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Diep versus implant

kaynotrealname Member Posts: 422
edited December 2022 in Breast Reconstruction

I am recently recovered from 4 rounds of chemotherapy after a double mastectomy, on endocrine therapy, and scheduled for a DIEP mid January. I find I am dreading it. I originally wanted to do it because I liked the idea of using my own tissue, not having to worry about replacement implants, etc. That's still why I like it but as the surgery date is getting closer the cons are really rearing their ugly head. Chemotherapy was tough and I just got back to feeling like myself. I don't want something else done that has a long painful recovery anymore. Plus although originally the idea of having a flatter stomach was appealing I've actually lost quite a bit of weight already and I like my stomach now. I don't want a long scar, I don't want loss of sensation, and I kind of like my little pudge down there. The other factor is the scan I need done for it. I thought it was going to be an MRI but was told today it's a CT scan with contrast. I had an abdominal CT scan about six years ago and they involve quite a bit of radiation. I don't want a second one before I even hit 50 years of age and I especially don't want it for an elective surgery. I'd rather keep those types of scans for emergency uses if they need to diagnose something. Plus, I have horrible scananxiety as it is. It was bad enough with an MRI but now that I know it will involve radiation, I'm just dreading it horribly. I thought about just putting off the surgery until mentally I felt more prepared for the DIEP recovery and process but the thing is that I want surgery. Just not the DIEP surgery. I want some breasts back. Small ones to fill my skin pockets that my mastectomy left and I'm looking forward to that. So I don't want to wait. I think I may just want implants instead. Can anyone offer information about implant reconstruction? What scans do you have to do before it? How many surgeries until you were done? Could they be the prepectoral ones and is it possible to just go straight to those and not have expanders put in? And most importantly, are you happy with them? Thanks for your help!


  • debee71
    debee71 Member Posts: 3

    Hi. I had my chemo in 2016 and followed that with bilateral mastectomy and immediate DIEP flap reconstruction. My surgery was 14 hours long and the initial recovery was AWFUL. ( thank God the pain meds were good!)

    If I had to do it all over again, I'd just go flat. Every time I gain weight, it's in my foobs ( fake boobs) .

    I will say, I was 44 when I was diagnosed and single and there was no way I was going flat back then. I weighed the pros and cons and the bottom line for me was that I didn't want anything fake inside my body.

    I will also add that I didn't have any scans prior to my surgery. ( maybe because I had my mastectomy after chemo? They were able to tell if there was any cancer left in my breasts. Not sure why?)

    Trust your gut. If you don't think you're ready and need more time to decide, take it. The surgery will still be available when you're ready.

  • kaynotrealname
    kaynotrealname Member Posts: 422

    I want surgery though and I do want it now. I just don't think I'm up for that kind of recovery any longer. I don't know when I would be. Six months, 12 months, 5 years? But I also don't want anything foreign in my body either nor do I want to be flat. So I am trying to pick the choice that sucks the least and I think for me, implants may be it if it can be a relatively simple procedure.

    Thanks for the info about the weight gain in the foobs. I also like right now that I can be braless. I had triple D's for most of my life and am a small person. Getting rid of them and not having to wear bras has been a highlight. I recognize it's not for everyone though but my attitude certainly helped my recovery from a double mastectomy. So I was looking for small foobs so I wouldn't have to wear a bra after reconstruction either but them going so much up and down with weight gain might make that not possible.

  • wondering44
    wondering44 Member Posts: 261


    I did not have more scans for the reconstruction.

    I opted to do TEs and implants. The TEs were placed during the BMX. The implant exchange was three months later. The recovery time was not a problem for either one. It was originally planned for me to do the skin grafts, which came with a five-day stay in the hospital. I wanted to get back to anything but cancer recovery. I chose implants, and the Team made that plan for me. The TEs were uncomfortable for a LONG three months. I did have pain on the outside areas of my breasts and ribs at night that would wake me up. I am not sure if that is common or not. I wanted implants to get my breast size back. I questioned why I did not go flat and chose to put myself through the reconstruction. However, my PS did an exceptional job. I finally put on a tank top and went outside in a tank top. That was the first time in sixteen months I felt okay putting my breasts in a tank top and going outside of my house. I am also happy to wear small shirts again rather than trying to cover up my chest area.

    I will put it out there that, for me, the sex with TEs was not great. It was AWKWARD & BORING. I found it a challenge to get comfortable or maneuver with the pain. My husband and I discussed it several times, and I had to explain it was me and not him because I was bored & uncomfortable with the TEs. That did clear up after the implant exchange (phew). I mention it because I was unaware of the sex part, even though it was explained to me the TEs might cause discomfort. I didn't relate the two together until I had TEs.

    It is ultimately up to what look you want to achieve and how long you want to recover. There is still time to discuss all options and recoveries with your PS until you are 100% which way you want to go. If not, you could talk with your PS about options to postpone it until you feel mentally ready to take on another recovery challenge.

    I wish you the best on your health and decision.

  • jbc3
    jbc3 Member Posts: 5

    I had a unilateral mastectomy 17 years ago. And then a few months after I finished chemo, I had reconstruction with tissue expanders, then "permanent" saline filled implants. My ps wanted to put in silicone implants, but I was trying to keep my risk to a minimum and insisted he used saline implants. I was not super-pleased with the results, but maybe that is because I went against his recommendation for silicon implants and got saline implants instead. It was nice to not have to use an external prosthesis after I got my implant.

    It was 2 surgeries. The first surgery to put in the tissue expander, and the second surgery to put in the "permanent" implant. I don't remember having any scans done prior to the surgery. I believe my implant was put behind the muscle. It felt very stiff for a long time after the surgery, and even now, sometimes it hurts a little.

    Now, 17 years later, I am looking at a surgery to remove the implant because I found out that it has been recalled because it might cause lymphoma. My understanding is that I do not HAVE TO remove the implant if I am not having symptoms/problems, but I don't like the idea of waiting to see if I get lymphoma. My new ps recommended either DIEP flap (which she would send me to a different doctor to have done) or getting a newer implant that hasn't been recalled. I can't get excited about the DIEP flap because of the amount of recovery time, but I'm a wimp. And I also don't want another implant, since I now realize they don't last forever, and I don't want another elective surgery as I get older. So, now I am about the have the implant removed and go back to using the external prosthesis. (I just need to decide what, if anything, I want to do with the other side.)

    Good luck to you. If you don't feel ready for the surgery, then take your time and make the decision you will feel good about.

  • kaynotrealname
    kaynotrealname Member Posts: 422

    Thank you all so much for your feedback. My surgeon's office called me today and we spent 45 minutes discussing my issues. Because of my thin size and lack of previous abdominal surgeries he is comfortable going in blind if I want a diep. There is a small chance of course that it won't work but not having to have a CT scan is a huge relief. The recovery also is expected to be a little shorter than I had read up on. Due to my health and size they are thinking three to four weeks. Granted, I still have an abdominal scar to worry about along with some numbness and possible bloating but they also told me an implant procedure isn't as simple as my research indicates due to the amount of time that has passed from my double mastectomy. I'd have to do expanders no matter what so that puts off my date of surgery. Plus my relative small size would mean that the final implants might be a little more noticeable. Lypo might help but aesthetically speaking it would be more challenging and he's more confident of a good result with a Diep. So in light of the new info and the elimination of the cat scan I've decided to again settle on the DIEP with understanding that if he gets in there and finds it's not possible that he puts in an expander, closes up my abdomen, and we go from there preparing for implants. Not excited but am comfortable that I am in good hands with the best most efficient plan in place.

  • meow13
    meow13 Member Posts: 1,363

    Had my single side DIEP April 2012, still looks good. There was very little discomfort or pain, I had more discomfort with the fat grafting in July 2012.

  • ubershop7
    ubershop7 Member Posts: 32

    Deip was recommended for me because I am a former smoker, and also to acheive symmetry due to the fact that I have little breast tissue at the pole. If I choose implant, I will need to do both breasts. With Diep, your breast will age normally. Deip is the way to go , but it is a long surgery. I was told Implants have a high risk of failure in bc patient. I am personally not ready for reconstruction, but when I do feel ready, I will do Diep. You should talk to PS about your concerns and ask for before and after photos.

  • kaynotrealname
    kaynotrealname Member Posts: 422

    Thank you both for your feedback!

  • clemmieluv
    clemmieluv Member Posts: 6

    Holy cow! I had fat grafting in 2017 and it was crazy painful...I'm glad to hear I wasn't the only one. Man o man,