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Topic: Implant vs Diep Flap Reconstruction.

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

Posted on: Dec 11, 2019 07:17PM - edited Dec 12, 2019 07:03AM by Jkr

Jkr wrote:

I had a lumpectomy on right breast followed by radiation last year 2018 for DCIS and was diagnosed with another DCIS by biopsy Oct 21, 2019 post MRI same on right breast. I am a BRCA2 mutation gene carrier so I decided to go for double mastectomy this time as all medical team had advised me since they found I was a gene carrier last year.

I just came back after I saw my OS and PS today to plan for double mastectomy and immediate breast reconstruction. I preferred to have Diep Flap if I have enough tissue in my tummy because it is my own tissue and I think it will be more natural and comfortable in a long run. I think it is worthy even with longer period of recovery after longer surgery but my PS said my boob size will be 2/3 or half if I do Diep flap as I don't have enough tummy to donate. I am 5'4" (163 cm) and 121 pounds (55 kg).

They seemed to advise me to go for implant reconstruction if I want to have adequate size of boobs and my PS said she might have to use some latissimus to replace radiated tissue in right breast. My skin has recovered very well over 1 year after radiation last year but my PS was worried about delayed healing and infection with implant option.

I could not decide what I can choose so they gave me a week. I will see them again next Wed.

I prefer Diep Flap if my boobs won't be too small after the surgery. I am 48 and size of my bra is 32B. I love playing golf in Summer. I play golf almost everyday whenever I am off. I am a nurse and work 12 hr shift so I have day off 3-4 days/wk.

What I am worried about if I go for implant reconstruction is I might feel uncomfortable with implant and might have to have another surgery in 10-20 years (?) to replace old ones. The benefit with implant is better looking with bigger size that I am interested in but my activities with golfing is also important as well.

Can you please advise me or share with your experience to help me to decide ?

I would like to link youtube videos of Diep Flap surgery and I think it is useful for those who would like to watch the whole surgery but someone might not tolerate to watch this.

https://youtu.be/wNYuPK32pXo

https://youtu.be/lGmoI21Tfbc

Dx 3/27/2018, DCIS, Right, <1cm, Stage 0, Grade 2 Surgery 5/1/2018 Lumpectomy: Right Radiation Therapy 6/12/2018 Whole-breast: Breast Dx 10/21/2019, DCIS, Right, Stage 0, Grade 3
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Dec 12, 2019 05:23AM purple-flower wrote:

Hi there. What did you decide? I am in very similar boat, and PS insisted that not enough fat for 2 boobs, only 1. ha ha. I think I have enough.

You may think this is weird, but I'm going in for implants to replace tissue expanders in an hour and still sitting here wondering. All in all I think the implants will feel fine once settled, but it's the longer term issues I worry about. That said, I have a few friends who have done the diep, and the surgery is no joke, and there are long term issues with it also like numbing of stomach, nerve pain ,etc.

I am freaking out a bit thinking I should have insisted to go the other route. sigh.

Having bc overall really sucks.

PS


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Dec 12, 2019 06:43AM Jkr wrote:

Thank you purple-flower ! I hope you have a smooth one today. Most likely I am going for Implant and thinking to save my tummy in case I have problem with implant (feeling pain, uncomfortable etc) in the future. I am 48 now but I would not care much about boob size after 65 I guess but I am worried how I tolerate a long surgery with Diep Flap and wound healing when I get older so should I go ahead with Diep flap even with small size at younger age ?

For implant, I will tell my PS I prefer not to use my latissimus to replace radiated tissue for right breast as I am worried it will affect my golf swing. PS told me yesterday she may try without taking lat to see wound heals well otherwise I have to do another surgery with lat graft. My skin and tissue usually heal well but If it is really necessary, then it should be taken from left side. I checked with my hubby last night and I feel I need more strength in right side for golf swing.

Dx 3/27/2018, DCIS, Right, <1cm, Stage 0, Grade 2 Surgery 5/1/2018 Lumpectomy: Right Radiation Therapy 6/12/2018 Whole-breast: Breast Dx 10/21/2019, DCIS, Right, Stage 0, Grade 3
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Dec 12, 2019 07:37PM milkyway2 wrote:

go for Diep ,its a long surgery but its worth it i had mine in Toronto general hospita

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Dec 12, 2019 08:53PM Jkr wrote:

Thank you for your advice. I would love to do diep flap but I will be A cup if.My surgeons are at Sunnybrook. They are excellent but I don’t have enough tummy.

Dx 3/27/2018, DCIS, Right, <1cm, Stage 0, Grade 2 Surgery 5/1/2018 Lumpectomy: Right Radiation Therapy 6/12/2018 Whole-breast: Breast Dx 10/21/2019, DCIS, Right, Stage 0, Grade 3
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Dec 13, 2019 10:52AM Bubblybubbles_1 wrote:

I am in the similar boat as you. I am planning to have Double Mastectomy and Breast reconstruction with nipple sparing/skin sparing surgery at the same time. I choose silicone implants because of few reasons A) Recovery is way faster than DIEP flap B) Why go through a big surgery when I can have nice breast with implants? Just my personal thought C) I am not eligible for DIEP flap as not enough tissue to create C cup. D) I have a gene mutation that can create blood clots. After surgery, I just can not have a blood clot in my veins in breast as this can cause issues and later I might have to remove that fat and go for implants (so 2 surgeries)

After reading your post, I literally thought "did I write this?" haha. My case is very similar to yours and I am also in Toronto (Waterloo, ON) and my surgery is planned for Feb 19th :)

Good luck with your decision.

Dx 5/25/2018, Right, 3cm, Stage IIB, ER+/PR+, HER2+ Chemotherapy 6/13/2018 AC + T (Taxol) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Dec 13, 2019 11:18AM - edited Dec 13, 2019 11:18AM by mightlybird01

I am 50, 168cm height, and weigh 59 kg. I have had A cups my whole life and never felt too small. I loved my small boobs. Much less to get in the way for any type of sports. I just had a UMX and chose no reconstruction. Instead, I wear a bra with a breast form if I want to. It feels great and to me totally normal, even after just 5 weeks out of UMX. I would say for your size and weight, A cups would look perfectly fine.

Dx 4/12/2019, IDC/IDC: Medullary, Right, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2- (FISH) Chemotherapy 5/21/2019 AC + T (Taxol) Surgery 11/7/2019 Mastectomy: Right
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Dec 13, 2019 11:54AM - edited Dec 13, 2019 11:55AM by Jkr

Hi Bubblybubbles 1,

Thanks for sharing your story. It will be helpful for my decision. Let's stay strong ! I feel sorry for you and myself.


Dx 3/27/2018, DCIS, Right, <1cm, Stage 0, Grade 2 Surgery 5/1/2018 Lumpectomy: Right Radiation Therapy 6/12/2018 Whole-breast: Breast Dx 10/21/2019, DCIS, Right, Stage 0, Grade 3
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Dec 13, 2019 12:04PM Jkr wrote:

Thank you Mightlybird1.

That was what I thought before I saw two surgeons but I was thinking that the purpose of plastic surgery is to look good. Otherwise I don’t even need to be bothered to have this. But I am still interested in Diep Flap option with small size. Thank you again for your advice

Dx 3/27/2018, DCIS, Right, <1cm, Stage 0, Grade 2 Surgery 5/1/2018 Lumpectomy: Right Radiation Therapy 6/12/2018 Whole-breast: Breast Dx 10/21/2019, DCIS, Right, Stage 0, Grade 3
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Dec 13, 2019 02:00PM OnTarget wrote:

I haven't golfed since college and I wasn't an avid player so I am not the best judge, but I don't think my implants would interfere with my swing.

I am 5'9" and I have 600cc implants, which are about a D in width and a C in depth.

They aren't perfect, but they're kinda growing on me. I wanted bigger boobs than I carried around for the first 40 years of my life. The second 40 is going to be with boobs that stick out enough to be reasonably noticeable to me and maybe fill out shirts a little better. I wish they weren't so flat, but otherwise I'm ok with them now.

Diagnosed at 42, Oncotype score 16, ITC in one node- considered node negative Dx 4/8/2019, ILC, Left, 3cm, Stage IB, Grade 2, 0/3 nodes, ER+/PR+, HER2- Dx 4/23/2019, ILC, Right, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- Surgery 5/15/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 6/14/2019 Zoladex (goserelin) Chemotherapy 8/6/2019 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 11/6/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Dec 13, 2019 02:01PM mightlybird01 wrote:

Jkr, when I had my breast form and bra fitting the other day, there is also the option that you can augment your breasts with breast forms. For example, if you would do the DIEP flap and end up with A cups, but for some occasions you may want to look bigger, you can augment the A breasts with some breast forms, that can be custom fit to whatever you have naturally. My insurance would carry the costs of the augmentation breast forms too. Maybe something you can think about too.

Dx 4/12/2019, IDC/IDC: Medullary, Right, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2- (FISH) Chemotherapy 5/21/2019 AC + T (Taxol) Surgery 11/7/2019 Mastectomy: Right
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Dec 13, 2019 03:35PM Lanne2389 wrote:

Hi Jkr

I had BMX with tissue expanders, then went through radiation. The expanders were about 500cc when put in and I added about 100cc on each side after radiation. (I’m 5’11” 185#) I had a v v hard time with the expanders as I seem to have a more sensitive chest than most. I originally planned on implants but when I saw my PS to set up the swap, he mentioned DIEP. Since I hated the expanders (painful, always felt cold in/on my chest and felt bolted on) I decided to switch to DIEP. Still had sensitivity but it’s getting better and they feel like real boobs - warm and soft. I had a very long surgery bcs of complications with arteries on my radiated side, and unfortunately that boob did not “take” as much as the other side - they’re about 2 cup sizes different. I’ve taken 18 months off from dealing with it all and will be seeing my PS soon to see what a stage 2 surgery and fat grafting can do to even things out. I’ll probably end up as a B cup but after 50 yrs with “J” sized boobs, it’s fine with me. Even with complications, I’m glad I chose DIEP - I just did not like the feel of the expanders and didn’t think I’d like cold heavy implants. When my Dr first mentioned DIEP, he said that the majority of women with implants are happier than women with DIEP, but the numbers reverse after about 5 years.

Also just to mention, my BMX was “skin saving” so my PS did not need to use tummy skin to craft a breast - she just used the fat etc to fill the pockets I had from BMX+expanders.

Good luck with your decision.

Lanne

Lanne Dx 11/20/2016, IDC, Right, 3cm, Stage IIB, Grade 1, 3/17 nodes, ER+/PR+, HER2- (FISH) Chemotherapy 1/3/2017 AC + T (Taxol) Surgery 6/14/2017 Lymph node removal: Right, Sentinel, Underarm/Axillary; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Radiation Therapy 8/8/2017 Whole-breast: Lymph nodes, Chest wall Hormonal Therapy 9/15/2017 Femara (letrozole) Surgery 7/17/2018 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Dec 13, 2019 04:59PM Jkr wrote:

Mightlybird01,

That was what my hubby suggested to me too if I go Diep Flap. I still have several days to decide. I watched so many implant surgeries on Youtube yesterday and ended up taking Tylenol. It is not an easy decision

Dx 3/27/2018, DCIS, Right, <1cm, Stage 0, Grade 2 Surgery 5/1/2018 Lumpectomy: Right Radiation Therapy 6/12/2018 Whole-breast: Breast Dx 10/21/2019, DCIS, Right, Stage 0, Grade 3
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Dec 13, 2019 05:08PM Jkr wrote:

Thank you OnTarget !

Dx 3/27/2018, DCIS, Right, <1cm, Stage 0, Grade 2 Surgery 5/1/2018 Lumpectomy: Right Radiation Therapy 6/12/2018 Whole-breast: Breast Dx 10/21/2019, DCIS, Right, Stage 0, Grade 3
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Dec 13, 2019 05:35PM - edited Dec 13, 2019 06:31PM by Jkr

Hi Lanne2389,

My PS mentioned skin will be too tight to close/suture the incision site after Diep Flap is taken from my tummy. I was pregnancy twice and my tummy had stretched well - no stretch mark. I did not feel comfortable to move on Diep Flap since I heard this from PS unless I agree for very very small size. I thought I have some but when I was lying down on bed, so flat (?). She is my surgeon she should know better than me.

I just got an idea that I can go ahead with expanders on double mastectomy then I can decide to go either Implant or Diep Flap reconstruction as I have to go another surgery anyways and I don't need much skin graft from Diep Flap after expanders can stretch skin.

Fat graft will fill up the pockets with Diep flap but fat grafting is not covered by health system in Canada. Maybe I can pay by myself if it is necessary (?).

Dx 3/27/2018, DCIS, Right, <1cm, Stage 0, Grade 2 Surgery 5/1/2018 Lumpectomy: Right Radiation Therapy 6/12/2018 Whole-breast: Breast Dx 10/21/2019, DCIS, Right, Stage 0, Grade 3
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Dec 15, 2019 12:45PM Jkr wrote:

After all my searches, I am still kinda keen on diep flap plus/minus small implants (without TE) on the same day of the surgery or with another surgery later so that I can have an option to remove implants if they bother me a lot in the future.

Plus plan - small implants is not a 'must ' for me if my PS does not recommend as long as diep flap is sucessfully/symmetrically grown in and it does not interfere my activities including golf then I will be happy with small size.Will update you after I see my surgeons on Wed.

Dx 3/27/2018, DCIS, Right, <1cm, Stage 0, Grade 2 Surgery 5/1/2018 Lumpectomy: Right Radiation Therapy 6/12/2018 Whole-breast: Breast Dx 10/21/2019, DCIS, Right, Stage 0, Grade 3
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Dec 15, 2019 02:17PM Lucysbff wrote:

I was in a similar situation, but when I met with my ps she concluded I didn’t have enough tissue to do the Diep flap. I chose to have prepectoral implants at the time of my double mastectomy. I was always on the small busted side and didn’t want any bigger than what I had, so went with 400 cc implants. I’m fairly active, go to the gym 5 times a week and within 4 weeks I was back doing Pilates, and a couple of weeks later doing more active classes. I have had no problems doing anything that I was doing before, and am really happy with the results. I did consider the fact that I will have to replace them in 10-15 years, but that’s something I will deal with down the road

Best of luck, it’s a hard decision but thankfully we do have options and amazing doctors to perform these incredible surgeries!

Dx 6/9/2018, IDC, Left, <1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2- Dx 8/1/2019, IDC, Right, <1cm, Stage IA, Grade 1, ER+/PR+, HER2- (FISH) Surgery 9/20/2019 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery Lumpectomy; Lymph node removal: Sentinel
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Dec 16, 2019 08:22PM Jkr wrote:

Thank you Lucysbff for sharing.

Dx 3/27/2018, DCIS, Right, <1cm, Stage 0, Grade 2 Surgery 5/1/2018 Lumpectomy: Right Radiation Therapy 6/12/2018 Whole-breast: Breast Dx 10/21/2019, DCIS, Right, Stage 0, Grade 3
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Dec 18, 2019 07:28PM - edited Dec 18, 2019 07:40PM by Jkr

I met my surgeons today. My two surgeons and their team are so kind and professional. I have decided to do Diep Flap. My PS advised I have to choose either Diep Flap or Implants and they can not be done at the same time. Just possibly fat grafting to fix difference in the shape after Diep Flap. My surgery (double mastectomy and Diep Flap reconstruction) is scheduled on Jan. 21. My PS said cost of fat grafting for that purpose can be covered in Canada and nipple reconstruction can be done 6 mon after Diep Flap. Also I am considering breast augmentation with fat/ stem cell grafting at my own expense in the future if I am not happy with size. It was really worthy to have a week to think/ search and decide what I want. Everyone has different life style and priority in activities etc. My mind is at ease. It was little stressful but it was kinda fun to decide too. I have thought more about breast reconstruction than mastectomy. It helped me already I was not too depressed about double mastectomy.

I am planning to go for a golf trip in Florida for a week prior to the surgery and hope I can feed my tummy well for Diep Flap :)

I hope I can post my photos - before and after to help someone as they helped me a lot for the decision.

Dx 3/27/2018, DCIS, Right, <1cm, Stage 0, Grade 2 Surgery 5/1/2018 Lumpectomy: Right Radiation Therapy 6/12/2018 Whole-breast: Breast Dx 10/21/2019, DCIS, Right, Stage 0, Grade 3
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Dec 26, 2019 07:24AM JRNJ wrote:

I am in same boat. Had Bilateral 9/24 with tissue expanders. Due to infection TEs were removed. I’m now doing chemo so am on hold and have time to think. I was a saggy double D maybe bigger. I always tried to hide them and bought tight bras. I don’t want same huge boobs but want to look like me. So I’m thinking a C. Not enough fat for DIEP. I was in a lot of pain for 4 weeks after surgery in chest area until TEs we’re removed. Now I look terrible but feel great. I want to hear from people that implants won’t be annoying and painful and can be comfortable. I would probably get saline. I’m afraid of silicone leaking.

Pleomorphic Multifocal LCIS, Extranodal Extension, Lymphovascular Invasion. TE removed due to infection Dx 8/15/2019, ILC, Right, 2cm, Grade 3, 2/5 nodes, ER+/PR+, HER2- Dx 8/15/2019, LCIS, Right, 6cm+, Grade 3, ER+/PR+, HER2- Surgery 9/24/2019 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 12/2/2019 CMF Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall
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Dec 28, 2019 07:04PM Tutina wrote:

Hello, 1st post. I had a lumpectomy earlier this month & received recent results showing I didn't clear margins on 3 sides. So a 2nd surgery to follow.

Considering mastectomy this time & Diep Flap reconstruction.

milkyway2, can I ask about your recovery experience & your reasons for saying it was well worth it? Your insights would be helpful. Thx!

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Jan 4, 2020 05:46PM NVDiane wrote:

Jkr, you are right, implants vs DIEP is a very hard decision! I had a unilateral mastectomy in 2008; the next year my expander was removed and an implant placed in the cancer breast. At the same time, a smaller implant was put in my non-cancer breast, and for the first time in my life, my boobs were symmetrical! I really loved them. They were soft, and never bothered me. Everything went well until I took a hard fall and fell on my cancer side. That implant started hardening, so this August I had an MRI, which showed a rupture. Unfortunately, it also showed I now have cancer on the other side. So now I have a choice like yours to make. My implants worked well for 10 years, but I am 65 now and I am concerned about changing them out again when I am 75. So, I am considering a double DIEP, after the plastic surgeon I consulted said that I had enough tummy fat for both. I don’t know what to do either! It’s a case of easier recovery with implants, vs hopefully not having to replace anything after DIEP. Which way are you leaning now

We delight in the beauty of the butterfly, but rarely admit the changes it has gone through to achieve that beauty--Maya Angelou Dx 8/11/2008, DCIS, Stage 0, Grade 3, 0/3 nodes Dx 12/27/2019, LCIS/DCIS, Right, 1cm, Stage 0, Grade 2, ER+/PR+, HER2-
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Jan 5, 2020 02:55PM - edited Jan 5, 2020 02:57PM by Jkr

Hi NV Diane,

I posted earlier I decided to go for Diep Flap reconstruction with skin sparing BMX. My surgery is scheduled on Jan 21. I would not have implants if possible. It will be A cup from B. But I am considering fat & stem cell grafting if I am not happy with size after Diep flap. I can also put small implants if fat grafting does not work well. I hope I don't need any procedure after fat grafting. I think this is the way I can have alternate option in case I hate implants.

I am very thankful I can have two surgeries at the same time and lucky to have two surgeons. They are excellent. Especially for Diep Flap there are not many PSs who can do Diep Flap. My mind is settled and at ease as I am in good hands. I guess I really love golf, very excited to play golf next week in Florida.

Gook luck with your decision.

Dx 3/27/2018, DCIS, Right, <1cm, Stage 0, Grade 2 Surgery 5/1/2018 Lumpectomy: Right Radiation Therapy 6/12/2018 Whole-breast: Breast Dx 10/21/2019, DCIS, Right, Stage 0, Grade 3

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