2018 DIEP Surgery
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mrslaariz- generally they do a tissue expander if you’ve already had mx or if you’re doing a delayed Flap recon.
Whether or not to do DIEP prior to rads varies PS to PS with some preferring to do flap recon first so the tissue heals really well for the big surgery and then deal with any needed tweaks after rads. Others just prefer to start from scratch after rads.
I honestly don’t know if they took a piece of rib. Typically you don’t know and it’s not mentioned. Sometimes it’s not rib but some cartilage. Sometimes they don’t have to do it at all. It all has to do with where your mammary vein is located and accessing it to establish blood supply for the flaps. Most women that notice it say they have some pain in the upper middle rib area and they have no idea why until they say something about the pain to their dr. It does resolve though. I think it’s good that your doc brought it up so you’re not left wondering why you hurt after surgery in a bony area vs the breast area. Where are you having your recon done?
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Scubamom & parachutes- most stacked flap recons are DIEP flap + SGAP flap neither of which require leg incisions. Finn’s stacked flap would have been DIEP + TUG or PAP flap probably (flap harvested from leg) which would’ve prevented her from running for some time. In the case of An SGAP stack that should not be a problem. However I will say that running for any length of time shortly after surgery is very unlikely even without a stacked flap or leg incisions.
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mrslaariz - lula explained the rib thing. It has to do with access to your blood vessels. Small piece may be removed. Not a whole rib. 🤗
I had a tissue expander placed at the time of my mastectomy. We knew I was having chemo and radiation post mastectomy and my plastic surgeon wanted me healed from radiation prior to DIEP. My DIEP was 8-9 months after my last radiation. At the DIEP surgery he removed some of the damaged breast skin as well as the scar tissue from the mastectomy (sent it for biopsy- all clear).
Sounds like your doctor is following a similar path as mine- complete treatment before final reconstruction. Feel free to private message me if you want to talk in more detail.
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I have tried to read most of the posts on this thread. I am meeting with my PS on Thursday. I had BMX, with expanders in July, four rounds of TC, and 28 rads with a bolus. All along I have had in my head that I am getting implants. However, last time I was at the PS she said I might have better results on the rads side with a flap. She only does the Lat Flap and I am not interested in that. She said she could refer me to a PS who does DIEP and when I see her I am going to ask for the referral so I can me with this PS ask questions and decide what to do. This surgery and recovery scare me to death! You all seem so confident about the decision, maybe after I meet with this other PS he will make me feel better. I don't know if I have enough fat for both breasts. If not, do I just get an implant on the non-cancer side? What questions should I ask about the DIEP? I was hoping to get my implnat excange in June which is 5 months since my last rads. Is that going to be long enough? Thanks for any feedback you can share.
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Thanks Lula~yes, Scubbamom and Parachutes, she basically is correct. I didn't know all those initials but yes. Sorry, I'm new to this and realize I need to leave more detail for those to understand. It wasn't "because I am a runner" that was the main reason. Taking ALL things into account, I thought I wanted to be bigger but than decided the "extra" wasn't worth the extra cutting. Like I said before in an earlier post, I have been through 16 rounds of chemo and just want to be done already. I am a slow healer and am not concerned about size of my new breasts to take from any other areas other than my abs. He brought up the "because I am a runner", I wouldn't like the extra time to heal, the scars on my legs or adding an implant to make me bigger. I bring up the implants because I really didn't want them if possible. First, because I don't want to have to think about them or replacing them when I am 65ish, second I have been HYPER aware of my port 24/7 since it was put in, third I find it hard to believe that you don't feel them on the inside of you, when I can "feel" them on friends who have them, when I hug them. All personal choice, I'm not in anyway judging someone who chooses an implant. I appreciated the time Dr. Boutros took in asking me ALL about my life before cancer. It helped pick the right path for me and my way of life. I had my pre op today and brought up alot of the things that I had taken from so many of all your posts. He is only expecting me to be in the hospital 1 night. The majority of his patients see that kind of stay. He is also not a fan of any compression type apparel.
Scubbamom~my brother-in-law and his fam live in Ipswich, so I've heard first hand how brutal your winter and "spring" have been, rough stuff! I heard from all my runner friends and they said it sucked! But that made the finish line that much sweeter! Maybe we can connect off of here and compare notes?
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Thanks for the response Lula73. I had my mastectomy in Feb 2017. I had radiation after that and last one was April 2017. It has been a year and I am now ready to do reconstruction. I really want Diep. I am just afraid of so much down time. Did you have to be in the hospital overnight when they put the expander in and was any down time involved?
I am in Phoenix and am considering Dr. Pablo Pritchard for my DIEP.
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mrslaariz- I had immediate DIEP recon so no TEs. But I think it’s done outpatient.
OCDAmy- what state are you in? I posted a list of questions awhile back on the 2017 DIEP thread. I’ll see if I can find them for you. Best advice i can give you: Before you go see the new PS, check out before & after photos of other surgeons so you know what good looks like. Make sure to see the new PS’s before and after photos before deciding. And make sure you would be happy with the PS’s results in those photos for yourself...not just happy with it considering you had BC. Here’s a link to the NOLA doc’s before & afters. They are considered to be the best and even fix other doc’s botched recons. Women travel from literally all over the US (including me), Canada and even from Europe for their expertise and skill. https://www.breastcenter.com/result-photos/diep-photos/
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I found it. I’n Sorry it’s so long. I just cut & pasted...
I finally found those questions! They weren't where I thought and they were put out there as an answer to a different question so please excuse how they're worded. Here's the excerpt from the original post with additional comments/advice from that previous post at the end:
Did they tell you that if the cancer shows up in the other breast you can't go to your abdomen a 2nd time for reconstruction (if choosing UMX w/DIEP recon)? Did they show you their before and after photos? Did they share with you how many of this exact procedure they personally do every year? How about their flap failure rate? Their infection rate? What are the reviews of this dr and their practice online? Do you need chemo and/or radiation post-mastectomy and if so how does that play with the reconstruction you're planning? Did you know that your insurance should allow you to go out area (to anywhere you want to go in the US) if you don't have anyone within a certain mile radius who does this surgery? And that they will likely cover you at a higher reimbursement rate even if the dr you choose is out of network because of the out of area stipulation?Oh and how about if you opt to travel for the surgery those expenses are tax deductible as long as you hang onto your receipts?
I'm not trying to scare you. I'm pointing out very important questions that should be resolved before making the decision on which dr to select. Every post I've seen online where doctors hop online and respond say to ask all of these questions before making the decision. After all, you likely would prefer to have the surgeon whose done over 1,000 of these exact procedures with a very low failure and infection rate vs one whose only done 50 with 10% of greater failure/infection rate. Ideally they need to be doing this exact procedure at the very least once a week if not more often. This is a major procedure combined with microsurgery that requires a lot of skill and patience mixed with a eye for artistry with the womanly human form. And like anything else, practice makes perfect.
Those before and after pics will tell a very good story. If they give you any excuses on why they can't show you any (including HIPPA), move on to another dr ASAP. When you're looking at the photos, don't fall into the trap of comparing them with a mastectomy photo without reconstruction. Compare them with other photos of the exact same procedure from other surgeons. I can tell you firsthand that the really good surgeons have results where you can barely tell anything has been done if at all and the new breasts look 100% natural -even with nipple reconstruction and/or tattooing. If you need direction on seeing what excellent results look like for these types of procedures, check out the Center for Breast Restoration Surgery website at breastcenter com. I'm living proof that those photos are accurate. And my recovery has been nothing like the many "standard" mastectomy with/without reconstruction stories or the "horror" stories online. I'm either the exception to the rule or the surgeons at the center are REALLY REALLY good (hint: it's the surgeons).
I know this diagnosis is hard to take, it's scary as all get out in so many ways and I'm sorry any of us have to deal with it. But YOU are WORTH taking the time to ensure you're choosing the path that will give you the best outcomes long term physically, emotionally, mentally and cosmetically. YOU DESERVE to have the best prognosis with physical results you don't just "live with" but are proud enough of to wear a skimpy bathing suit without a coverup if you choose to.
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Lula, thank you so much! Great questions and I will be sure to look at photos. I live in St. Louis and am being treated at a large NCI cancer center.
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1 more question to ask that I just heard about for those who are doing immediate flap recon or know upfront that they will be doing flap recon just delayed: Does the surgeon leave any amount of visible breast fat behind during mx?
I can't believe that even has to be asked, but evidently it's a standard practice for many breast surgeons when they perform a mx.Personally, I'd run in the opposite direction and never look back if the answer to that question is yes.
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Hi ladies, I am two weeks out from bilateral DIEP reconstruction and doing well! I don't have much pain now just my abdomen feels very very tight especially when I stand up. Wish everyone here a smooth recovery!
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Hi OCDAmy Sounds like we’re in the very same boat (and have very similar stats). I had a BMX with tissue expanders in June 3017, followed by 28 rads ending late September (had chemo before BMX). I also thought I’d be moving to implants but PS my now suggests DIEP (fat move only). I guess now that I’ve gained back 20 lbs I’m a candidate! I meet with the DIEP surgeon (Dr Chang:OHSU) on Monday. Let’s compare notes?! I think I’m leaning toward doing it as I can’t stand the TEs and even if the implants felt 100% better I’d still hate them. Even tho I can’t feel on the outside, I can feel on the inside and need Gabapentin to get through the day. (In my TEs’ defense tho, I had my first fill recently -100cc each and the TEs feel much more comfortable. If I’d only known!).
Lanne
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Lanne, are you hoping to have DIEP on both sides? I'm overweight but not sure there is enough to do both breasts plus I was hoping to be a C. I got the name of the PS that does this procedure so I hope to get an appointment soon. Cancer sucks and I'm tired of making important decisions
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Hi everyone, it's been a while sinse I have posted and wanted to share my concerns regarding my up coming DIEP. I haven't seen my plastic surgeon since 11/22/17. At that time. I was a candidate for bilateral delayed DIEP. He said he could make me a B cup and I am OK with that. But now I am a bit concerned. I have lost about 10 lbs in the last 5 months. I am 5'9" and weigh about 153 now. I am sure hoping I have enough fat for him to work with.
I emailed him with several of these concerns:
Thinking about that partial rib removal. A San Antonio breast surgeon did a study regarding the internal lymph nodes that are not generally able to be tested, are routinely checked there and a few out of 75 are found to be cancerous and 30% of those patients have had systemic chemo and radiation. This revelation has changed the course of treatment forthese patients and most likely saved their lives. I plan to ask him to check a couple of my lymph nodes while he is in there. My cancer was at 2:00 on my right breast and the right side was extra nodal. Anyone here have their internal lymph nodes checked?
Another interest I plan to ask about is if they can connect a couple nerves so I might have feeling in my new breast tissue. San Antonio also routinely connects nerves.
I also checked to see if I can get an order for a few things to help sinse I plan to a recouperate without a care giver. I found my insurance covers a daily care giver as well as a skilled nurse if ordered by a local DR. I am a veteran and my VA primary care physicians assistant will Order what ever I need to help me recuperate and heal, so I am very happy about that. MY plastic surgeon is not sure I will need all the things I Was asking about. I asked him for an order for a hospital bed so I can sleep with my head raised and my legs raised, a walker, and elevated toilet seat (my toilet is very low) a skilled nurse to strip my tubing and the daily nurse to help me with daily bathing and maybe warm a cup of soup. I can't reach the microwave without raising my arms. And I can eat cold food mostly but it would be nice to have a hot something once in a while. I just need these I think for the 1st 10 days. Then I should be good to take care of myself.
I also asked him to tell me exactly where all the scars will be. Will I have any cleavage. CAn the scar on my abdomin be very low so no to interfere with my pant waste band? Will my chest still be scarless like it is now, or will I have to wear only high cut tops?
He said. We will discuss all this on May 9th. He is very happy I am concerned and asking so many questions. I am glad he thinks all these concerns and questions are a good thing and doesn't label me as a high maintance patient.
Another concern,
What about lymphedema patients, how do they do the IV for DIEP if they can't use your arms?
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is anyone using anything for scar treatment? My PS sold me a small bottle of “Biocorneum” for $160. I feel like I’ve used almost the whole thing in a month and have not seen one bit of improvement. Hoping there is another alternative since this could get awfully expensive!!
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carmstr- they use a vein in the leg if lymphedema risk is on both sides.
Mitzi-medical silicon scar strips or gel is the latest invention on the scar front.
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mitzi458, my PS sold me Siligen or Silage, it’a a silicone gel. He sold it for $105. I too went thru it in a few weeks. My husband found it on E-bay for $69 with free shipping. Amazon was selling it for $160. It has helped my scars a lot.
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Lula73
How long did it take you to recover from DIEP and get back to work (if you work outside the home)?
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Thank you for the info I appreciate it
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Lula73, you look great! Thank you for posting, it helps in my decision making. Who did you go to for your DIEP?
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mrslaariz- pretty sure I was out of work for 8 weeks. My job requires lifting, a lot of driving, and a lot of in & out of the car all day. If not for that I could’ve gone back to work probably at 6 weeks. I’ve heard of some women being able to go back at 4 weeks if they’re behind a desk all day. If I’d had the option of working from home it probably would’ve been 4 weeks.
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I hear a lot of women from AZ are heading to TX to PRMA for DIEP. Isn't their any good PS in AZ that perform DIEP? I am looking now and have some that say they do DIEP but I am not sure how to find out how many they have done.
Any suggestions in how to research the # of these surgeries a PS has done?
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mrslaariz- best way to find out is to call and ask. I posted a list of questions on April 17 to ask as well. And you need to see their before & after photos before making the decision where to go. If you look at the photos and would not be happy with those results for yourself (truly happy with the results not just happy considering you’ve had BC and it could be worse), mark them off the list and keep looking.
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I agree with Lula73. I am at 8 weeks post op for BMX with DIEP. I am back doing more strenuous activity (yard work). I do have to pace myself because I can easily over do it and suffer the fatigue the next day.
I turned the corner at 5 weeks. The chronic pain lifted and I started feeling like myself again. If I worked at an office job I could have gone back to work at four weeks. I would have been uncomfortable but sitting at a desk would be doable.
I am happy with my decision to have BMX with DIEP. I am relieved to have the major surgery behind me. If I need anything further it will just be a nip-n-tuck to correct any imperfections.
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OCDAmy, I do want to use DIEP for both sides. I've gained 20 lbs since BMX so now my PS (apparently) thinks it is an option! If the DIEP PS thinks I don't have enough tummyfat to fill my 500cc pockets I'm happy to work on that! I can't wait to get my boobs finished so there are 2 less things that hurt. Letrozole is a b*tch!
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This may be a dumb question but if your own tissue is now in your breasts do you need to get mammograms? Does this increase your chances of getting cancer in your breast vs. implants
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OCDAmy- DIEP and other flaps do not increase chance of recurrence vs implants or going flat. The tissue is not breast tissue which is filled with mammary glands and ducts; rather it is straight up skin and subcutaneous fat. Every PS has a different view on mammos/MRI follow ups. Mine said no scans unless o was having problems/felt a lump. Personally if I was to do routine monitoring I’d go MRI.
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I am seeing the plastic surgeon again on 4/25. When I met with the surgeon I consented to a right side mastectomy with implant but am now unsure about it. Wondering if I should have DIEP flap instead? has anyone had this? Also trying to decide about a double M? just not sure which way to go? this is my 3rd BC diagnosis, have had radiation on both breast and know that can be an issue. So confused
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Lula73 we sound similar -- I am also a 2 time survivor, soon to be a 3rd time survivor - 2 prior lumpectomy's with the most recent diagnosis on the right (past was left in 1996 at 32 and right in 2004 at 41) I am more confused then ever about how to move forward. I am going back to the PS on Wednesday to talk again about my options. Keep leaning toward the DIEP flap, a little afraid of the long surgery and pain during recovery would love to hear how yours was.
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Hi Primrose- the good thing we both have going for us is it's been awhile since rads. it lets you see how your skin heals and it has sufficient time to do so. I highly recommend DIEP flap. Yes it is a long surgery, but you sleep right through it :-) Painwise, I'd say I've definitely had worse pain. Not to say it was all peaches and cream, but with DIEP they're not cutting through any muscle and it does make a difference. The docs/nurses work really hard to keep you pain free and nausea free. I recall hitting the pain pump button shortly after returning to my room following surgery and a few times over the next 24 hrs. Then moved off IV pain meds to pills. The key is staying ahead of the pain, so you kind of take the meds on a schedule vs waiting on it to get bad and then taking something. By second week I was down from 2 pain pills every 4 hrs to 1 every 4hrs + 800 mg Advil. By 3rd week pain pills only at night before bed with Advil as needed during the day. 4th week it was just Advil as needed. Have you had any other types of surgery before other than the lumpectomies?
even with all that being said, the results have been so worth it. I look better now than when I started and I looked pretty darn good then. And they feel like me. I feel whole-almost like all this never happened. Only real issues I had was where a knotted stitch on 1 breast and along the abdominal incisions pulled through the skin and left a small hole that had to heal from the inside out. Took an extra week or so to heal.Being able to go into surgery with breasts and come out with breasts was very helpful emotionally I think too.
One of the reasons we went to NOLA was their vast experience in doing flap recon on women who have basically had their whole chest radiated for various reasons. Where are you looking at having it done?
I don't know if I answered your questions. Please feel free to ask away with any questions I didn't cover.
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