out anything to make it stop?
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Hi Suburbs, Lula,
thanks for your info and I have more questions: do either of you know, what are the guidelines, how do they decide when the necrosis is able to be broken up, vs. having it removed surgically? mine is pretty large I would say a triangle shape with the bottom edge probably 4 inches across 2 inches tall at largest section. If they break it up: does the fat stay in shape? dissipate? does fat grating replace it? If it removed surgically, do they rearrange the flap and do the fat grafting elsewhere? What are the chances this can really all be taken care of in one more surgery?
I know these are questions for the surgeon but it's another 5 weeks till my consult and 4 months till my stage 2.
What is the recovery like in the donor sites? How long does the bruising and swelling last? Everyone including my PS says it's an easy surgery but I read someplace it can take up to a year. Are the areas smooth? do you have to wear compression garments? Will my 5/29 surgery take me out of commission /have me off the beach the entire summer?
Also: I am at week 7 tomorrow, the abdomen is still pretty swollen. How much longer do you think on average till I shrink enough to wear my pants?? Black leggings getting tiresome.
It is so hard to remain patient and optimistic. I already had 7 months from when I scheduled, to the DIEP date, feels like endless worrying.
On the upside, I have been increasing my exercise. Yesterday I actually added a VERY slow jog in little bursts, for a couple of minutes, I did 3 miles in 45 mins. Goals! gonna try for 44 mins tomorrow. Can't wait to run again.
I didn't go back to sleeping laying down till about a week ago, (tried a few times but I didn't like it plus my husband snores) I slept on the futon sofa with lots of pillows and a big ottoman. (and ROKU!) Now I have a big body pillow on one side I can lean against so I don't have to roll as much to switch positions. I kind of made a triangle of pillows.
Cathy sorry for your diagnosis and best wishes. I thought going into surgery, I was going to have small implants but it turned out I had more fat that they realized! All I know is I am glad to have the implants I did have, taken out from under my pectoral wall. What a relief.
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hi Michelle- I’ll do my best to answer your questions:
what are the guidelines, how do they decide when the necrosis is able to be broken up, vs. having it removed surgically? mine is pretty large I would say a triangle shape with the bottom edge probably 4 inches across 2 inches tall at largest section. If they break it up: does the fat stay in shape? dissipate? does fat grating replace it? If it removed surgically, do they rearrange the flap and do the fat grafting elsewhere?
No idea if there are guidelines however I still think it’s a case by case basis. All your options listed could happen to correct it.
What are the chances this can really all be taken care of in one more surgery?
Very good. It seems like a lot especially if you’re having other revisions like reduction, lift, etc but it’s kind of one of those “while you’re in there let’s do this” kind of things.
What is the recovery like in the donor sites? How long does the bruising and swelling last?
I was very sore and bruised from the fat grafting donor sites for at least 4-5 weeks. Still slightly sore in some areas at 9 weeks out. Yes you should be in a compression girdle after to help keep swelling and fluid retention to a minimum. 6 weeks in the girdle 23/7. 1 hour out of girdle for showering daily. My advice: go ahead and purchase a cushioned toilet seat. Lowering down onto the seat, sitting on the hard seat and subsequently trying to rise from the hard seat was the worst part for the first couple weeks due to the lipo from my thighs for the fat grafts. That was the most painful part of the recovery.
How long to wear my pants?
It took about 8 weeks before I even thought of putting on anything but my yoga pants. And then anything that fastened in the front was super uncomfortable. I ended up buying some really nice wide elastic waist capris from Belk’s New Directions line. Wearing pants that fasten in front is better now after stage2, but not perfect. Before all this jeans were my go to comfort pants. Today I will pick the yoga pants in a heartbeat. So wish I could wear them to work.
Beach/Summer?
Mid-July you should be pretty much good to go. That should be your 6 week point. At 6 weeks we took off for our annual holiday vacay at the beach. No problem wearing bikini and hopping in the pool/hot tub/lazy river. Just make sure all your incisions are well healed first.
7 weeks out & still swollen:
Did you have an abdominal binder given to you? It helps with swelling. It can take awhile for swelling to go away but 7 weeks seems a little long for most of it not to have subsided. Your tummy shape will be different regardless. Women with a pear body shape tend to have quite a flatter tummy after stage 1. Those that have an Apple body shape tend to still have a round tummy shape, but usually smaller than before. Either way, many report having more “volume” at the center and less on either side above the hips. This can be corrected in stage 2 as well through lipo and/or plication. I bring up these scenarios as one of these may be part of what you’re seeing vs actual swelling. I have also heard 12-18 months for everything to settle down and recover from the surgery.
Hope this helps answer your questions!
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Does anyone have any advice for my abdomen scar, it’s very itchy at one endafter they removed the tape yesterday.
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Houmom- if the incision is closed and healed a little vagisil cream works wonders on itches. The 20% benzocaine that’s in it is what does the trick.
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Haha wonder if I can get my husband to pick some of that up for me
I’ll give it a go though!0 -
I've asked this on the 2018 thread but we're just getting started there so I'll ask here too.
Do you feel like you got a legit tummy tuck of which you'd be happy with if you'd done it for just cosmetic purposes? Also, did they do plication? Just learned about that from Lula73
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I did not get plication and did not know to ask about it. I still have more upper belly than I like. Of course during phase 2 some of my fat in my upper torso was used. My original PS said that it is considered cosmetic and if done during the DIEP surgery insurance could deny the procedure. I may see about a true tummy tuck someday. With very little lower abdomen I do sometimes have trouble keeping my jeans up at the waist.
I went to PRMA for a revision to my breasts and scar revision to my abdomen. I asked this surgeon about plication and he said they do plication, if necessary, during the DIEP but could not do it for a revision. I asked them if they could fix my bulge to the left of my belly button. They did fix it but 6 months later I got a bulge above my belly button. My OB/GYN said I appear to have a weakened abdominal wall and a possible umbilical hernia.
I would ask your PS if they can do plication. It doesn't hurt to ask.
Good luck and let us know how it goes.
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I had stage II of my DIEP flap last week. My ps "shaved" some of a hard lump I had in my flap breast and lifted my healthy breast. I thought she was going to reduce it as well but she did not. Right now the lifted breast is much bigger than the flap breast. You can definitely tell even though I have clothes on. I know the breast is swollen but I'm just wondering how long it should take the breast to go down to regular size. Fat grafting isn't an option because I don't really have anywhere to graft fat from. Anyone else have this issue?
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TWills - my PS told me ahead of time that this is not meant to be a 'tummy tuck' but they do their best to have a favorable outcome. Basically the same reason that jbdayton said, this was for breast reconstruction and DIEP flap and not a cosmetic surgery. I had also not heard of plication. That being said, I think my PS did an amazing job.
My PS also used the PICO bandage and for anyone just heading into this type of surgery, I would say insist on it. For anyone that does not know, it is a large bandage that applies a negative pressure onto the abdomen, it wicks away moisture from the wound. I was really well healed under that when it came off. The only downside, they tape it down and that tape has to come off.
That was quite an experience.My abdomen scar is about 95% perfect. It is nice and low if I ever did want to wear a bikini LOL. There is only one dog-ear but that is not that major. The only thing that happened to mine is a couple of hard lumps dead in the middle of the scar. He said he could remove those but I am only 6 months out and we are waiting until April to see if those go down. You have probably all heard the same thing, removing scar tissue can sometimes cause more scar tissue.
He did a great job on the belly button as well.
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Me again - I’m 4 weeks out from stage 1, my right breast is still very firm with not quite fully faded bruising,and I still have a lump very high up on the front that I feel like is pressing into my lungs when I breathe sometimes. In comparison the left breast which was also reconstructed looks and feels almost normal, except for some pressure on the side, both breasts are too big at the side. Is it just a waiting game or am I looking at revision surgery sooner rather than later?
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houmom- it’s both a waiting game and a revision. They can definitely pull the breasts in so they’re not so wide and they can remove the side boob under your arms. Hoping that lump you describe is just necrosis-they should be able to break it up or remove it in stage 2. It will take about 12 weeks for everything to have settled & adhered enough to go back in for stage 2. Plenty will continue to change between now & then.
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Thanks Lula, sometimes I feel like the worrying makes it feel much worse than it is.
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