2018 DIEP Surgery
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Twills - wow. No caffeine 😢. Thank goodness that was not in my directions. I had my sister bring Starbucks to the hospital. If your pre-op is one week prior to surgery, keep doing what you’re doing till the doctor or nurse tells you otherwise. No reason to restrict yourself any earlier than necessary.
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I know right! I don't actually drink much caffine, just a little coffee every morning but I'll slow it down and cut it out two weeks or so before surgery. I wouldn't want to add caffine withdrawal headaches to the discomfort of surgery and recovery!
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no ibuprofen (Advil/Motrin), Aleve, migraine meds, or aspirin for 2 weeks prior to surgery. If you're on a blood thinner like Coumadin/warfarin, Xarelto or eliquis You'll need a bridge protocol with lovenox at least for 2 days prior to surgery. (Make sure to alert surgeon to these types of meds if you're on them).Discontinue any non-prescription supplements that can thin the blood or increase bleed rate. No smoking I believe 6 week's minimum before surgery and thru recovery.
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These are the instructions that my surgeon gave me even though my surgery date in May hasn't been scheduled:
PRE-OPERATIVE INSTRUCTIONS
INFORMED CONSENT
Procedure planned:
Bilateral breast reconstruction with deep inferior epigastric free tissue transfer
Risks of surgery include but are not limited to:
Flap loss from vascular thrombosis or infection
Need for re-operation, possibly urgently
Infection at all operative locations
Bleeding, need for transfusion, transfusion reaction
Disability, arthritis, chronic pain,
Nerve damage, pain, numbness
Fluid accumulation under operative sites, need for drainage
Blood clots, venous thromboembolism
Organ system damage: respiratory, cardiovascular, liver, kidneys, brain, gastro- intestinal, immune
BEFORE SURGERY
DIET
No solid food by mouth after midnight before surgery
Clear liquids OK up to 2 hours before surgery
SKIN CARE
Wash the surgical sites with antiseptic sopa in the shower (avoid the face)
MEDICATIONS
Pick up preoperative medications before surgery
Do not start taking unless directed to do so
BLOOD "THINNERS"
Stop these at least 14 days prior to operation.
Aspirin
NSAIDs (ibuprofen/Motrin, Advil, Aleve, naproxen, Naprosyn)
Herbal product
Fish oil
Vit E.
Check with you doctor when to stop these medications
Plavix
Warfarin (Coumadin)
HIGH BLOOD PRESSURE
Avoid on the day of surgery
Lisinopril
Hydrochlorothiazide
Furosemide
Take on the day of surgery
Beta blocker (atenolol, metoprolol)
DIABETES
Avoid on the day of surgery
Metformin
Insulin (reduced dose will be given at hospital)
TOBACCO
Tobacco smoke and nicotine, including supplements from patches and gum are harmful to your body's ability to heal surgical incsions and wounds. These last for many weeks after you quit and some harmful actions can last for many years after you quit.
It is important for you to quit smoking and use of nicotine supplements for as long as possible before your operation. Your operation will not be scheduled until you have successfully quit for at least 12 weeks. Urine levels of nicotine metabolites will be measured before surgery to ensure your procedure can be done safely without heightened risk.
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Just spoke with the plastic surgeon, got some news I really didn’t want to hear.
I requested to have a DIEP which he initially stated I could have but he rather it be done in two stages then at the same time as the mastectomy because it would be a total of 12-15 hours.
I told him the reason I was was choosing the DIEP was to avoid having to be cut on numerous times.
Now here lies the problem, while he was examining me he noticed the radiation tattoos on my upper abdomen from my radiation treatments I had seven years ago for lymphoma.
Now he is hesitant to perform the DIEP because of the possible tissue damage due to the radiation,he is afraid that there is a chance that it won’t take causing the tissue to die.
He said that they only do the DIEP and the latissimus dorsi which I don’t have enough for double mastectomy.
Now I am having to consider having possibly having implants. Which means possible tissue enhancement and nipple grafting.
Feeling really stressed out right now, because I also had my biopsy today and have to wait another week for the results.They made it sound like they might not even see it and I wouldn’t need the biopsy after all.
Well they did and they took about 10 samples. I would have rather that they had never said anything because it only got my hope up for nothing. Gotta love military medicine.
Thanks y’all for letting me vent
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Elijahgirl - Actually most PS don't want to do implants if you have radiated tissue. My PS only does tissue flaps after radiation. The only difference is he made me put in tissue expanders during radiation to save as much skin as possible.
The problem with implants and radiation is capsular contraction.
If you call PRMA now maybe you can get the referral necessary since you have radiated tissue and may need stacked flaps to get enough tissue to reconstruct with. Not many are experienced with multiple flap surgeries. They are and maybe that is how you can get them approved.
Also PRMA has a minimum of 2 doctors in the operating room to cut down on anesthesia time.
I hope you can find the solution you want.
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Elijahgirl, is that because your abdomen was radiated? So sorry, I know is frustrating not having a plan.
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Twills, yes I was diagnosed with Malt Lymphoma in 2010, an underwent both chemo and radiation it was located in my upper intestine just below my stomach. The way the PS explained it was that it was not a problem transferring the tissue to my breast but stretching the skin from the upper part of my abdomen to the incision site. It is basically a coin toss as to how much tissue was damage with the radiation.
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jbdayton, thanks for the information, I did call PRMA and unfortunately they don't take TRICARE, and that would be the only way I could get a referral to them as much as I would love to have them as part of treatment plan for my care. Looks like I am stuck with the military docs
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Elijahgirl, that makes since, dang radiation!
What's your next step?
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TWills, I honestly don’t know yet, I am still waiting for the results of the biopsy which will be another week. So I will wait until I talk with my surgeon next week. In the meantime continue researching all my options
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There are flaps that can be taken from the upper and lower buttocks and inner and outer thighs. But Finding someone that will take tricare may be the problem. Is there a tricare insurance help desk or patient navigatorthat can see if this is possible in another location?
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elijahgirl- let’s start with the radiation... I also had rads and chemo for lymphoma about 30 years prior to diagnosis. Rads to chest and abdomen. I have actually maxed out my lifetime amount of rads. I also had exploratory laparotomy & splenectomy back then too. NOLA had absolutely no problem with doing DIEP - both from a pre-surgery standpoint (without even seeing me in person until day before surgery) as well as an actual surgery standpoint. The fact that they had experience doing flap procedures on women with previous full mantle rads was one of the reasons I went there. It sounds like your doc may not have experience dealing with our unique situation.
Jbdayton is right. If you had rads to the chest the chest wall likely will not hold the implants in place. My OB/GYN agreed with surgeon’s assessment and told me about patients who end up with one implant up by the collarbone and one sliding down into the upper abdomen because of the damage to the chest wall
An SGAP flap may be a good second option and is worth looking into if you end up not going the DIEP route.
A 2nd opinion may be good too. Have you tried seeing if NOLA, Dr Massey in Charleston, and/or Dr Craigie in Charleston take Tricare?
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Lula73, wow that is very encouraging to hear, I didn’t know if anyone had heard of a situation like mine. I will definitely check out NOLA it does not hurt to ask right. The PS made it sound horrible, like the tissue dying and having to get potential skin grafts. Knowing that it worked for others gives me hope.0
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elijahgirl- here’s links for all 3:
NOLA: www.breastcenter.com
Massey: www.drmarga.com
Dr Craigie: http://naturalbreastreconstruction.com/
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Definitely not having an easy time of late..and now rejected from access to the before/after picture forum as I have only posted so many times and need to post a certain number of times and maybe I can get access in two weeks. I do not have 2 weeks, my first plastic surgeon appt is Thursday and the surgery is Monday... so many things going wrong, work is totally hectic and now I feel like I am getting sick.. makes you just want to run away and forget this is happening. And my efforts to get anti-anxiety meds were written up by my gen dr but CVS who normally fills my prescriptions would only do them for 30 days. I call the prescription insurance and they said in order for me to get 90 days I have to get it filled at a walgreens...wha?? what is this corporate monopolies? and the walgreens are two towns away and the cvs is local local local...spent all this time and nothing, gonna have to start again tomorrow.. very much crunch time.. I did get my power recliner based on suggestions though...that was a pretty penny but hopefully well worth it.
Getting a full body ct scan tomorrow.
Quitting coffee is a thing? I was thinking of slowing anyway prior, but I wonder what the medical reasoning is before and especially after...
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lifewins- perhaps some of us can help on the before & after pics. What do you need? On the Walgreens for 90 days of anti-anxiety meds: guessing you’ve got express scripts for your pharmacy benefit. It’s a new thing they’re doing vs mail order to help out people like me who forget to re-order in a timely manner and need their meds right now. I actually spoke with them about this the other day and was told that if there was not a Walgreens in your town they sometimes have another pharmacy like cvs that will do it. However you need to verify which pharmacy locations are doing it even if it’s walgreens. (Hope that makes sense). Glad you got your recliner. It will be worth it. Quitting coffee/caffeine is important because caffeine constructs you’re blood vessels. You want the blood vessels nice and dilated so that the newly moved tissue gets plenty of blood, that the newly sewn together vessels heal, and your flap surgeries have the best chance of a survival and little to no necrosis. Hope this helps!
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I am a morning coffee addict, however I will do what ever it takes for a successful outcome of my DIEP. How far in advance before surgery should I start tapering off the caffeine and how long after surgery should I stay off of caffeine
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I was told 6 weeks after surgery. Before is only to help the weaning process. So cruel! Lol
So for all the difficulties you're having Lifewins
My husband has been home with the flu and we've taken every precaution to not spread it. Fingers crossed. He's on day 7 now so we're over the worse of it. So thankful I had a box of masks left over from chemo.
I might look into delaying my March 2nd surgery date, we just found out my son will be deploying around that time. I don't want to have to deal with all of that at the same time and possibly risk missing any time I might can spend with him. Ugh!!!
I'd like to see the picture forums as well but didn't want to hassle with it.
Actually just asked for access so we'll see how it goes.
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lifewins, remember to breathe. You are very close to your surgery date so it’s natural that your anxiety levels are high. I will be in the same place in three weeks. It’s also normal to feel like you don’t have control over what is happening to your body. That anxiety for me came with the moment I heard my cancer diagnosis. The anxiety also bleeds over to managing our daily lives. It gets into the details and the little things that would normally be a small speed bump seem to just exasperate me. Everything that is happening in this journey is huge.
I can’t get on the before and after pics either. I Googled DIEP Flap before and after pics. The Center for Restorative Breast Surgery in NOLA has hundreds of photos of every type of breast reconstruction surgery. They show every body type too...young and thin to older and thin to older with more weight.
Do you have a family member that can drive the distance to pick up your prescription(s) for you? Do you have anyone that will be going with you Thursday to see your PS? My husband and my sister have been to every appointment with me since I was diagnosed. Remember to write down your questions. My question that I forgot to ask, “what will my breasts look like when I am able to see them. I know they will be bandaged with drains but when the bandages come off I want to be prepared. I know it will take time to have the beautiful breasts that are in the photos.
I do believe that you will have more confidence in this process after meeting with your PS. He/she is a very important piece of this surgery.
I remind myself that I am not sick. I am a healthy 60 year old woman who had a cancerous tumor in my left breast. I am going forward with BMX because my margins were not clear. I am not a victim of breast cancer. I will have victory over this! My breast cancer team is amazing and I have confidence in their ability to bring me through the other side!
Blessings, I am praying for peace for each one of us walking this path
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hi ladies, it has been a long time since I posted on here. My mom is having her technical 3rd surgery for her diep flap. ( the second one was Just a minor revision and lift) the one coming up is the third and last one to give her new nipples and make them perkier. I am writing to ease the fear of diep flap as my mom isn’t tech savy and I write on here for the both of us.... it is almost a year but diep flap was a blessing. Message if you Have questions
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Thank you all for your responses.. The CT scan waiting room today was a sobering reminder of the impact of cancer on so many and in so many ways and an additional reminder that my future mastectomy is not the enemy but hopefully a guide to clear and clean waters.
My husband will be with me tomorrow to meet the plastic surgeon, I will ask to see pics if available.
And I called a counseling service and left a message requesting a call-back.
With all the intense activity at work and at home and with all of this, I think I will be really good at the RESTING part of the equation post-surg...
thank you all again...I feel a bit like Jeckyll and Hyde lately!
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It’s a roller coaster ride for sure.
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Going tomorrow for mastectomy and DIEP reconstruction, seven weeks ago I didn't even know I had cancer, luckily, first mammogram ever found it. As a single mom, working thru this w/ a host of friends, but omh, it sucks. Luckily, the doctors seem sound and insurance has come thru, but still, not my plan for 2018.
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Fme, I will be praying for you and your medical team. When you wake up from surgery you will be cancer free!
Blessings
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Been reading all of your posts. I feel like I can't get enough information. Diagnosed about 3 weeks ago after feeling the lump myself .. yearly mammos , call back US etc never found anything except cysts. I'm told lobular hides in dense breasts guess I didn't really understand that before. I am now a huge supporter of Breast MRI too late for me to go back now but not for my daughters.
Since diagnosis I have had an MRI and subsequent follow up US of left and right underarm (lymph nodes appear normal) . And biopsy of 2 areas on right breast. I have deciced on a BMX with immediate DIEP reconstruction. Scheduled for FEB 13th.
They will still need to test the sentinel nodes during surgery and it scares me so much not knowing for sure if it has spread or if the reconstruction will take place. Trying to stay positive but absolutely shaking inside.
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Fme, lots of luck to you! Keep us updated on how you're doing. It was my first mammogram as well:)
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Teaberry11,I have heard it said over and over that this is the hardest part, it definetly was for me. You will have a better understanding soon and a then a plan, after that you can start to get some peace of mind and focus. It's so mind boggling in the beginning and so hard to see past that.
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hi I have been trying to keep up but this thread moves pretty fast! Thanks again to everyone who has given advice, it has been helpful. Today I went into my pre-op appointment and my surgeon has changed my surgery to a “delayed muscle sparing TRAM flap"based, on the CT scan I had a few weeks ago.
I was a little shocked but didn't really know if I should keep pushing for the DIEP. They seem to be all interchangeable based on anatomy. Like some others I am starting to get nervous about my upcoming surgery and Trying to plan as much as possible.
Good luck to Fme, wishing you a smooth recovery.
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Lulu73, I left a message with NOLA and it looks like they will take my insurance. I get my biopsy results on Monday and will be talking to my surgeon. I have decided that I am going to insist on having the DIEP procedure. If the PS doesn't agree with my plan I am definitely going to try to get a referral to NOLA as well as command approval. I refuse to settle for convience sake and get implants I just can't see me being happy. Thanks again for the information it was a great help.
On another note the closer my biopsy results draw closer I am finding myself feeling very nervous. I was doing ok until I listened to a BC survivor whose story sounded a lot similar to what I am going through and hers turned out a lot worse than initially thought. In the last few weeks I feel I have been learning a whole new language. I have seen how BC has destroyed my family already and I hate it. I really don't want to be part of this club, I recently lost my Mom from BC and my sister has stage 4 BC with no cure. This site is so informative but it saddens me to see how this has effected so many beautiful people. Well I have ranted enough thanks again for all your help and letting me vent
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