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Topic: Implants failing -- help on flap options?

Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.

Posted on: May 21, 2018 09:18AM

marketingmama wrote:

Hello Ladies. It's been a while since I've been on the Boards. I've had multiple surgeries to fix implant issues: bottoming out, contracture, etc. I'm starting to contract again on one side and I'm just sick and tired of the discomfort and am thinking that implants won't work for me long term. I have a consult with Joe Serletti at Penn this week (my PS helped get me in). We will discuss flaps but I can't do anything with the tummy as I've had surgeries there. I am not slim so I could certainly have a flap from my legs or bottom. I've got fairly heavy thighs and hips. So a few questions. I had a nipple sparing BMX originally and am wondering if I can keep my nipples if I go with a flap. What non-tummy options are most successful typically, especially if I want to get to a full C? If I'm only contracted on one side would they leave my implant in on one side and only do a flap on the bad side? That seems weird to me in terms of symmetry. Appreciate advice from ladies who have done non-tummy flap procedures. Thanks so much!

Dx 12/2014, LCIS, Both breasts, 0/5 nodes Surgery 5/19/2015 Lymph node removal: Left, Right, Sentinel; Prophylactic mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 8/23/2015 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 9/18/2015 Reconstruction (right) Surgery 11/29/2015 Reconstruction (right) Surgery 2/10/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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May 21, 2018 02:04PM Lula73 wrote:

hi markwtingmama- I’m sorry the implants haven’t worked out. No they don’t have to leave one side an implant unless you want them to. You can have a matched set. And you can keep your skin and nipples. Previous abdominal surgery does not rule out being able to do DIEP unless it was a tummy tuck you had done. Here are the important things to look for in a microsurgeon PS for flap procedure:

1) how does he address the changes to the lower half of the body after stage 1 (they should address it, if they say they don’t or say something like they do it right during stage 1 so nothing’s needed later, keep looking for a PS),

2) how many of this particular procedure does he do in a year (minimum of 52 a year, preferably 100),

3) can he show you more than 2 or 3 before & after photos of his work (not his partner’s work or anyone’s else’s) on patients who had the same surgery as you’re looking at having. If you would not be happy with those results in the photos for yourself (not just happy considering you’ve had BC and trouble with implants), keep looking for a PS

4) is breast recon his primary focus or does he do a bunch of other procedures too? (breast recon needs to be his primary focus)

5) google the surgeon’s name and put in the names of different procedures you’d be a candidate for (ie Joe Serletti Penn DIEP, Joe Serletti Penn SGAP) and see what comes up.

6) google the surgeons name, location and reviews. Then read the reviews. The good the bad and the ugly. Let those sink in. (If the doc has a lot of bad reviews on his work or you don’t like what you’re reading, keep searching for a PS)

I know nothing about the dr you’ve been referred to except for when I did those exact google searches online just now. I went to NOLA and I would do it again in a heartbeat. Most women travel for their flap recons. It’s not a big deal to do the travel. I’m posting a link to their site below. Great explanations on the different types of flaps and plenty of before & after photos. (NOLA is one of the top centers for flap recon in the world). I’m also posting a link to a great talk by Dr Dellacroce from NOLA that he did at an international conference of microsurgeons. Well worth the time to watch it and take note of the different procedures he talks about and the pros and cons of each. Feel free to ask any questions you think I might be able to andwer

www.breastcenter.com

https://m.youtube.com/watch?v=lGmoI21Tfbc


-Lula Dx 1/2017, DCIS/IDC, Right, 1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 2/14/2017 Lymph node removal: Sentinel; Mastectomy: Left, Right; Prophylactic ovary removal; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 3/3/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 11/1/2017 Prophylactic ovary removal Hormonal Therapy 1/3/2018 Femara (letrozole)
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May 21, 2018 02:16PM marketingmama wrote:

Lula, thank you so much for detailed response. So incredibly helpful. I did have an abdominoplasty previously so definitely can't do DIEP. I've googled Serletti extensively but I need to meet him and talk with him (and ask all the questions you've mentioned). He is the Chief of PS at Penn and primarily does breast reconstruction. I believe his team is also very well regarded but need to learn more. Read a ton about NOLA and must admit that I'm hesitant due to the need to travel (and added costs), but will definitely consider. Just thought that given Penn's reputation...I might have a great resource in my hometown. Have had so many surgeries that I'm just a bit weary... Need to focus on trying to get myself fixed once and for all.

Dx 12/2014, LCIS, Both breasts, 0/5 nodes Surgery 5/19/2015 Lymph node removal: Left, Right, Sentinel; Prophylactic mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 8/23/2015 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 9/18/2015 Reconstruction (right) Surgery 11/29/2015 Reconstruction (right) Surgery 2/10/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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May 21, 2018 03:14PM Lula73 wrote:

Definitely meet in person, definitely insist on seeing photos. If there’s one thing I’ve learned in life, titles don’t always tell the whole story. Sometimes they’re well earned, sometimes it’s given to the only one who would agree to take on the added responsibility. And titles can also mean that they only do the “big part” of the surgery leaving the rest to PAs or residents. In the case of a flap surgery that would be the actual reconnectionbof blood vessels after the tissue is transferred to the chest, leaving others to handle the opening incisions, harvest of tissue and closing the incisions...the things you actually see when all is said and done. Just check anyone you’re considering out thoroughly is all I’m saying. Definitely consult with more than 1 PS too. Most centers including NOLA have a Hope lodge nearby that offers free housing for traveling cancer patients undergoing surgery/treatment in their area, so that just leaves plane tix/gas money as expenses. Thatcould open up many different avenues for you.

-Lula Dx 1/2017, DCIS/IDC, Right, 1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 2/14/2017 Lymph node removal: Sentinel; Mastectomy: Left, Right; Prophylactic ovary removal; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 3/3/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 11/1/2017 Prophylactic ovary removal Hormonal Therapy 1/3/2018 Femara (letrozole)
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Sep 1, 2019 08:07PM Olinda1 wrote:

suffering from repeated contracture of implant. PS recommending Diep surgery. Worried about abdominal weakness. So tired of discomfort and feeling discouraged.

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Sep 1, 2019 08:43PM Moderators wrote:

Dear Olinda1,

Welcome to the BCO community. We are sorry that you are having these issues. We hope that you can find some support and helpful information here from the shared experiences of our members. This particular thread has not seen recent activity. There are a number of other topics that address the DIEP surgery, one of which is DIEP Surgery 2018. Despite the fact that it is 2019 it still sees a good number of posts. Let us know if you need more help navigating your way around the boards.

The Mods

To send a Private Message to the Mods: community.breastcancer.org/mem...
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Sep 1, 2019 09:31PM HopeWins wrote:

hey Marketingmama - I, like you, was hesitant to travel. While the NOLA Drs are undoubtedly doing hundreds of these procedures annually, there are plenty of other highly capable PSs doing flaps, especially in metropolitan areas.

I just did DIEP with a surgeon in Baltimore who has done 3000 in his career, so its not only being done in NOLA. that being said, understand your options and it is important to have a PS highly experienced with your specific procedure. I changed hospitals specifically for the PS, so I get it. I just didn't see the need to fly for care. Im sure you can find a PS within a few hours of Philly with the experience you seek. Keep this in mind - every PS I spoke to will steer away from procedures they have less experience in, and towards those they prefer. Its subtle but it's apparent. To an extent, know what you want walking in, and know what the PS is good at walking in. Take in what they have to say about the procedures for which they are SMEs. Take with a grain of salt what they have to say about procedures that are not their bread and butter.

If you cant do DIEP, I think you would have Latissimus flap, SGAP and TUG as options.

If I couldn't do DIEP, personally, my next preference would be SGAP. It would take the upper love handle/flank area and lift the butt. On the downside I have heard that some women experience a shark bite effect from the tissue transfer. I would just advise to ask about expected incisions, impacts, etc. Ask to see pictures. My PS is also experienced with this procedure, so let me know via PM if you need a referral for a second opinion.

I think Lat flap includes muscle, but I'm not certain. It wasn't a consideration for me but may be worth looking into. Its the upper back/side boob area.

If TUG is a possibility for you, again, just ask about all the potential impacts. I'd be afraid of the recovery. I'm 10 days out from DIEP recovery and it's mostly abdominal but I cant imagine the pain of sitting after TUG... it's not as common, so I encourage you to seek feedback from others. If TUG makes the most sense for your body, you can do it. Just go in eyes wide open. Best wishes to you in your journey!

There is an active member here who has done both DIEP and SGAP so hopefully she'll weigh in

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Nov 7, 2019 11:01AM - edited Nov 7, 2019 11:02AM by MaudeB

Hello!

I am 6 weeks out, post Stage 2 DIEP with Dr. Trahan in NOLA. I flew to NOLA in June for phase 1 and again in Sept. for phase 2. I am 64 and had a bi lat mast in 2016, implants that I found very painful, and wanted to have DIEP. I am very very pleased with Dr. Trahan's care and skill. My results are beautiful. He told me the truth about outcomes, appearances, pain and expectations. Everyone down there from my anesthesiologist to my nurses were excellent with me and cared for me very well. Before and after the surgeries, while back home, there was constant contact with Dr. Trahan's staff for questions and I sent photos to document my recovery and I felt well monitored.

I am outside Phila. and I did 2 years of research with PS/breast reconstruction Docs all around my area (Baltimore too) and there is no question that I made the right decision in going to NOLA. You need expertise in the microsurgical procedure, and compassion and I could not find BOTH in my area. Docs I spoke to in the northeast wanted to push me toward other procedures, (without valid medical reason), that apparently they were more familiar with, but would have impacted my strength and use of my arm. They recommended LAT flap, SAG flap, moving implants above my muscles, etc. One chided me for wanting a 13 hour surgery (DIEP) because my implants were "cold". Being cold was reason 11 on a long list of implant problems I had shared, like constant pain, muscle animation, loss of strength in arms. I was also a perfect candidate for DIEP, and my being in pain from my implants was taken seriously at NOLA. And, BTW at NOLA it was a 6 hour procedure to do both breasts. This is what they do all day every day.

I am very pleased with how it all went, but there are a few things I might do differently if I had known in advance. The travel is something you have to treat as an additional factor and have respect for the wear and tear of flying, hydration, nutrition while being in a hotel, etc. I had my husband and adult daughter with me for phase 1 and we found an Air BNB so they cooked for me and we kept things healthy and fresh. I would make SURE to plan in extra days for phase 2 to stay down there and give yourself some recuperative time - despite the urge to get home to your own nest. Also, I would meet with your PCP before you go and make sure they will be ready to help if you pop a stitch or are worried about an infection - it is good to have local backup if needed. I was impressed at how caring my PCP was and how willing to help me no matter what. That vague feeling of "This surgery was done out of town, am I stranded when I come home?" is not something to be concerned about. Take the warnings to go slow and rest very seriously.

Phase 1 was 3 full months before I was back to my normal energy, stamina, mood, clothing choices. The first month is astonishingly low energy and dedicated to recovery mode. Naps mid day, resting, and someone needs to cook for you and help around the house. Dragging wet laundry over to the dryer - no. Lifting grandchildren - no. Lifting pots of water for spaghetti - no. By 3 months you have your life back though. Phase 2 was more difficult than I thought it would be - fatigue, incisions, etc. But it resolves much more quickly and by week 4 you are feeling like yourself. I'm very happy with NOLA and Dr. Trahan. I am very happy to answer any questions I can, honestly and openly, if I can be of help to anyone who stands where I have been in this decision. I wish you all peace and comfort and safety.

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Nov 8, 2019 09:31AM Bshine wrote:

Hi everyone. I had a DIEP in June 2019 and my PS is Dr. Hani Sbitany in New York City. He did an amazing job and I am very happy with the results. He is affiliated with Mt. Sinai (was previously in San Fran), which is one of the top hospitals in the US and I received great care. The surgical recovery is a process, and as MaudeB writes, there is a lot involved. But overall I am thrilled with the result. Dr. Sbitany also specializes in breast reconstruction, and does a high volume of flaps in his practice, and i really think thats the key....going with a high volume specialist. Best wishes to everyone!!


Dx 6/2019, DCIS, Right, 1cm, Stage 0 Surgery Mastectomy: Left, Right; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Nov 8, 2019 09:24PM MaudeB wrote:

Great points Bshine! I wanted to add that the nursing and care staff are very important too, and when considering where to get treatment keep this in mind too. My microsurgical results were monitored via Doppler every few hours to ensure blood flow was well established. I had 5 drains for phase 2 that had to be managed and outputs measured. I would work hard to seek treatment from a surgeon or facility who had done lots and lots of these flap procedures. Best to all

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