2018 DIEP Surgery
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Hi Lula,
I’m deciding btwn implants and DIEP. I currently have tissue expanders. Met with the DIEP surgeon today and was surprised to learn that she will need to make an areola-like incision plus an inverted “T” incision under each breast. I (naively) thought they would use my same under breast incisions only. The surgeon would use harvested skin to fill in for the cut in the areola (if I had an areola). If I may ask, where are your scars positioned? Are you happy with them now?
The surgeon also suggested moving lymph nodes from my groin to my right underarm to help with slight lymphodema, and fixing a separated rexus muscle which separated bcs of my twin pregnancy.
I’m a bit overwhelmed with it all given that two weeks ago I thought I’d move forward with implants. Had no idea I’d be offered a full body makeover! It all sounds like too much vs an implant exchange - but I’m trying to look at the long term benefits using my tissue vs implants
Lanne
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thanks so much for sharing all this information, nice to hear the pain was manageable and that the results were worth it. Only other surgery - gall bladder removed in 2014. All my surgeries have been day procedures, this surgery will my 1st ever hospital stay
I am looking at having the surgery done at Brigham and Women's hospital, the PS is my newest doc. I am hoping to get some references when I go on Wednesday. You mention NOLA I am not sure where that is?
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carmstra835, I will being having DIEP surgery next month at PRMA and researched your same nerve question. I'm under the impression that since my breast tissue was removed and a tissue expander was placed that there are no more nerves present to connect. I'm also under the impression that blood vessels can be reconnected. Therefore, my new breast will feel natural but won't have any sensation. I haven't had a phone consult yet so maybe someone can correct me if I'm wrong
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Primrose- NOLA is New Orleans. The NOLA acronym is used in these boards to refer to a specific group of PSs there that only do breast recon and specialize in flaps. They do more of them than any other group in the world. And they focus on quality outcomes clinically and aesthetically WITHOUT clothes or in a skimpy bikini. They also focus on making the whole body proportional again vs just the breasts after stage 1. They are the ones that are pioneering all the newer techniques as well. If you’re “interviewing” PSs, I’d review the before & after photos from NOLA beforehand and compare. Here’s a link to their site:
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Lanne- Yes, you are looking at it right...it's about the long term. Not the short term quick fix. And it sounds like the DIEP surgeon you're meeting with has her ducks in a row. I'm guessing she's doing plication to take care of the recurs muscle. And she's doing the lymph node transfer which isn't done very often but is very promising especially if you already experience lymphedena from the mx. I had just a straight line incision from under the nipple to my chest wall after stage 1. Then the same incision you're talking about after stage 2 minus the circle for the areola as I still have mine. Which PS is it? What do her before & afters look like? Has she said what she does to rectify the shortwaisted look in stage 2?
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parachutes- that's correct you won't have sensation in the breast, however if you still have skin sensation on your breasts now that shouldn't change much if at all. It's really hard to describe how you don't feel the underlying tissue but you can feel the chest wall behind it and the skin over top of it. It's not a weird feeling at all, if that helps.
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Hello carmstra835. This is a great question for you to pose to PRMA when you have your initial phone consult. They will likely explain it in a similar manner that I can touch on here for you. Nerves are actually cut at the time of mastectomy. What PRMA does is take an existing nerve from the tummy tissue, attach it to a nerve in the intercostal area of the breast so that sensation in the breast area is then restored during the DIEP flap procedure. I had it done so I know. Sensation was lost during my mastectomy and restored during my DIEP. It's not exactly like it was before but I have some amazing sensation below my nipple area that I'm very happy to have! I hope this helps and am happy to answer any more questions you have.
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I use InviCible scar cream that was developed by my plastic surgeon who did a burn fellowship so I know the ingredients are safe. I used it after my Diepflap surgery and I use it still on new scars when I have a mole removed. You can purchase it on Amazon. Let me know if you need help finding it. It is a small tube for around $27 but a little goes a long way. My scars have faded beautifully.
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I'm happy to help out. Let's connect. I'm from AZ and had successful DIEP done at PRMA. I have some resources for you.
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Lanne2389, incisions can be different if you’ve had radiation and can vary widely according to what surgeon you go to. Someone that has not had radiation would typically only need the underneath incision.
To answer some previous qustions and concerns from posters and to also put my two cents in...
It’s important to remember that If you need any skin replaced because of prior removal like with nipples for example or if some of the skin will be replaced because of prior radiation then your incisions can vary. I had bilateral DIEP and because of radiation on one side I had a skin flap and fat but on the other side I just had the fat so they only used my previous mastectomy incision(I had a previous nip sparing BMX) My skin flap is the shape of a small bikini top so it’s hidden under swimsuits and bras even. A lot of the photos I’ve seen have the top incision of the flap more straight across. I didn’t want that because that could possibly show in the cleavage area, not that I show it much lol.
You can look at photos that are posted on the Drs site but I would imagine that those are the best of the best. Actually asking around and if you can find an actual patient is much more reliable. More than one though. When I was asking questions months ago someone PM’d me with photos of their personal results from a very hyped center and I was not impressed one bit. She wasn’t either. It did not look like what I had seen on their site. That was one case but I think it’s important to mention. There are MANY surgeons all over the country that do this surgery a lot and with great success and have patients that love their results. It’s not so easy to find them though, this site and google got me started but then I had to ask Drs in my area who they recommended or if they had heard anything about any specific Dr. It was slow going but as I learned more I knew what to ask and I made calls and asked how many surgeries they did and if DIEP and breast restoration was a priority in their practice. Then I made consultations, I looked at photos while there but asked questions of how the photos might pertain to my case. I learned a lot by sitting in the waiting room too. It was a process but I was able to make a confident decision on who I trusted and where I could actually comfortably travel to. That was important to me as well. Just my two cents
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DiepGal, thanks for the scar cream recommendation. I’ve just started looking for that sort of thing.
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Hello, Ladies!
Hope everyone is recovering well and healing swiftly!
I had my lumpectomy and oncoplasty two weeks ago, and am hoping to schedule my UMX with DIEP for sometime in next couple of months. I'm just waiting for oncotype results to see if chemo will be needed. If it is, then my surgery will be pushed back.
Has anyone experienced arm/underarm numbness after SNB? it feels WEIRD to shave an armpit you can't feel.
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cev20- so glad the lumpectomy and oncoplasty went well! Yes it does feel weird to shave an area you can’t feel. Now would be a great time to get laser hair removal under your arms as you can’t feel it😀. All humor aside...the feeling may return. Sometimes the surgeon uses a numbing injection or solution in the area that can last a good while. Sometimes it’s the nerves that were cut/disturbed and they may regenerate restoring feeling. Time is your friend right now. In the meantime, Schick makes a disposable ladies’ razor that has thin wires that are wrapped around the razor blades that help protect against nicks while providing a close shave. The razors are light purple and pearl white. A true godsend when the skin you’re shaving is numb
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Dr. Massey is no longer in Chicago or Salt Lake City. Just Charleston SC.
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Hello everyone, I am happy to report that my knee surgery is behind me and I am doing well. But most importantly, I found a PS who will do the DIEP surgery, I have an appointment on the 9th and hopefully a date will be set for the surgery. This has been a emotional rollercoaster as I had a scare in January and had to get a biopsy on my right breast ( B9). I lost my mother in November and my sister in March both had BC. And I carry the CHEK 2 mutation. I am so ready to get this done BC will not claim another member of my family!
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Thanks, Lula73! You rock!
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Hi Everyone, Reporting in 8 days post DIEP. I spent 4 nights in the hospital. Most of that time was spent just recovering. I didn't need much in the hospital. Was glad to have chapstick. They were checking my new breast every hour round the clock at first. The surgeon put a silicon sleeve on the artery they moved which was attached to a wire into a Doppler machine so they could hear the blood flow all of the time. I was a little surprised by the wire which was stapled between my breasts. So I wanted to mention it here for those having future surgeries. They cut it off before I left the hospital but the silicon sleeve will stay there. They transferred a small piece of ab skin to below my breast. I can't even see it since I'm a D cup. That is how they were also monitoring the health of the tissue transfer. By looking at that skin. I didn't need more breast skin, they just move it to be able to monitor.
I'm off the rx pain meds. Don't like how they make me feel and also had a constipation issue a couple days ago. Listen to the advice to stay ahead of the constipation! Only taking advil now plus a daily full strength aspirin. The aspirin is to be taken for a whole month.
I am ready to start walking around more today. Still bent over, but making progress. I have loved my power recliner! I sleep in bed at night with pillows under my knees, but am in recliner most all day. I don't like looking at my chest and tummy yet. Too much bruising, tape, etc. Kind of gross to me. I know it will get better though!
After this week, I have no idea why anyone would voluntarily get a tummy tuck. We are all doing this due to breast cancer. It is amazing that they are able to move our own flesh and repurpose it!
Happy to answer any questions!
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Elijahgirl, glad you are moving forward, you’ve gone through a lot.
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Great to hear from you jsm22! Sounds like your recovery is going well so far. Wishing you a continued comfortable recovery!
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You are most welcome. Let me know if you can't find it. It certainly worked for me.
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great to hear from you jsm! I’m so glad everything has gone well for you so far. One foot in front of the other, girlfriend!
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Lanne - I had my rectus muscles stitched together during DIEP, it wasn't discussed beforehand but was on the surgical report, so I think some things they do when they see what your body is like inside. My PS was pretty clear there with me that was the way it goes, another reason it's so important to be with someone you like and trust. My nipple was removed as it had cancer in it, so I have the round circle scar filled with skin from my tummy. One thing that surprised me is it has fine hair on it! So it's different than the remaining breast skin. My breast looks amazing although it is a little larger than my non-reconstructed breast, which has something to do with making the skin look best and can be addressed in Phase 2 correction if I like. Basically looks like the nipple part was sliced off in a deli slicer, which is not at all noticeable under clothes and I felt really good having that silhouette from day 1.
I also feel completely confident in the choice for DIEP versus implant, for me. That said, my abdominal area is very tight still, from the scar up through my belly button (which, don't be surprised, will be entirely new!) and all the muscles throughout. It can get quite uncomfortable and I take a tramadol from time to time. My PS said tightness can last up to a year. I've just started working on it in PT and hope that will help. I've been doing PT for my arm for about 6 weeks and it is definitely improved. It's a lot of exercises and stretches to keep up on, but valuable!
I am using Oleeva on my abdominal scar at the recommendation of my PS. It is a silicon patch in the correct shape, it's a little bit of a pain because you have to wash it every day but it also helps keep clothes sliding over the scar area comfortably and I definitely recommend it. I think it's about $65-70 per patch and it lasts about 4 weeks. Too soon to say if it's helping, I'm curious if anyone knows the difference between the gels mentioned in this thread and the patches.
So happy to hear from the ladies recently recovering!
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thanks 2002chickadee! I still haven’t made up my mind on DIEP vs implants. Now waiting to hear about insurance..
I’ve been finding out that Drs do several things as a matter of course that surprise us. I found out that my PS added a layer of left over breast tissue (I guess they just shave off the thin “skin” layer and use everything else?) at the top of each new breast so I have a layer of fat/tissue giving a nice smooth look - I don’t need fat grafting there (and my TEs are pre-pec). I have to admit that one con for me for DIEP is that I’m content with the beasts at this point - they have a decent small C- cup shape with scars only underneath - I only need the inner corners rounded off a bit and the dog ears thinned down.DIEP will add more scars and a skin patch to what is now a pretty smooth surface.
ACK I’m having a hard time deciding.
Lanne
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Hi all,
I had a follow up with the the PS yesterday and have decided to move forward with a DM with a DIEP flap waiting on a surgery date (hopefully soon than later) reading all the posts here have help educate me and clarify what this experience will really be like and what to expect after the surgury - Thanks to everyone for sharing your true life experiences, very valuable information when trying to make a tough decision about surgery.
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Lanne- they should be able to use your current incision sites to do the DIEP. If not they may just have to do like they do for breast augmentation with the incision running from bottom of nipple to chest wall. That incision line heals really well. They should not have to add any skin patches unless you’re flat on one side or both.
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Thanks Lula! I’d be ok with the inverted T scar. I’ve healed really well, including on my radiated side. Both sides are the same, nice breast pockets, no nipples. I’m going to email the Dr and see what she says. I’m wondering if she was thinking about a BMX/DIEP and not a delayed DIEP. I don’t see how the extra hole would give that much more access - but I’m obv not a breast surgeon.
Also, you mentioned above about asking the Dr how she’d handle the shortwaisted look - I’m not sure what you mean?
Lanne
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Lanne- technically you’re having delayed DIEP and that usually that requires the skin patch as the mx took all the skin. However, you have implants. That means you have plenty of skin to work with already in place. They’ll just open the breast, slide the implant out, connect the blood vessels in your chest to the harvested tissue from your tummy, tack it in place and close. Piece of cake!
So when they harvest the tissue from your tummy you have a significant swath of exposed abdominal muscle area open. They pull the upper and lower parts of the incision together and close you. Pulling those 2 sections of tissue together tends to reduce your waist height visually by a couple to a few inches. And it can make your natural breast to waist to hip to thigh curve more angular at the waist-hip juncture. Pants/shorts don’t quite fit right. So they resculpt the lower half to restore the natural curve. Not all PSs do it though and not all who do it get it paid for by insurance as it should be. I hope the description makes sense. If not feel free to ask
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Lula73, well said. It is a bit weird when your belly button and waist reshuffle. I still can't wear any of the shirts or pants I used to where as they feel strange and fit awkwardly. That's a good point. Hold off on any extensive wardrobe additions.
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My clothing still fits thank goodness but some of the thickness that was in my hips is now higher up so my waistline is thicker. Reshuffle is a great word for it.
I thinking we will start to have some “Stage 2” surgeries coming up. My Dr doesn’t call it that but that’s what it is.
Hope everyone is doing well!
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ScubaMom24, Finn21 and Cindyann, good luck next week with your surgeries! It will be behind you before you know it!
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