DIEP Flap Reconstruction 2017
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Lula73- My lymphedema is doing good. Went back in to therapist and I only need to wear my sleeve when flying unless I notice any changes. I am going to watch it and feel I know better what changes to look for in my arm. Thanks for asking!
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RLSteadman- I’m so glad it’s doing better and you’ve gotten some relief. BC is just the gift that keeps on giving - LOL!
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Hello everyone: I haven't posted on this thread before but have read through much of it. Thank you for your honesty, wisdom and stories. And for the all the support to each other and to those of us who tend to lurk.
I'm considering diep because I've had capsular contracture with two separate implant attempts. I'm very apprehensive about this approach but feel that perhaps my body just won't tolerate implants. I had a UMX and have enough fat for one small breast so would only do the one. . I'm not worried about the breasts matching or looking fantastic, or really even the recovery or the pain. I'm worried that after all the struggle of umx, several surgeries and chemo and all things cancer that I have to deal with an entirely different body shape. I'm reading the look of your whole breast, waist, hip ratio changes and has a boxy look because the waist is shortened. I know it is perhaps vain but honestly I cannot deal with any more body image issues.
Do you find the repositioning of the belly button etc makes your body look strange to you? I do notice the difference in many online photos with PS groups. When I asked my PS about this she really downplayed it and said it'll be like a little tummy tuck. I think she means to keep me calm but it seems cavalier.
Thank you. Wishing you all so much love and happiness.
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Willa,
My waist was not shortened. When they removed the fat, they stretch the tummy skin and sew the sides together. They then re-position the belly button. The funny thing is, my belly button was not great looking after a gallbladder surgery about 20 years ago and I like how it looks now. It is where it should be.
I am unsure why your waist would be shortened and my apologies if I am incorrect and anyone else had that happen but it should not. Your tummy will be tight for a while but even that has passed since for me. The worst thing that happened to me is that I had a couple of spots in the very center of the scar that I had a bit of fat necrosis that became encapsulated so I have what you would compare to two round hard lumps under the scar (each about the size of a pea). My PS did an ultrasound and they are superficial so they can just be removed in his office as an outpatient without any further issue. If I decide to - which I probably will.
I did also have the Pico Negative Pressure bandage which I would highly recommend anyone asking their PS for. It really helped the scar heal much nicer.
I am really happy with my DIEP flap surgery. I actually will be having a stage 2 follow up surgery where they tweak the look and will actually just be having my right breast - which is my original one - filled with fat grafting just at the top so that I am a bit more symetrical. My PS was really amazing and made the left /reconstructed breast match my right. Kind of funny because at 51 they droop a bit which I hated for years but after all this, I like my droop and will keep it.
My new breast looks good with a bra and even without the stage 2 yet, it is really hard to tell that the two are not the same. I see it but anyone else is hard pressed to notice.The one thing that will happen, everyone is different but this seems to be consistent, you will have some loss of feeling on the skin in some areas. You know that feeling if you sit on your foot or have your arm in a position where it goes to sleep? That is what I feel between my belly button and the scar. Also, you don't feel your breast if you touch it - though I have never asked anyone with implants to know if they are the same as well.
The biggest risk you face from the surgery is if the blood vessel doesn't take and you start to lose blood flow to the new breast. My PS warned me, it didn't happen to me but I did go pretty purple and ashen on the bottom pole (the breast below the flap) and I did have some scabbing and have a pink scar but even that is fading now.
I also encourage everyone considering the DIEP flap to ask their PS for photos of past patients of theirs. I did and my PS was not bothered at all by my asking. He actually was trained by the surgeon in New Orleans that was one of the first doctors to do the DIEP flap. I wanted to see his 'resume' so to speak and his patients looked good. I think many PS believe they can do this but it is your body and your decision, in my opinion a plastic surgeon should have to prove to you they are worth your body.
Best of luck, blessings to you. This is a really shit thing that happens to us but we persevere because it is our life and we are worth it.
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hi Willa! I just answered the boxy question on another thread for someone else. I've copied & pasted that response for you below. I went to NOLA for my DIEP.
Will I look boxy and have a scar around my middle?
After stage 1 DIEP, the answer is not necessarily. After stage 2 DIEP the answer should be no. In stage 1, the goal is do mx (if needed), harvest the fat, and transplant it to the chest wall creating new breast mounds. after they've removed the swath of skin and tissue from your abdomen the will pull/stretch the skin back together. This is what gives you the boxy shorter waisted look after stage 1. Ideally the scar should sit low on the abdomen so that it can be easily hidden under a bikini bottom (and not one of the high waisted ones either). Sometimes they place it low from the start, sometimes they lower the incision line in stage 2. It's important to ask this question during your consult.
During stage 2, your PS should recontour your lower half. This in addition to a lift on your new breasts helps restore a natural breast to waist to hip ratio. Additionally, they will do some light lipo across your abdomen (upper and lower) to help reduce any uncomfortable tightness you may be experiencing. For women who have the apple shape, they can do more aggressive lipo And something called plication in the waist area to recontour it to your preference. It's important to also ask about this during your consult.
And they should be able to get all the recontouring procedures for your lower half covered by insurance. It's important to ask about this too.
*Note that not all PSs agree with recontouring your lower half - their thought process is, 'you have boobs now and this is breast recon not a total makeover. Hit the gym!' The problem is hitting the gym does not fix the short waisted/boxy issue or correct the new breast to waist to hip ratio that's out of whack and can cause your pants not to stay up. The new shape is a direct result from the recon and correcting it should be too. Not all PSs know how/want to know how to get it covered by insurance so they either don't do it or have you pay out of pocket. The reality is, the new bottom shape is a direct result of reconstruction which is covered by insurance so insurance should and will pay for recontouring it. If your PS is committed to superior quality outcomes for you as a whole, not just you and your breasts, none of this should be an issue.
What's the point of going through all this reconstruction crap if it's not going to make me feel better? Maybe I'm asking too much...
You are NOT asking too much. You should be able to honestly say you are happy with the results you get thru recon (not just happy considering you had BC and mx) or even thrilled with the results - you deserve it. Finding the right PS is a huge part of this. Ask your questions plus the ones i posted above in my comments. If you're not hearing the right answers move on to the next PS. If you're investigating a DIEP or SGAP flap, be sure you're only discussing your candidacy for the procedure with a plastics microsurgeon who does the procedure. A PS who does not do those types of procedures will almost always tell you you're not a candidate for it or you won't like the results. It's not in his best interest for you to go somewhere else to have your recon done. And he is not trained to even evaluate you for one of the flap procedures. It's like asking the butcher in the grocery store how to select a ripe cantaloupe. When you do start doing consults with PSs who do DIEP/SGAP, be sure to look at their before & after photos. Make sure they are photos of their work and not their partner's work or someone else's. If no pics, cross them off your list and move onto the next DIEP PS. If you look at their pics and wouldn't be thrilled to have the results you're looking at for you, cross them off your list and move onto the next DIEP PS. Don't think your outcome will be any better than what you see in those photos-odds are the photos are of their best work.
Keep in mind that the vast majority of women travel for their DIEP or SGAP recon. Even with major nationally recognized teaching hospitals with cancer centers that have gotten every award imaginable that is right in your backyard, they may not have DIEP surgeons or may not have good outcomes. It's not the size or prestige of the facility, it's the skill of the surgeon and whether they are committed to superior quality outcomes. The more DIEPs they do, the better their skill gets. The more committed that are to superior quality vs just average quality outcomes, the more attention to detail/incision placement/recontouring they will have. They will also have flap failure rates well below the national average of 10% and they will have low infection rates (<2-4% is ideal).
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trhbfc and Lula: Thank you so much for your information and thoughtful responses. I was just in tears last night from the frustration of trying to make yet another "right" decision. I forget how great it is to come here and hear from people who deeply understand and who have actual first hand knowledge. You've both given me lots to think about it. I'm sure I will find my way through all this fretting. I look forward to the day when all of these surgeries are put behind me - and I wish that for all of us.
Wishing you good health, love and joy.
Happy Sunday everyone.
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Hi ladies, I haven't had this surgery but my best friend just had her diep flap on May 2nd. She went home 5 days after surgery and is well except for a bed sore on her buttock that she developed while she was in the hospital--that is one of the places that was harvested for the flap. It is bothering her quite a bit now and has turned into a wound. I think she has used neosporin on it but now has to wait until Thursday to see a dermatologist who can prescribe something stronger. I'm worried that she will develop a very bad infection. How did any of you deal with this? Thank you so much. I just don't want to have this get out of control.
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Hi Cowgirl- Are you saying this bed sore is more on her hip near the scar there? If she has an incision across her buttock that would be an SGAP or perhaps a stacked flap using DIEPband SGAP. That’s very quick to develop a bed sore. I’d be worried it’s something else. Has she contacted her surgeon? That would be the first step. Well wishes coming her way!
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help - im in a dilemma about doing Diep in Boston or NOLA?
I had silicone implants 16 yrs ago that need to be removed.
Always wanted diep but it was a new innovation and I had two small kids when first diagnosed
I’ve waited a long time and want to make the right decision I have factor V Leiden which affects blood clotting v mildly ! Help please
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Lula, she contacted her surgeon and the surgeon didn't seemed worried--just said to do wound care or whatever. I'm not sure about her procedure but I know it was diep. She's doing quite well otherwise. Dermatologist can't see her until Thurs and I suggested she get surgeon to call derms office and get her in sooner. Maybe I'm just worrying too much. Just don't want her to end up in the hospital with IV antibiotics. Thanks.
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Cowgirl13, you are right to be concerned about infection. My best advice is to start discussing the need for awound care specialist and infectious disease doctor specialist and make them take her concerns very seriously. A dermatologist who can't make time for a serious post-surgical issue may not be the right doctor. Good luck helping your friend.
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Cowgirl-suburbs took the words right out of my mouth. If the spot is more toward the hip it may be where her hip drain was and not a bed sore at all. Either way a call from the surgeon to the derm or a wound care specialist should happen. If surgeon won’t, perhaps get a same day “sick” appointment with her primary care doc and get his evaluation and referral phone call to the specialist to speed things up.
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colliebluebell- it sounds like you’ve narrowed your options down to two centers. I’m guessing Beth Israel in Boston and you mentioned NOLA by name. What are your concerns with each center? What are the things that made you narrow down to these two centers? That would help us better able to offer advice.
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jakilla- I’m in my 40s so I don’t really fit the age category you asked about. But I can tell you that the docs won’t do a surgery on someone who can’t handle the required time under anesthesia. Usually it’s people with other major conditions going on involving heart, lungs, etc. They say that however many hours you’re under, it takes that many months to feel 100% again (that does not mean that all the days in between are awful. It’s a process from day 1 postsurgery typically being the lowest, significant increases in the next few days, and another significant jump to I’d say about 80% around week 4-5 and another again around week 12 to about 85-90%.) So it’s really not the time you’re under, it’s the recovery. And recovery is different for everyone. Some are quicker than others. I hope this helps!
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Lula and Suburbs thank you for your reponses. You put into words my concerns and i feel validated for these. My friend is my best friend and we have been friends for over 50 years and it drives me crazy she won't listen. I have been on these boards for almost 10 years and read many times of someone ending up in the hospital with iv drips for up to a week. I really have to let go of this and you two have helped me with this and validated my concerns.
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Hi all, I selected this thread hoping that some women who had their surgeries in 2017 might have some answers. I had my DEIP Flap surgery in February of this year and learned today that the PS will not remove the overly-white, football-shaped flaps on my breasts. (He had indicated several weeks back that this was "no problem" so I assumed removing the flaps was SOP.) Anyway, would any of you women who are several months out from your phase 2 surgery, with flaps still intact, be willing to share in a description what your breasts look like and how you feel? I'm pretty upset today that this is what I'm left with so I'm hoping to hear that maybe the deep scars fade and that the coloring eventually matches up somewhat?
Thank you in advance.
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Hi Marina- I think they sometimes reduce the football shape down if the reduce your breast size in stage 2. They also try to hide as much as they can under nipple tattoo (if you're getting one). To help with the scars, a silicone gel or silicone scar strips are the latest and greatest in the S world for scars right now. They may help.It sounds like you had Non-skin sparing mx before the recon?
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Marinacat, I too had BMX with DIEP Flap Reconstruction on Feb. 22. I too have the elliptical shaped flaps. I never expected they would remove them. I am using Silacin (a silicone gel). It is helping to heal and fade the scars. I am expecting it will take up to a year or two for them to disappear. I meet with my PS on June 5 to talk about changes that he may want to make.
I will let you know what he says
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MarinaCat, are they monitoring flaps? Sometimes they are used just to monitor the blood flow in the first stage and then removed in Stage 2. If it was just for monitoring and not because of radiation or non skin sparing BMX then it “should” be able to be removed.
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Thanks all for replying.
My PS said he did not want to remove the flaps because doing so (and then suturing the opening) would flatten the breasts. I’m just in a very sad state right now because I feel like I should have done some more research into skin sparing or nipple sparing options. I can’t imagine that these breasts will ever look close to normal again.
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I’m sorry you’re not happy with your results MarinaCat, you should definetly get a second opinion, you could have more options with another PS.
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Twills, you have been through so much I see. Thank you for your generosity in listening to me whine!
I am definitely looking into a second opinion.
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It’s not whining, we all deserve to be happy with our outcome. Sometimes the journey, I actually hate that word, is complicated and takes a little longer:)
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marinacat-I second the suggestion for a second opinion. It can be difficult to find another PS who is trained in microsurgery/flaps and who will touch another surgeon’s work. We do know that the docs at NOLA will do so. Their work is phenomenal. AndThey can do a consult via phone/email.
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Marinacat, during stage 2, I had nipple reconstruction which reduced the shape of the flaps to a smaller size and the outline of the scars has been slowly fading. The tattoo artist said they could fill in the remaining round circles. The bigger concern is viability of the blood flow rather than appearance.
In addition to consulting with NOLA, I have seen questions posed to other sites like "ask Johns Hopkins" and smaller lesser known sites specializing in reconstruction. I wish I had saved the links. I researched for months.
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Chiming in post-revision, early last week.
My biggest problem going into the surgery, which I THINK is now fixed, knock on wood, was DIASTASIS RECTI (separated ab muscles). I am so surprised I didn't see it discussed more, on the threads I was reading! I had ZERO idea I had it, or that repair was part of the DIEP process (the abdominoplasty itself). I was shown the images of my pre-op CT scan, afterwards, and it was certainly evident. I believe that it is not discussed or documented because technically it doesn't qualify for insurance coverage. As I was being wheeled out of the DIEP surgery, Dr. mentions, "we tightened up your ab muscles while were in there so you should have a nice flat tummy" Well. I guess given 17 years had passed since I had my last kid, and I am athletic, the abs were firmly in their mis-placed place, so the repair failed... Also, my extensive internet searching revealed in some NIH article that .7%-5% of the time DIEP itself can lead to bulging. (they don't know why. nerve damage??) Anyway, my tummy NEVER looked so bad and it was supposed to have looked better! it was SO distressing. I looked 3-4 months pregnant but lopsided, and with a shelf poking out from my incision.
Also, I had a good sized area of fat necrosis in one flap, A very uncomfortable reaction to the surgical glue, top and bottom, and A three month journey with 2 open wounds that left nasty scarring. It was nearly 6 months from DIEP to revision, and it felt like FOREVER.
Well, they re-did nearly the entire incision hip-to-hip since they had to lift up skin to repair the abs. I am supposedly Thoroughly stitched together, with permanent sutures. (Ouchie, oh even a tiny cough knocked me over) The belly button also had to be re-done. I still have swelling, but it is MUCH flatter and the incision looks good, all the nasty scars are gone, and so are the "dog ears."
Dr. told me he didn't want to remove the necrosis but he did poke at it a bit and it's a tiny bit softer, and may improve with time. Some lipo to try and bring right side closer in size, to left side. The one thing I am not sure I like is the boobs are now flat in front. Not sure if this is permanent or not. My flap windows were round not football shaped, because I had implants before(skin expanded). The flaps window incisions were pulled in smaller so that a tattoo can hide them. but made me flat. I am not sure yet if I care or not. Overall, I can't believe what a freakin' wreck I was for 6 months cause it mostly turned out totally fine! And WAY WAY better than my implants were.
Well hope this will help someone out,
Michele
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I'm a bit confused. I keep reading about mesh with people who have had DIEP. I thought that the whole point of DIEP was that no muscle is used, so why the mesh?
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Oh, man. I really hear you. My husband had multiple myeloma with two rounds of VDT-PACE chemo and then two back-to-back stem cell transplants. We finished 11/2017, but he'll be on maintenance infusions for the next 3 years. In the middle of all of that, I got a text from one of my "prayer warriors" that she was getting TMI!!! We did this in NYC, which was far from our rural Texas home. I was totally alone during the whole thing, and texting my friends kept me sane. It was an awful thing for her to do, and it was an awful thing for your lumpectomy friend to say to you, as well. There might be very good reasons these women couldn't handle the miserable reality that we were communicating but to tell you so at the time was cruel (although she probably really didn't know). I made a decision to just drop relationships that drained me in any way, including people who couldn't lift me up. Not knocking them, but I don't have enough energy to keep myself up, and if my friends can't help, they need to be sidelined.
Oh--btw--after all that, I'm diagnosed with invasive lobular CA. Waiting staging and what's next. Trying to decide on whether to have lumpectomy or mastectomy. God be with you--and don't feel guilty that you felt hurt by that person.0 -
Macmomma- they use the mesh to create an internal bra or sling to help support the tissue. It's usually used in stage 2 as part of the lift. (Yay! Going braless is an option!!) it can also be used if you’re having hybrid flap recon to create a pocket for an implant without having to expand muscle.
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Hello All-
This is my first post although I have read through these boards for support over the past year. I am wondering if anyone has added an implant to their DIEP flap for volume and projection. If so, were you happy with the outcome?
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