2018 DIEP Surgery

Runrcrb

Twills,

one of the plastic surgeons I met with initially was very clear. Under no circumstances will a breast implant look like a natural breast or a flap breast. Up to you about how important symmetry without clothes on is. Another consideration - if you gain weight, a natural or flap breast gains weight too; an implant doesn't.

deehenn

The drains are pretty yucky as everyone has mentioned. Cumbersome and awkward more than painful. I purchased extra lounge shirts that had pockets sewn into them for the drains prior to surgery and I did not use them. I donated them. The belt and such you get in the hospital were easier to use than the shirt pockets. I did ask for an extra belt for the drains when I left the hospital so I would always have a clean and dry one.

I so hate being queasy or nauseous...I forgot that happened the first 24 hours in hospital until I read y'alls posts. I agree and recommend drinking as much water as you can while the catheter is still in. It does help flush out those anesthesia drugs that cause the nausea. And eat fruit and fiber so that you can poo as easily and quickly.

Throat lozenges are a must! Your throat is sore for a couple of days.

I am amazed at how good the breasts look and feel now. The pain and discomfort was all worth it!

lifewins

I am one week out from my DIEP flap mastectomy.

I had a bit of a restless sleep last night, I am a bit worried about little things like the bruising and the discharge being possibly too red in the drain. The general bruising doesn't disturb, just some specific areas that I wonder about in tandem with that redder blood in the drain.

The thing that was confusing to me in the hospital was communication. So much depended on us asking questions, but the answers could vary depending on who we asked, so ay yi yi.

For example I was told not to move my left arm or use it at all (surgery was on left breast). So definitely avoided that. The physical therapist who came in twice told me the reason was because my left arm could destroy all the new vascular connections... oh my! He also told me my arm exercises should start 5 days out. But then on my last day in the hospital one of the surgical fellows said my arm could NOT hurt the new vascular connections as they were all connected to veins nearer to the middle of my chest. So I proceeded to move more accordingly, but still favored that arm and did not lift or utilize it really, just great range of motion.

I kind of don't want to call the office and ask questions, just wait for my Thursday appointment. But I am dreading the possibility that I had engaged in too much movement and hurt a vascular connection which has caused the blood to be redder in the drain. It is not a lot, the fluids in general are smaller everyday.

It is funny though, the first days if you have skin sparing and the flap is not observable without a mirror, your breast is beautiful but only later bruises.. mostly yellow with some patches of red, the red patches or dark patches are the ones that leave me a bit worried.

Another thing that I forgot to address is that some people on this board indicate stage 1 and 2. My Dr is not dealing with stages. He said this is it, if I have tweaks or adjustments that is a separate matter, but he definitely molded the breast in a finalized manner. It is amazing, I am just amazed. It is a bit heavier than my other breast, swelling still to go down. I am just a bit nervous about everything surviving. My breast still is warm and soft, I am told hard is not a good sign.

I am also going to ask how many veins were connected, so funny that I hadn't asked, just out of curiosity. How long does it take for those new vein connections to be fit as a fiddle? Will I be able to play rough-house with my nephews and engage in intense yard work without fear or ripping connections? It would be so good to have seen week to week descriptions of what to expect along with pictures...My deeply dark nipple bruise is getting smaller. I totally have sensation for every inch of my breast..

Sorry for scattered thoughts! I am still majorly good and progressing, but have these nagging worries.

bella2013

Lifewins, call your breast cancer surgeon. If you can’t talk to him then speak to his PA or ARNP. You are not bothering them. This is your body, your surgery and your health. They should not have any problems answering your questions. I believe your concern over the color of the fluid in the drains and your arm mobility exercises are very valid concerns. Don’t wait until Thursday. Call them this morning.

Blessings...

bella2013

Lifewins, remember your tummy tissue and breast tissue has been through a lot of trauma. It makes since that it would be bruised. I watched a video of DIEP (don’t recommend watching it prior to surgery) but it’s a clear picture of what your body is going through to start healing after the trauma.

I am six weeks out from my lumpectomy which was in a way a partial mastectomy because of the amount of breast tissue that was removed. It is still changing colors. The area where the tumor was located still has a large hematoma.

I am like you though, this DIEP surgery with the microscopic vein connections is new territory. I look forward to reading responses from others who are several months post surgery

Lula73

so glad to hear from you lifewins! Women do report that when they are more active they get more drainage. If the drainage is red red and no longer translucent to any extent with or without clots call dr asap even if it’s after hours. Hoping your dr is right on not needing a stage 2. For those of us that have them it typically involves much more than sculpting the breast. They take care side boob (under your arm) that results from where they attach the flap, dog ears at your hips, lower the incision scar, overall scar revision both breast and tummy, sculpt the waist-hip-thigh area to restore your shape close to what it was prior, then they use that fat from the sculpting to do fat grafting in the upper poles of your breasts which tends to hollow out. If you notice any of these things you’ll want to revisit them with your PS

Casun19

lifewins great to hear that you are home. And reporting back! I am less than a week away. I have been preparing everything and getting very nervous.

Also, I have come down with a cold. AHHHHRG. I put in a call in with my primary and the surgical team. I will be so upset if they reschedule.

lifewins

Update, I did call my Dr's office and sent photos. I got a call-back and was assured everything did look normal. The red red blood was of low volume, they said they would be more concerned about it if there was more volume coming out. This could be a hematoma releasing its blood etc but because it was a small amount, no worries. The darker bruising, no worries. The spots could be aggravations set off from the stuff put on skin during surgery and the soap I used in showers, but to wait for Thursday appt to see any changes and to see more.

Yes, it was silly not to call right away and this started yesterday. After ALL the intense care of last week, I didn't want any attention, but this is not the time to be shy for sure... Thank you Bella and Lula for pushing for that simple call that took away a lot of worry..

Lula73

lifewins- so glad you called and all is good! Healing prayers and warm thoughts coming your way!

bella2013

Good news Lifewins! What would we do without cell phones with cameras??? That was great that you could send them a picture.

Blessing to you as you heal. Hopefully all your drains will come out on Thursday

TWills

Definetly my concern Runrcrb, just want to fully examine all the options. I feel like since “I didn't know what I didn't know" in the beginning before my BMX I missed some opportunities to possibly have had a easier time. Luckily I'm not a regretful person but I'm definetly trying to learn and do better as I go. I have to live with the hope that each Dr will do what's best but I know I have to be more involved in each process, more than I'd like to be. I find it uncomfortable to question Dr's but I know it's important.

Happy healing Lifewins! So glad you're doing good and I know you're happy to have the surgery behind you:)

Casun19, I hope you get well soon and are able to stay on schedule. Get lots of rest! Hard to do while you're preparing but try:)

Silly question but what kind of underwear is most comfortable after surgery?? Before and after drain removal? Granny panties so they might hit above incisions or really low panties so they're under the incisions. I suppose commando is anoption as well lol!

MommaGin

Stacked DIEP on left breast

Feb 14, 2018

Dr. Sean Boutros

Houston, Tx

Thanks,

MommaGin

TWills

Today MommaGin? Good luck, safe surgery and comfortable healing!

Thinking of Newusernam3, her surgery was Monday and Teaberry11 was yesterday. Also, Leatherette has her TE surgery today. Hope to hear from them as soon as they feel up to it!

Lula73

underwear post-surgery answer - something light and soft that does not rub and does not have a waist and that squeezes. 1 size bigger than normal helps too. It’s nice if they just kind of lay there covering you and that’s it.My incision was really low (across top of pubic bone and 1/2 way across hips - made a smiley face if you will) so ones with a higher waist and and broad sides. I usually wear bikini undies so broad sided hipsters and boy shorts worked great. Something without seams up the front middle and/or hips or offset hip seams to the rear.

TWills

Thanks Lula!

lifewins

TWills - Post-op at home I did and am still doing commando and have used loose sweat pants or loose flannel pj's. Men's flannel pants were easier to find. With the difficulty of negotiating around the drains and pulling down your pants, one less thing to worry about to me is better.

I did of course go commando in the hospital for the time I was there and just had the surgical gown. In fact they gave me 2 more gowns to take home with me upon request as I felt the opening in the back was so much easier to go to the bathroom. I was also given some big butt pads that they use in the hospital bed, so I used that in my recliner chair for the days I wore the hospital gown.

Soon enough I tired of that and wanted more normality so graduated to the sweats and homedepot apron. Today I graduated to fanny packs to hold my drains and that enabled me to go outside for a walk in the warmer weather and not 'show.'

Tomorrow for my Dr's appointment I would like to look even more like a back to normal person or at least try, but I think it will be sweats and anyway until I get these drains out..

Good luck to people approaching their surgery or working on prep or in post-op.

bella2013

I had a dear friend give me a gift today... She ordered it off of Amazon. I am very happy to have this although the list price is expensive. I think there are coupons and discounts available.

aquilegia

lifewins - red color in the drain fluid after a week is totally normal and nothing to be worried about. Only if the color suddenly turns red after it has been orange for a while or volume goes up. You sound like you are healing really fast - I didn't get the last of the drains out for at least a month.

mitzi458

hi Elijahgirl!

Ugh...ok...3rd opinion I received from the third surgeon gave me yet ANOTHER plan, and says it’s the only way to go. All three surgeons agree that I need a DIEP flap on the left side (my flat, radiated side). But they all disagree on the right side that already has an implant but was never finished. Doc #1 says use another implant, but this time silicone, not saline. He says i’ll Be too small with bilateral DIEP and I’ll hate it.

2nd doc says definitely do a bilateral DIEP and he can get a C cup.

Both Doc 1 and 2 do not really believe in fat grafting, but #2 MIGHT do just a little but doubts he’ll need it. Doc #1says it does not work and he will not do it.

Now Doc #3 says to do DIEP on left, but do fat grafting to build the breast on the right. Says he can’t do a flap on top of a flap and I already have a latflap on the right side. I’m honestly more confused than ever.

Wish I could just go to New Orleans!!

Lula73

gosh Mitzi, I'm sorry it's all so confusing. Did you ever reach out to Dr Marga Massey's office? She is affiliated with NOLA docs BUT takes different insurance. She trained with the docs in NOLA and by all accounts sounds just as good. And there's also Dr Craigie who trained with the same PS the NOLA docs trained with who also gets good reviews. Massey & Craigie both come up as preferred providers in the BCBS national network under the regular PPO/EPO plan. It is worth a phone call at the very least. Also, here’s a link for BCBS of CA preferred provider lookup tool for out of state docs-you’ll need your insurance card handy to get an accurate list.

https://provider.bcbs.com/app/public/#/one/city=&state=&postalCode=&country=&insurerCode=BCBSA_I&brandCode=BCBSANDHF&alphaPrefix=&bcbsaProductId

TWills

Thank you lifewins! Keep is posted on your recovery:)

Bella2013, what a sweet friend you have.

Mitzi458, I know it must me aggravating not having a definitive plan, hopefully as you keep asking questions you’ll start to feel comfortable with your decision.

bella2013

lifewins, how are you doing? How was your follow up today

GreenEyes81

Hi all, just a quick update. I went ahead and reached out to NOLA and have my first call today with Liz. She was great---and never for a sec rushed me with all my questions. You may have seen my seperate post regarding getting out of network doc covered as in network. So far that actually seems like it will go well. Don't have a final "ok", but it did not scare NOLA in the least. Seemed very normal.

She was also willing/brought up phase 2. No one had wanted to talk to me about phase 2 until "we are there" which made me a bit nervous. I am confident I will not end up crazy looking due to a lack of "coverage". Lipo here I come!

Looking at a September/October time frame. So we shall see. Trying to focus on the end result and not the cost to travel and hotels....no idea how that will work out. One day at a time I guess. lol

mitzi458 - sorry if I missed it in all the pages is NOLA not an option due to insurance? Don't quote me....but if a stacked flap is an option for you, NOLA may be the only place you can go, thus you may be able to get it approved like I am working on.

lifewins - So glad to hear all is going well so far!

cindyanne

Mitz--I see you had a lat flap. I really want a DIEP but my PS says I do not have enough tissue for one. I am reading horrible things about the lat flap and am now confused.

mitzi458

Hi Lula73-

Thanks for that link. I swear though, the people at Blue Shield who answer the phones are not helpful at all. I've called them twice. Both times they actually googled doctors in the area who do a DIEP flap. So annoying! I can do that! Plus the two doctors I finally got approval for in Network in my area, I was told were not in Network. It's crazy.

Greeneyes81... I did hear back from Liz today after I sent all medical records and photos. They said they will not take my Blue Shield insurance, even though it's a PPO. Liz said the cash price would be $40,000 and I should tell her what I would like to do. I don't even know what type of surgery they recommend after seeing my files. Do they have to tell you that you need a stacked flap? Or do you tell them?

I met with a surgeon named Dr. Leif Rogers in Pasadena (also Beverly Hills) who I was told does a lot of DIEP flaps as well as fat transfer. I have to meet with him again on Monday because I still have so many unanswered questions. I'll check with Dr. Massey tomorrow. My problem with all of this is timing.

I have to travel for a week at the end of April. Also at the end of May for another week. And then starting around June 12th, I have to leave for Europe for two months of work. Not sure what my schedule is next year. So I have to get everything done within a year or I have to pay my deductible and out-of-pocket costs again to finish everything. Not even sure if this is possible.

TWills...I'm scheduled with Dr. Tseng next week for my surgery. I'm probably going to have to cancel it now because I don't think I'm ready yet. Too many unanswered questions. If I cancel though, I might have to wait until next year because I can't get in with Dr. Rogers until mid to end of March. I'm afraid this will not be enough time to recover before I have to go back to work. Bummer because all of my pre-op and everything is finished.

mitzi458

Hi cindyanne-

I did have a lat flap back in 2007 after my second mastectomy because my doctor also said I didn’t have enough fat for a DIEP (even though I was 12 pounds heavier then than I am now, and now he says I have enough to do one!!). : (

I actually thought going into surgery that day, that I was getting a DIEP flap until I was lying on the guerney and I spoke to the nurse who told me I was there for a lat flap. I wasn’t expecting it so I didn’t have time to research it. I did it anyway because I was already scheduled for a mastectomy and both surgeons came to talk to me and talked me into doing it. In hindsight, I wish I would have told them to do the mastectomy and forget about reconstruction but it was too complicated (we hadn’t discussed any other options).

I ended up getting a staph infection in my wound and then had to go in and have more surgery to clean it out and be on round-the-clock antibiotics/home health care, etc. I’m normally a fast healer but I did not heal quickly from that so I may not be the best one to ask. I never went in for any stage 2 so I’ve been unfinished for 10 years. Honestly, I was too traumatized by the whole thing, which is why I’m just now finally getting back to revisit my reconstruction. Because of all that, I never got physical therapy. I do get soreness in my back area where my muscle was, and my scar still gets itchy. I will say that since getting a lat flap, I have full range of motion. I had an implant put over the muscle and have had no problem with that either. i live my life normally and do everything I want to do. I’m still flat on one side but use a prosthetic.

Would I have another one? Now that I know what’s involved, I think it would be fine if that was my only choice. I can’t compare it to anything else though. It might be a walk in the park compared to a DIEP, or it might make the DIEP flap seem like a breeze. There are no blood vessels to attach so I have a feeling it’s easier to get a lat flap. I would just make sure your doctor prescribes physical therapy if you do it, and that you trust your surgeon first and foremost.

Even after all that, I would not say getting a lat flap equates to a horror story. Just be sure going into it that it’s what you want. Are you only having one side done? With an implant?

Lula73

Cindyanne- how thin are you? Are you in a situation like mitzi was where surgeon said there was not enough tissue but obviously there was as she was 12lbs heavier then do you think? Another question: have you verified that the PS you’re talking with does DIEP and on a regular basis? Many PSs who don’t do them or who are trained but prefer to do other procedures will tell patients they are not a candidate just so you’ll stay with them and they will get your business. Plastics is a whole different world than general surgery as most procedures they do aren’t covered by insurance. In the case of BC it is and they see deeper pockets and $$$ compared to the average cash paying patient. They don’t want to see that opportunity walk out the door. There are countless women who were told by other PSs that they didn’t have enough tissue who did a consult and surgery with NOLA and found out differently...the proof is in the recon itself.

cindyanne

Mitzi--I am most worried about losing strength and having back issues. Currently I have great upper body strength. I was very active in cross fit prior to my last diagnosis. I will need skin also due to twice having radiation on the same side.

Lula--I lost over 30 pounds during treatments and I was kind of lean prior to that but before I lost all the weight he said I could do DIEP. I currently go to Moffitt and my plastic surgeon does do DIEP. That being said I have decided to check out New Orleans and have scheduled a phone call with them for the 21st. We live in Destin, FL so New Orleans is actually closer than Moffitt. From what I am reading though it looks like I would need a stack?

LMichele

Twills: Every consult I had with my PS, he said I didn't have enough tummy for bilateral DIEP reconstruction in a similar size to what I had with the implants. So the plan was, a small implant (the smallest one they make) ABOVE the pectoral wall, held in place with mesh and my own tissue on top of that. I thought that sounded like a fine plan, and it WAS the plan, going into the ER. Then they ended up not doing an implant after all. I had enough fat or so it seemed at the time. (I am not symmetrical at the moment - alas! we have a consult next week I can't wait).

Could that be an option for you? since you are not opposed to using an implant? That way you would be more symmetrical and the weight gain/loss thing would change accordingly as well.

Michele

LMichele

Twills: re: undies: I came home from the hospital after DIEP without drains. I chose commando. Had a bunch of leggings and running tights, just wore a different pair each day. None of my panties were gonna work out. No way.

I had a "DELAY of flap" surgery two weeks before the DIEP and had one drain for those 2 weeks, before the huge ab incision. During that time, I had a couple thongs with a very wide stretchy lace front that hit the perfect spot to hold the drain again my skin, then a pair of snug leggings on top of that.

I used a lanyard around my neck and under one arm and safety pinned the drain grenade to that.