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Three-Stage DIEP?

I'm scheduled to have my implants removed next month as part of my post-mastectomy DIEP. However, the Stage I and Stage II I see described in many posts isn't what my PS has planned.

My Stage I surgery is only on my abdomen - something about isolating the blood flow to the tissue that will be transferred, so the remaining tummy tissue has an opportunity to regrow blood flow before the big surgery. Then my Stage II seems to be the Stage I described by others, and then my PS has a Stage III which is fat grafting and scar revision if necessary.

My PS, whom I trust completely, says doing some of the microsurgery in a separate surgery leads to healthier tissue, fewer complications, and a quicker recovery. Does anybody have experience with this scheduling? I'm curious what to expect after the first surgery.

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Comments

  • ratherbesailing
    ratherbesailing Member Posts: 117

    I wouldn’t pretend to know whether your surgeon’s technique is a better approach. And it is difficult to understand exactly what the first stage entails. But I wonder if the extra first stage means another round of general anesthesia and another round of downtime while you recover.

    Do you know how many times s/he has performed DIEP this way? Are there any studies showing a benefit to the method? Are they, perhaps, working on a study themselves?

    It may be a good way to go, and I understand trusting your doctor. But I still would ask more questions - including what to expect in recovery from the first stage - and also get a second opinion.

    Hope it all goes well for you. I think most women who have DIEP are happy with the end results.

  • kaynotrealname
    kaynotrealname Member Posts: 346

    Ratherbesailing has a great response. Three times under anesthesia seems a little much. I could only tolerate it once when I went for a DIEP. But then I had gone under with my double mastectomy, too, six months earlier so I was just done. Luckily my PS did good enough the first time around for me to be completely satisfied without going under again. Anyway, what you PS wants to do sounds involved. I've never heard of it before so I would check around.

  • nns121317
    nns121317 Member Posts: 102

    I had my pre-op appt today, and it came with a little more information. In the first procedure, the PS will make incisions in my abdomen, separate my skin and fat from my abdominal muscles, and curtail blood flow to the flap so it's only receiving blood from vessels he intends to transplant. Then we'll wrap it up with some drains and let it sit for 10 days before the standard Stage I procedure, which for me will be about 5 hours shorter.

    The advantage is that by the time we do the actual transfer, the tissue has grown accustomed to using only the transplanted vessels for blood flow, so there's less shock to the tissue - and if any of it gets hard or necrotizes, he can just trim it before it's transplanted up top. He is a reconstructive surgeon (hands, burn injuries, and breast reconstruction) and frequently uses similar methods on other types of tissue grafting. He does 2-3 DIEPs per month using the same procedure I'll have, and feels like splitting it into two shorter surgeries (plus fat grafting/revision down the road, if necessary) is better than one long period under anesthesia. I suppose if I had ever had any issues with anesthesia, I might feel differently about that, but I've only ever woken up happy and hungry and ready to go.

    I definitely feel excited after chatting with him! I wanted to report back in case anyone else underwent a similar process.

  • ratherbesailing
    ratherbesailing Member Posts: 117

    Sounds as though you got a lot more info, and happy for you that you're moving forward. Do give us an update!

  • nns121317
    nns121317 Member Posts: 102

    I had my first surgery yesterday. The surgery went well - the surgeon cut my flaps, then isolated four blood supplies on one and three on the other. I'm stiched back up, and will have the actual DIEP on 2/20. I had a bad experience in recovery due to excessive pain meds, but today I'm up and moving around with only Tylenol. I'm wearing a binder, so I haven't looked at my incisions yet, but tomorrow I can shower so we'll see then.

  • mavericksmom
    mavericksmom Member Posts: 1,048

    nns121317, interesting! I had a traditional DIEP in 2019, it was all in one including the mastectomy. Medicine is always evolving, so maybe this is the newest advancement in DIEP? Do you live in USA? Once we have DIEP surgery, we never really think about advances in the surgery.

    My only regret is that I didn't ask more questions. I thought moving my belly button up had something to do with blood supply. Turned out no, just to look normal. I understand that for a woman who wears bikinis or wears clothes that expose that area of their bodies, but I am older and no one except doctors see that area of my body so I wish they would have just taken the belly button out altogether. It is hard to ask questions when you don't know about an issue to even ask!

    Thanks for sharing and wishing you the best as you move forward and continue your surgeries.

  • nns121317
    nns121317 Member Posts: 102

    Mavericksmom, I wish I could have had the DIEP at the time of my BMX, but in 2021 it wasn't possible due to COVID protocols. I am in the USA. I will say that my surgeon is truly a reconstructive surgeon - think burn patients and mangled hands, plus cancer reconstructions - and so I think keeping transplanted tissue alive is paramount to his practice. The documents I signed also specified that doing the surgery in more steps allows him to do the surgeries without a second surgeon, which is interesting.

    I did uncover my incisions today, and all looked well. It's hard to imagine what I'll look like without the belly he dissected, but I suppose I'll find out in a week!

  • mavericksmom
    mavericksmom Member Posts: 1,048

    nns121317, I forgot about Covid protocols! I assume the mastectomy was not considered elective, but the reconstruction was. I am so sorry! Sounds as if your doctor is excellent and you are in good hands! Wishing you a great outcome!

  • nns121317
    nns121317 Member Posts: 102

    My DIEP was completed on 2/20. Surgery took 14 hours, and the only item of note was how far back they had to dissect the nerves in my breasts - the implants had left the surrounding nerves "bruised and swollen". It was on both my radiated and non-radiated sides.

    The first couple days of recovery were intense. The ICU room temp was maintained at 85, I had to have three blankets covering me at all times, and I had a Bear Hugger on (think an inflatable pool lounger that's being filled with hot air). I was constantly dripping sweat, and it was miserable. I have a heart condition from chemo, and the tachycardia from the heat and dehydration was terrible. I also probably received too many pain meds, because the nurses didn't see the doctor's note that I take gabapentin instead of narcotics for pain. It also took me a long time to get the anesthesia out of my lungs, and I was on oxygen for awhile. All in all, those first couple days were intense, and I don't even think I remember them fully. I wanted to sleep through that hell, but couldn't because they checked my flaps every 15 minutes with the doppler.

    48 hours after surgery, I was out of ICU to a room with a more reasonable thermostat and no Bear Hugger. The change in climate made a lot of difference, and I started to eat again. I worked on my lungs and my mobility, got my heart under control, and discharged on Friday afternoon following a Tuesday surgery.

    I've been home for three days now, and things are going alright. I came out of the OR with four drains, two were removed before I left the hospital. I also have a wound vac across my abdomen. I can't stand fully straight yet, so I use a walker for longer distances to save my back (trouble there is from prior trauma). My non-radiated breast doesn't hurt at all, and is a perfect, warm, natural breast. My radiated breast likes to be special, and it's still pretty tight and riding quite high. The incision is pretty dusky, and it has a giant blood blister. It is improving, but will just need more time to settle down.

    I am so glad I did this. I felt completely vindicated when the surgeon noted how jacked up the nerves were surrounding my implants, and I already feel much, much better compared to when the implants were in. I'm only 44, and I feel the flaps give me a natural, permanent fix which will allow me to move forward from this awful diagnosis and treatment.

  • ratherbesailing
    ratherbesailing Member Posts: 117

    Nns, so happy for you!

  • mavericksmom
    mavericksmom Member Posts: 1,048

    @nns121317 I am so happy for you! Yes, difficult surgery, but well worth it! I had skin healing issues from being radiated, but I am not sure if that is the same for all who have been radiated, or if it was because I was burned so badly, jelly bean size blisters and sloughing off of skin, when I had radiation.

    You are young and this was a great choice for you!