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Diep vs Implants after partial mastectomy and mammoplasty

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meandmyittybitties
meandmyittybitties Member Posts: 4
edited March 2023 in Breast Reconstruction

Hi there, I was diagnosed with metaplastic TNBC in my R breast in Dec 2021 at the age of 32. I have since undergone 8 rounds of dense chemotherapy, a partial mastectomy and mammoplasty, radiation therapy and 6 rounds of capecitabine chemo pills.

I had a scare at my recent mammogram which required a stereotactic biopsy. My L breast has a 3cm thick dense calcification and fibrous tissue as well as cysts. R breast is fit and healthy apparently.

I have decided to remove both of my breasts and have reconstructive surgery. My trouble is I am unsure what route to take in terms of opting for implants or the Diep flap. Both have their pros and cons. Any personal experience on either would be so appreciated. Why you chose that option, are you happy with the results, recovery time, any complications or additional surgeries?

Thanks so much.

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  • mavericksmom
    mavericksmom Member Posts: 1,200
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    Hi, I had DIEP reconstruction of my left breast in 2019. It was difficult to recover from as it was three surgical site, cut hip to hip, the belly button is moved up and the breast. I had a lot of swelling and it took 7 months for my breast to stop bleeding and heal ( due to previous radiation). That said, the end result was great! I only wish they had done both breasts which I requested and was denied. ( long story) I would highly recommend the procedure especially for young women!

    If you live in USA, make sure your insurance company will pay for it as on the Learning page of breastcancer.org there is an article about changes in coding that now insurance companies are refusing to pay for DIEP surgeries. The out of pocket cost is well over $50,000.

    I am currently recovering from my exchange surgery on my right breast. This was due to my third time with breast cancer, not recurrences, but each was a new cancer. I can’t comment on final result as I have compression bandages from my breasts to my hips, I had abdominal liposuction as part of the implant process. I think I will be satisfied with this once I am fully healed.

    I am sorry you are going through this, and wish you the best as you move forward. I am very thankful for the options we have today and I am amazed at the positive changes since I had my first breast cancer 20 years ago!

  • meandmyittybitties
    meandmyittybitties Member Posts: 4
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    Thanks so much for your reply. Wow it sounds as though its been a tough run for you! So sorry to hear. I hope you recover quickly!

    The thought of new cancers occurring is what motivated me to make the decision to remove both my breasts. I couldn't imagine having to go through this whole process again. Thankfully I live in New Zealand and "most" medical treatment is free. I have an amazing oncology team that have been so supportive with my decisions and I am able to have the reconstructive surgery done through a private hospital, all government funded. I've not paid a cent in regards to any of my treatments apart from DRs visits which are $20 and prescriptions which are $5.. again government subsidised.

    I see my surgeon again in April and will go over both procedures in more detail. Its one thing getting the clinical facts from the professionals and a whole other thing hearing the real life experiences from real people. I was strongly leaning towards implants in the beginning but the more research I do and the more people I talk to the diep is a strong contender. I'm just worried about the recovery time. I'm a single mum with a 6yr old and only really have my 77yr old mum close by to help after the surgery. Its overwhelming trying to gather the info to make an informed decision.

    I agree, its amazing the advancements they've made in recent years!

  • mavericksmom
    mavericksmom Member Posts: 1,200
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    I am so glad you live in a country where medical care is covered! Unfortunately the USA is going backwards in health care, especially for women. We have excellent doctors but the politics is going backwards. It breaks my heart that women, especially young women, may no longer be able to have the DIEP surgery!

    The DIEP surgery took me longer to recover from than most women, especially young women like you. I would guess you should plan on at least 8 weeks.

    The surgery itself is long, mine was 8 1/2 hours and I only had one mastectomy done. I spent three days in the hospital. I was supposed to stay one more day but my doctor discharged me early so I could get home before a snowstorm. I lived an hour away from the hospital.

    You will need additional surgery if you want revision and nipples. I didn’t have nipple sparing mastectomy but maybe you can have that with a DIEP.

    I can tell you that even though I didn’t have revisions or nipples added at the time, I was extremely pleased with the outcome. As I said. It is a rough recovery but worth it.

    You are much younger than I am so you should be able to recover faster than I did. Actually my recovery issue was due to difficulty with my breast skin healing due to having been burned by radiation when I had breast cancer in 2003. If you had prior radiation it could be an issue but if you didn’t, you shouldn’t have a problem with your breast skin healing.

    I have 4 young grandchildren. You are smart removing both breasts regardless of your reconstruction choice! That is the most pro active thing you can do to allow you to be cancer free and live to see your son grow up and have children of his own! Six years old, such a wonderful age! Can you tell, I absolutely adore children!

    Again, I wish you the best. If you have any questions I can help answer in the future, you can always PM me! I don’t have all the answers but always happy to offer support!

  • serendipity09
    serendipity09 Member Posts: 769
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    Hi Mavericksmom!!

    meandmyittybitties - I had a BMX with immediate reconstruction with TE's. Nine months later I had my exchange to implants and four days after was dx'd with a recurrence. Talk about a slap in the face. Having a BMX does not mean you will not end up with a recurrence or a different diagnosis. It's impossible for the surgeon to get every single cancer cell that may be lingering around. I don't tell you that to scare you, I promise. I did 5 weeks of radiation which damaged the implant and I ended up having a DIEP (I'm about 6.5 months out). It is a long surgery, and recovery can be challenging, but it is very doable. I'm still struggling with a few issues and am scheduled for surgery again in May. Please be sure to get as much information as possible. Find a surgeons who specializes in DIEPs. Get a 2nd and 3rd opinion for both surgeries. Both my surgeons were amazing. I would never have done the DIEP had it not been for the rads damaging the implants. It is nice to have a flat belly, but then again, my belly wasn't that big to begin with. I really liked my body before and now it is different. Not a bad different, but def a big change for me.

    Best wishes to you and that everything work in your favor!


  • meandmyittybitties
    meandmyittybitties Member Posts: 4
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    Hi, thanks for your reply serendipity09. Wow that must have been a huge slap in the face alright, so sorry to hear that. I hope you're doing well now?

    I know that having a BMX does not completely eliminate the possibility of a recurrence, but it vastly decreases the likelihood of developing a new cancer so the peace of mind for me outweighs that. I'm told that no matter what, I will be closely monitored as my diagnosis was very rare especially for my age and that there was no evidence of cancer in my lymph nodes and the margins were clear so that gives me some hope that a recurrence is less likely.

    I chose to go this route as my left breast is riddled with calcifications, fibrous tissue and cysts. I'll be needing regular biopsies and even more regular check-ups to track any changes. Its been a long hard journey so far so this feels like the right decision for me going forward. Also my mum has had BC twice, even though I don't carry the inherited gene I'd rather take action to decrease the risk factors.

    Because I live in NZ there are only a handful of doctors who can perform the diep procedure, I am seeing surgeons and plastic surgeons who specialise in breast reconstruction after cancer so they are dealing with cases like these on a daily basis. The hospital I go to has a specialised breast clinic, so they are all experts in that field.

    I had radiation back in Nov/Dec and my skin held up pretty well with only minor skin breakdown in the armpit area.

    Did you have both breasts reconstructed with diep? I'm wondering if I have enough belly to be able to do both, I mean I have a bit of a belly but I don't know if it will be enough. I went from an F cup to a C cup after surgery and love the size. I wouldn't be opposed to going a tiny bit smaller but not too much as I'll look out of proportion.

    mavericksmom, I currently only have one nipple any way haha. After surgery my nipple turned black, dried up and fell off. I still have the areola but the pointy bit is gone. Doesn't bother me at all. Its quite a good party trick actuallyHappy

    I did recover pretty quick from my last surgery. I was back to doing my normalish household things within a week, just a little more carefully. I went to physiotherapy 4wks post op and got told I didn't really need to be there, they gave me a few exercises to help with strengthening my muscles but that was it. Fingers crossed I heal just as fast after the next surgery.

  • serendipity09
    serendipity09 Member Posts: 769
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    meandmyittybitties (love the name btw lol). I'm doing well, thank goodness, NED. I pray it continues that way.

    I chose the BMX because every little lump or bump was going to put me through some serious anxiety. I knew that any lump/bump would through me in a frenzy, so I get it.

    Sounds like you're in good hands!

    I did have both sides reconstructed. I was a D cup prior to my diagnosis and with the implants. I was told I had enough belly fat/tissue for a small C cup, but I feel like I'm on the larger side of a C cup. My left side (non-cancer) is hanging naturally and is bigger, but has a dent from the flap scar which somewhat flattens my breast. I'm not happy with it and will be corrected in May. My radiated side sits up higher and is nice and perky. My flap scar actually healed much quicker than the non-cancerous side.

    Feel free to PM with questions.

  • meandmyittybitties
    meandmyittybitties Member Posts: 4
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    serendipity09... haha thanks, it took me sooo long to find a user name that wasn't already taken.

    Yay that gives me hope! I'm happy with a small C cup, I hope I have enough belly for it! My left side is bigger as well, my right side shrunk a bit with the radiation. Its not super noticeable if you don't know, but i can definitely tell. its also slightly firmer. They used breast tissue from the bottom of my boob to fill the cavity left after the cancer was removed [7.1 cm] and after the radiation that tissue has significantly firmed up and I can feel a large lump there. Freaked out when I first felt it but its been thoroughly checked and its just one of those lovely side affects of the radiation.

    Oh I totally feel you on the lumps and bumps causing anxiety! Ever since I was a teenager I've had lumpy boobs and with my mums BC history I've been having biopsies since I was 17

  • tntbayer
    tntbayer Member Posts: 2
    edited April 2023
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    I had R mastectomy with implant reconstruction, 2011. Reoccurrence in the skin on mastectomy side, 2014. Had chemo, radiation, oophorectomy. Now I am scheduled for DIEP flap reconstruction in June, the implant after radiation became encapsulated, hard, very high on my chest. I feel very comfortable with my surgeon, Will be done at Brigham and Women's in Boston. I'm wondering if anyone has come across sites related to financial support. I'm a physical therapist and will be out of work 12 weeks unpaid, as my surgeon has restrictions for no lift/pull/pushing over 10 lb * 12 weeks.

    I've been told I'll be in the hospital for 4 days, can't drive for 3 weeks, will have three drains, two in my abdomen and one in my chest wall.

    Thanks in advance for any and all information!

  • thairpist
    thairpist Member Posts: 4
    edited April 2023
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    Hi to all...I had DIEP flap reconstruction of both breasts 7/20....My plastic surgeon was great. While I will admit that it wasn't fun I would say that the recovery was easier than expected. I had some issues with healing..but all in all I am so happy with the results! I had expander rejection on my radiated side so I was not able to have implants. I got tattoos and they actualy look great. I am wiling to send pics to anyone who is considering this surgery. It's very doable...I think all the treatments were worse. Let me know if you have any questions!