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Flap Reconstruction - Decisions

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fd1
fd1 Member Posts: 57
edited April 8 in Breast Reconstruction

Hello all! I was diagnosed in 2012 and had a mastectomy with TE/implant reconstruction. In November, I had a biopsy (benign 🙏) on three tiny bumps on the reconstucted breast. Unforntunately, the wound became infected and the wouldn't heal so they removed the implant (which they then found was ruptured) and replaced it with a tissue expander. I had another infection in late January, spent a week in hospital on IV antibiotics. It seemed that it had cleared but a week ago it became infected again so they removed the TE. They will not try with the TE again as the skin was raidated in 2013 and is not in good condition.

I am left choosing between LD and DIEP flap. I actually am not even sure if I qualify for the DIEP yet as my BMI is 20. I am leaning towards LD anyway because I find the scar would bother me less (I love my stomach) and it seems to be an easier recovery. I have however read horror stories about shoulder issues. Is anybody out there happy with their Flap reconstuction? How did you choose what was best for you? Any important information that you wish you had when you made the decision?

To be clear, my implant reconstruction was ruined by radiation adn was not good cosmetically. I also had very little range of motion in my shoulder anyway. I am hoping to regain some with the implant removed once I am allowed to stretch in a few weeks.

Comments

  • mandy23
    mandy23 Member Posts: 111
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    Hi @fd1

    Really sorry for all that you have been through. Yikes.

    The MOST important thing when you make your reconstruction decision is the Plastic Surgeon. Be sure they have done many of the type of reconstruction you are planning on doing and they have happy patients.

    I have (kinda) had both flaps. Instead of a DIEP, I had the older TRAM flap which is quite similar after my 1st MX in 2003. In late 2022, I had a Lat Flap after my 2nd MX. In my case, I didn't want an implant, so my PS did it with just fat grafting. This is a fairly new option and can only produce a pretty small breast. Although the recovery was probably longer, if I had to pick, I would do the DIEP, as I liked my TRAM results better. That being said, you are in a different situation and it may be that you are too thin for a DIEP. I am also happy (so far) with my Lat Flap, but it is a work-in-progress. My PS did the Lat Flap part with my MX. Then last summer, I had my 1st fat transfer. Last week I had my 2nd fat transfer. The amount of fat reduces so it becomes smaller than it was. In your case, my guess is that you would have a Lat Flap with an implant? That might be a better solution for you, since it sounds like you don't have much excess fat. It would also likely be less surgeries. I did go to physical therapy after my lat flap on my breast surgeon's recommendation. That's probably a good idea. I had some tightness where the muscle was pulled around from the lat flap, but my ps did make a correction to it last week, so hopefully that will now be better. Not to discourage you, but just so you are aware…..the lat flap has a very long scar across your back. You might want to google some images of that, just so you aren't surprised by it. They usually try and put it so it will be under your bra band. I only mention it because you seem concerned by scars.

    I am happy with both of my reconstructions. They are not perfect, but they are good enough for me. However, I have a really good ps and I think that makes a world of difference.

    Good luck to you with your decision.

  • fd1
    fd1 Member Posts: 57
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    @mandy23 Thanks so much for your reply! My surgeon is very reputable as I am at a McGIll University teaching hospital (one of the best medical schools in Canada). He only does the Lat Flap. To do the DIEP, I woudl have to switch hospitals but even then I am not sure how good that surgeon would be. I have considered a consult in the US but I do think my BMI is too low. I know Lat Flap leaves a big scar on your back but DIEP leaves a large scar too. I think a scar on my back would not only be obviously less noticeable to me but also it is an area I care less about, if that makes sense. I really don't mind a small reconstructed breast if they are able to reduce my existing breast to be of similar size. I lived for a decade with the reconstructed breast smaller and very high up so this all could end up in an aesthetic improvement.

    I will admit the last four months have taken a huge toll on me emotionally. I am exhausted.

  • mandy23
    mandy23 Member Posts: 111
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    Hi @fd1 -

    It sounds like you will be in excellent hands with your surgeon! As long as you know what to expect, I think you will do fine with the Lat Flap. I'm sure they will be able to reduce your other breast for symmetry.

    It is all SOOOO exhausting isn't it? Once you get things scheduled, hopefully you'll be able to put a pin in it until the day it happens. I think the decisions are the hardest part sometimes. Once you make the decision, it is the right decision for you.

    Hang in there! You WILL get through all this.

    Take care.