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DIEP flap and mastopexy questions

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gh11
gh11 Member Posts: 27
edited September 2022 in Breast Reconstruction

Hello to all of you - firstly, I wish you the very best in your struggle, and secondly, THANK YOU for sharing your insight and experience. I'm new to the "club" - right breast mastectomy done June 17th 2022 and sitting with these awful tissue expanders while I figure out next steps for my Frankenboob. Very ugly and uncomfortable - I feel like Frankenstein's bride - but hey, I am grateful no chemo or radiation needed so strategizing next steps. Diagnosis: invasive ductal carcinoma in right breast, 1 cm tumor, ER and PR positive and HER2 negative. No cancer in lymph nodes and low oncotype dx score of 10 with no genetic genes according to tests and in perimenopause. Sleepless nights, mood swings and irritability already and I am not even in menopause so dreading the big drugs they want to put me on - tamoxifen and lupron to suppress ovaries. Decided to pause on drugs for a few months while I get the surgery over with because I have 3% risk of recurrence.

Considering a DIEP flap and would love to hear from others if they recommend it or not. If you live in Atlanta Ga and have a fantastic oncologist or Plastic Surgeon, please do share names with me as I do want to get a second opinion! Did anyone has a mastopexy in one breast and a DIEP flap in the other one and if so, any regrets or advice to me before I start down that path? I fear I will look like a patchwork doll after all this....had a nipple sparing mastectomy on right breast so scar going sideways from nipple to side of breast on right breast. Anyone had a DIEP reconstruction on one breast only and did not mess with the other breast at all? Or is it impossible to have symmetry without messing with both boobs? Thank you for sharing your insight with me.





Comments

  • meow13
    meow13 Member Posts: 1,363
    edited August 2022
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    I had a simple mastectomy non skin sparring to left side with single DIEP left side reconstruction. My surgeries were over 10 years ago everything still looks good. If I were to wind the clock back I won't change DIEP is the way to go.

  • gh11
    gh11 Member Posts: 27
    edited August 2022
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    Thanks so much :). So no lift on the other boob for them to match? Did they make the DIEP flap look like the unaffected breast and you had symmetry? Appreciate your prompt reply.

  • meow13
    meow13 Member Posts: 1,363
    edited August 2022
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    I did have lift on right side at the same time as DIEP.

  • ratherbesailing
    ratherbesailing Member Posts: 129
    edited August 2022
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    I also had a lift (and reduction) on the other side, but the PS waited about six months until the DIEP side had settled. Great symmetry (I had an excellent surgeon.) I think you should ask your surgeon in advance for expectations on symmetry, and ask to see photos of patients s/he has operated on. The scars on my lifted side are barely noticeable.

  • elle2
    elle2 Member Posts: 57
    edited August 2022
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    gh11 - Hello, I wanted to respond that to have a DIEP flap reconstruction on one side only would not create a symmetrical look. A good surgeon will want to make even subtle changes to the other breast to achieve that symmetry. I had a DIEP procedure (my own tissue with fat graphing) on left breast last October during mastectomy. The DIEP includes lifting, shaping and reconstruction This October I am returning for a second fat graph to increase protrusion and a reduction and lift on the right side for symmetry. I had large breasts and clothes currently do not fit because of the big difference in size and shape of my breast’s. If you have smaller breasts, you may be okay not doing any further procedures, but it is impossible for me to feel comfortable as itis currently. I wouldn’t recommend it.

  • meow13
    meow13 Member Posts: 1,363
    edited August 2022
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    Mine match in shape and are symmetrical about 38 C, I didn't notice much difference after fat transfer. I did have a lift on right side and DIEP reconstruction on left side all in one operation lasted 10 hours. The fat transfer was about 4 months later, in outpatient facility. Many pictures I saw on internet look pretty bad.


    One thing I wanted to mention is that I have gained weight about 30 pounds over 10 years after surgery and my match still is good,.

  • gh11
    gh11 Member Posts: 27
    edited August 2022
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    Thank you for your comments - I definitely will be looking at a gallery of photo's. May I ask who your surgeon was? That makes a lot of sense to wait till the DIEP has settled before messing with the other side. Definitely something I need to discuss with the PS - I guess it just means a third surgery then.

  • gh11
    gh11 Member Posts: 27
    edited August 2022
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    Wow. 10 hour surgery and all done in one go, and symmetry. Good to know it can be done. How long did it take for you to recover?

  • gh11
    gh11 Member Posts: 27
    edited August 2022
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    Thanks elle2 - it's become clear to me that I will need to mess with the other side too, if I want symmetry. Not heard of fat grafting so thank you for mentioning that, another question for the PS.

  • meow13
    meow13 Member Posts: 1,363
    edited August 2022
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    I took my time to rest 2 months off work. I was pretty comfortable recovering I remember not wearing jeans for a month. The hip to hip incision area was numb but putting pants on and going out I kept to minimum it could get sore. I had the surgery beginning of April by end of May I was back to the gym.

  • meow13
    meow13 Member Posts: 1,363
    edited August 2022
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    My brother and sister in law (doctors) were very concerned about me being in surgery for 10 hours, definitely against it. I was in excellent physical shape at the time and went for it. I woke up in the ICU which I knew I would spend the night there. The ICU because of the monitoring of the blood flow making sure tissue takes hold. I actually spent 2 or 3 nights there until a regular room opened up by day 5 I was so bored just wanted to go home.

    No problems at all except constipation from all the drugs. I took Tylenol and Advil for pain relief not a whole lot of feeling in the donor area or reconstruction. Yes things seemed very hard took time to soften up. I have feeling back still have nerves coming to life.

  • serendipity09
    serendipity09 Member Posts: 769
    edited August 2022
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    meow - I was told I will not be in the ICU at all and they anticipate, so long as everything goes well, I'll be home by the fourth day. My surgeon's goal is to have me walking as soon as possible, which I'm ok with; the sooner I'm up and going, the quicker the recovery.

  • meow13
    meow13 Member Posts: 1,363
    edited August 2022
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    I was in ICU only because the frequent monitoring of the reconstruction, hourly I believe.

  • serendipity09
    serendipity09 Member Posts: 769
    edited August 2022
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    Right! I'll be monitored very frequently, just not in ICU I guess.

  • gh11
    gh11 Member Posts: 27
    edited September 2022
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    Hello again, I have a DIEP surgery scheduled next week after having a mastectomy with tissue expanders in the right breast. The surgeon told me that if I keep the healthy cancer-free left breast and just do the DIEP reconstruction on the right breast, it obviously makes sense that the natural breast tissue will age and droop differently to the newly constructed right breast from stomach tissue. Did anyone else get a unilateral DIEP (meow I know you did, thank you again for sending the scar picture) and has the drooping between a natural breast and the DIEP breast been very significant? Did you need to have a mastoplexy more than once to keep the symmetry? My surgeon tells me that she can keep lifting the natural breast as many times as I need but then how bad will the scarring be? After your unilateral DIEP, how many times has anyone gone in for a mastoplexy in order to keep symmetry? More than once? How many years after the unilateral DIEP did you need a second mastoplexy in order to keep the symmetry? Thank you!!


  • brinkofeternity
    brinkofeternity Member Posts: 181
    edited September 2022
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    I had UMX with DIEP flap and didn’t do anything to my other breast. It does droop a little but it doesn’t bother me and I don’t want more surgeries unless I have to. It’s not like I would wear a bikini so I don’t see any need to achieve symmetry. When I wear a bra they look the same from the outside.

  • ratherbesailing
    ratherbesailing Member Posts: 129
    edited September 2022
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    I had unilateral DIEP 3+ years ago. PS did a great job and they matched well, if not absolutely perfectly. The natural breast has, indeed, sagged just a bit. But, like brinkofeternity, you cannot tell in clothes or even, for me, a swimsuit. For reference, I am now a B-C cup. Hope this helps...

  • dancemom
    dancemom Member Posts: 404
    edited September 2022
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    oh wow, getting ready for this in the fall, and very nervous about the recovery.

    I know PS said she would need to make the still healthy one match, but I didn't think they'd sag at hugely different rates in future. I kinda thought that's why I'm doing diep. So there isn't one plastic perky and one wet sack. How often would one consider getting them rematched? I hope a decent bra can do the trick.

  • gh11
    gh11 Member Posts: 27
    edited September 2022
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    That's what I am trying to find out too dancemom :) Would the natural breast need to be lifted every 3 years or so in order to look symmetrical...I guess it boils down to how important symmetry is to us and how big the booos are. Yes, a bra will make them look similar with clothes on but the question is will it bother us when we look in the mirror....and the other side of the coin is the peace of mind.

  • gh11
    gh11 Member Posts: 27
    edited September 2022
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    Thank you brinkofeternity and rather be sailing...I am a B\C cup too and it really boils down to 1) peace of mind and how worried or unworried I would be risking cancer returning; 2)how important symmetry is to me when I look in the mirror 3)how many surgeries I could tolerate\afford. Just such a big decision because no going back once the DIEP flap is gone (one shot at the tummy flap).

  • mngrown
    mngrown Member Posts: 1
    edited September 2022
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    Hi all,

    I am newly diagnosed and have made the decision to have a unilateral mastectomy with an immediate diep flap reconstruction in my left breast. Can anyone tell me how the recovery is with regard to abdominal strength? I am active and want to once again be able to play tennis, kayak, swim, and play ultimate frisbee. Has anyone found their activity to be limited long-term after the surgery and how long did it take before you could return to sports and other similar activities? Also, did anyone have scar tissue build up in either their abdomen or their breast?

    Thnx!

  • meow13
    meow13 Member Posts: 1,363
    edited September 2022
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    My DIEP and real "natural" breast look the same aging together I am 10 years without any more surguries.

  • dancemom
    dancemom Member Posts: 404
    edited September 2022
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    thanks meow!! I needed to hear that

  • gh11
    gh11 Member Posts: 27
    edited September 2022
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    Hi meow and dancemom - good to know your experience, thanks meow...I did get a different story from ratherbesailing and brinkof eternity - they have had some droop after 3 years, which confirms what my plastic surgeon said would happen but we are all different so I guess it will affect us differently...

  • brinkofeternity
    brinkofeternity Member Posts: 181
    edited September 2022
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    mngrown - The abdomen skin did feel stretched for some time but I haven't had any issues with being active. I've done kayak, running, biking, swimming, elliptical… etc.

    The only thing that bothered me for a bit was a minor itch I felt under my belly button, under the skin. I could never “scratch" it, but over time it went away. It was probably from all the nerve damage/scarring.


  • gh11
    gh11 Member Posts: 27
    edited September 2022
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    mngrown I switched surgeons to someone who specialized in DIEP - some surgeons say they do DIEP but end up doing a tram - so that messes with the muscle, just an fyi

  • meow13
    meow13 Member Posts: 1,363
    edited September 2022
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    I just wanted to mention I did not get an implant with my DIEP some people do.

  • brinkofeternity
    brinkofeternity Member Posts: 181
    edited September 2022
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    I didn’t get an implant either. Didn’t know that was an option. Anyhow I had plenty of belly fat…

  • serendipity09
    serendipity09 Member Posts: 769
    edited September 2022
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    They offered me a very small implant for fullness which they place during stage two. Haven't made a decision about that yet. My girls looked nice when they were swollen, but now the swelling is gone and things have settled. It's the least of my worries right now.