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Topic: Ready for Stage II DIEP - Need Advice

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

Posted on: Jan 22, 2008 06:13PM

hopefor30 wrote:

Well it seems I am finally ready for Stage II DIEP -- it has been scheduled for the end of February -- my original surgery was on 10/24 --   I had some complications with my original surgery so while I am anxious to get the second stage behind me, I am nervous as well --  I had a hematoma and an infection last time -- am hoping all goes well the second time around. 

I definitely need stage II however -- have to fix the dent from my infection and reshape one side -- will also get rid of dog ears on the ab incision.  Nipple, if I want it, will be done in third procedure after everything else settles.   PS said surgery should take about 1.5 hours and will be done as outpatient -- would like to others' experiences with this stage -- was told I probably won't get a drain -- but what else do I need to know?

I was also worried about risk of lympedema -- PS said no -- he is not going near the lymph nodes which are in the armpit, but just having surgery again makes me nervous -- I had 6 nodes removed in my sentinel  node biopsy and all is well -- 12 weeks post-op I have no problems at all with my arm and range of motion and I would like to keep it that way.

Any advice?

Thanks,

M.

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Jan 22, 2008 09:40PM Patrish wrote:

my stage 2 was very easy, esp. compared to all that came before-single diep with complications.  altho my hips were sore from the small amount of lipo, the nipple was painless (breast numb) and was like finally getting a gift.  mine was 2 hrs. outpatient, and was no problem, even tho I had some lipo to my natural breast to reduce it a bit, and had an expander on the diep side removed.  best, Pat

Patrish Dx 10/26/2005, IDC, 1cm, Stage IIIA, Grade 2, 5/25 nodes, ER+/PR+, HER2+
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Jan 23, 2008 09:46AM puppyholic wrote:

I'm having stage 2 on Friday. I'm being very wishy washy too. Can't decide if I want my tummy scar to be revised. The thought of having 4 months of healing cut open again makes me crazy. I'm definitely having my dog ears taken care of and my "circles" made smaller. Also one side is slightly larger than the other so my ps is fixing that. Any advice ladies?

Dx 8/2007, Stage 0, 0/0 nodes, ER+/PR+
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Jan 26, 2008 01:22PM puppyholic wrote:

Well, I went for broke and did it all! Ouchy. I'm very please at the "circles." Much smaller. Haven't been able to look at my tummy incision as it's all wrapped and has a binder. Will be able to shower tomorrow and be able to peak! Thank goodness Stage 2 is over! Next is nipples!

Dx 8/2007, Stage 0, 0/0 nodes, ER+/PR+
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Jan 26, 2008 02:29PM Lynn12 wrote:

Newbie, glad all went well!  Did your PS make one side bigger or smaller?  I have one side bigger than the other and PS said I can do either...just wondering which way you went and how is the outcome?

Lynn Dx 11/7/2006, ILC, 6cm+, Stage IIB, Grade 1, 0/1 nodes, ER+/PR+, HER2-
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Jan 27, 2008 06:36AM TammyLou wrote:

Lynn, I would (personally) be inclined to "edit" the non-radiated side...if you had rads.  Less probablility of complications.

Tammy Lou

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Jan 27, 2008 02:18PM puppyholic wrote:

Hi, unwrapped my mummy bandages. Took a shower. My PS made the bigger side smaller. It looks a little lumpy now? Hopefully it will even out when the nipple is down. The circles are much smaller so all that will be left are the nipples and areolas. My tummy scar looks so much better but longer. My hips are killing me, but my tummy is sooooo flat! Oh the price of vanity!

Dx 8/2007, Stage 0, 0/0 nodes, ER+/PR+
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Jan 28, 2008 01:48PM Abby2 wrote:

I just finished Stage I 26 days ago and look forward to Stage II, although I am not looking forward to abdominal incision being cut again (it has a 4" long area of dead tissue).  Glad to hear you felt the results were worth the additional cutting.  Also, did you need drains of any kind with Stage II?  I had 5 after Stage I, and kept 1 drain for over 3 weeks --- ugly.  Also, very glad to hear that Stage II is out-patient as my hospital stay was scary.  Can nipples also be done as part of Stage II or are they always Stage III.  Really looking forward to having all the "surgeries" behind me!!!

Abby2

Dx 3/16/2006, IDC, 1cm, Stage I, Grade 2, 0/3 nodes, ER-/PR+, HER2-
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Jan 28, 2008 02:55PM puppyholic wrote:

I've read some women get nipples during Stage II. I guess it depends on how much work needs to be done. My PS wouldn't do nipples. So one more surgery for me and then tatoos. Nope, no drains - thank goodness. Can drive right away too. The only restriction that they put on me is raising my arms over my head for a week. I'm sore and tired, but nothing that can't be handled. Will be glad when this passes!

Dx 8/2007, Stage 0, 0/0 nodes, ER+/PR+
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Jan 29, 2008 03:55PM TammyLou wrote:

Stage II for me...fixed my butt (I had "issues" from donor flap)...and did a revision of breast (non-radiated side had more skin = more "floppy") and had nipples (skate flaps or some variation.)

I read (somewhere!) that stage II / revisions can take a flap reconstruction from "mediocre" to "excellent."

So...there's hope.

Tammy Lou

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Jan 29, 2008 06:45PM hopefor30 wrote:

Tammy -- I read that as well, so will hope for the best.   I am not as upset as I was about my stage I outcome, but maybe I am just getting used to it -- that and the fact that I no longer have nurses coming every day to pack the wound and look at it....

M.

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Jan 29, 2008 06:53PM 2NewOnes wrote:

newbie - how did they make your circles smaller?  Mine are more oval than round and much larger than the previous aerolas were.  The right one is puffier around the edge so it has a crater affect and that whole breast is larger than the left one.  Plus their "focus" is kind of off to the sides.  I had phase 1 on Aug. 17th and am scheduled for phase 2 on Feb. 27th.  I can't wait to fit normally into a bra again!

8/17/07 Bi-Lateral MS Free-Tram Dx 6/20/2007, DCIS, Stage 0, Grade 3, 0/3 nodes, ER-/PR-
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Jan 29, 2008 07:07PM puppyholic wrote:

My PS basically reopened the incisions and stitched them back up to be smaller circles. I guess he just stretched the skin. I also had some lipo on the left side because it was slightly larger than the right. The lumpiness seems to be subsiding as the days go by (had surgery on Friday) so maybe it was just swelling. Overall, I'm very happy with the results.

Dx 8/2007, Stage 0, 0/0 nodes, ER+/PR+
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Jan 29, 2008 09:04PM hopefor30 wrote:

My circle is also larger than most -- due to a previous lumpectomy scar that had to be cut out --  it is more oval than round -- PS has not talked about shrinking it, but the edge of the circle is where I have a dent due to infection that had to heal from inside out -- so I know that will be fixed -- perhaps the circle will shrink in the process.....I'll just be happy if the breast ends up softer and a better shape on the side.

M.

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Jan 29, 2008 10:55PM Kathy_K wrote:

My recovery from my Stage 2 was easy, easy, easy.  Oddly enough, I felt more anxiety over the prospect of this surgery than the original one.  I did feel twinges on the ends of the tummy incisions due to the lipo.

I had some healing issues with my Stage 1 and now the circles are waayyy off center.  I'm wondering what will happen with my nipple surgery.  I'm hoping my PS will be able to shrink or get rid of the circle then but have been unable to envision how that would work.  I certainly have the extra skin but not sure how it would work out.  I get the nipples done on Feb. 21.  I'm really looking forward to having all the surgeries completed!

When a woman tells the truth she is creating the possibility for more truth around her. Adrienne Rich
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Jan 29, 2008 11:11PM puppyholic wrote:

my ps said that the circles need to heal before he does the nipples so the nipples can be cut properly. check that out if you want that done first.

Dx 8/2007, Stage 0, 0/0 nodes, ER+/PR+
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Jan 30, 2008 08:28AM Lynn12 wrote:

2newones,

My left breast is just like your right.  It's puffy around the circle so it creates a crater effect.  Let me know how it goes with your stage 2.  I have an appt. w/ my PS next week to discuss phase 2, I have tons of questions.

Lynn Dx 11/7/2006, ILC, 6cm+, Stage IIB, Grade 1, 0/1 nodes, ER+/PR+, HER2-
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Jan 30, 2008 08:51AM abbadoodles wrote:

Uh, I'm coming in late on this conversation but interested because I am considering having a free TRAM done soon.  What do you mean by Stage II?  More surgery is always needed?  In-patient or day surgery?

Tina

Tina
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Jan 30, 2008 09:29AM TammyLou wrote:

Tina,

The bulk of reconstruction will be done in your initial surgery (Phase I).  You'll come out with "Barbie doll" breast mounds (nippleless) that may or may not be perfectly matched.

In the initial surgery (Phase I), the main reconstructive effort is aimed at establishing a new blood supply for the flaps and "approximating" the breast mounds.

Then, you will heal for about 3 months.

After 3 months, the surgeon will take a look at you to see if any tweaking is needed.  Maybe something puckered.  In my case, one breast mound turned out slightly off center.  Sometimes the scars have skin tags "dog ears" on the ends (not smooth).

Phase II is for any small corrections (and nipples).  This is typically a much smaller surgery and is performed outpatient.  I spent the night in the hospital because my insurance covered it, but I could have gone home.  It's a five hour drive, so I elected to take advantage of the overnight.

(...like making a dress.  Phase II is "final fitting.")

Tammy Lou

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Jan 30, 2008 09:59AM puppyholic wrote:

I didn't get my nipples in Stage 2. Bummer! Nipples in Stage 3. Then Tattoos after that! This is taking forever!

Dx 8/2007, Stage 0, 0/0 nodes, ER+/PR+
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Jan 30, 2008 10:03AM abbadoodles wrote:

Thanks, Tammy Lou.  Three  months, huh?  That means if I want to be ready for bathing suit season, I'd better get things rolling right away!  I have my appt. early Feb. with the ps's to talk more and perhaps finalize this.

What is this I have heard about people losing their waist after flap surgeries?

Tina

Tina
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Jan 30, 2008 11:39AM Abby2 wrote:

Tina,  The trick to "not losing your waist" during flap surgery is to ask your surgeon to "plicate" your abdominal muscles, which is essentially to lace them together (as a corset would).  I need to tell you, however, that the process is painful because the skin and tissue from the belly buttom up to the diaphram is peeled back so that they can visualize the muscles and then the muscles are laced together very tightly.  After almost a month, I am still sore to the touch all over my upper abdomen, but the results (having a waist) are worth it.  I have heard that some surgeons automatically plicate the muscles, but my surgeon told me that unless I had asked for it, he wouldn't have done.  Good luck.

Abby2

Dx 3/16/2006, IDC, 1cm, Stage I, Grade 2, 0/3 nodes, ER-/PR+, HER2-
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Jan 30, 2008 09:12PM puppyholic wrote:

I didn't lose my waist. Just lucky I guess.

Dx 8/2007, Stage 0, 0/0 nodes, ER+/PR+
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Jan 30, 2008 09:51PM Betty0 wrote:

Abby, do you mean if you don't ask for special favor,you will lose your waist after surgery no matter what kind of shape and weight you were before the surgery?  Can you explain that more?

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Jan 30, 2008 09:56PM - edited Mar 11, 2008 01:26PM by BethNY

Tina stage two all depends on the skill of the surgeon during stage one, and on how your body settles and heals.

For me, I had stage two 10 weeks after stage one.  All that was done on stage two is dog ear revision to my hip, using the ab scar to create my nipples, and a small lift of the inframmamory folds to make the breasts sit higher, and rounder.

My stage two I was in the OR for about 3 hours, in the recovery room for an hour or two, and then was home.  I felt shitty maybe for the first three days, and then I was totally fine.  No drains or anything, just caring for the nipples.  I took pain meds for a day, and then tylenol was fine.

three months later I had tattooing done, and then repeated it probably 6 weeks later, to achieve a darker pigment.

About a year later, I gained weight, and I felt like even though my abdomen was still tight and flat, the very center kind of had a little bump.  I also didn't like the way the center of my ab scar healed, it looked a little bigger where the old belly button was.  I also decided I wanted to beef up my right nipple a bit, so me and my PS hit the OR for an hour, and I was home in 2 hours, and it literally took a few days to heal.

Whats important to remember is that it may take several surgeries, regardless of the procedure you have performed, to achieve the asthetic result that you desire.  You shouldn't stop until you've reached that goal.

Always look at reconstruction as a work in progress.  It may have some hicups along the way, and some days it may feel like you've bit off more than you can chew... but in the end, for so many women, the outcome is totally worth every cut, stitch, drain, and lifting restriction.

Be your own hero
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Jan 30, 2008 10:05PM Kathy_K wrote:

I didn't have any special treatment - just time itself brought my waistline back.  There was some residual swelling in my midsection that needed to be resolved.  That just took time.  I can't tell you how much time as my original surgery was last January and my Stage 2 wasn't until July.  But, just before Christmas, I noticed that my waistline was back.  Guess I'd been busy checking out scars and fading that I hadn't paid any attention.

When a woman tells the truth she is creating the possibility for more truth around her. Adrienne Rich
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Jan 30, 2008 11:00PM LisaSDCA wrote:

I didn't lose my waistline at all. But then, my fascia and muscle weren't even touched on the left (SIEA) and no muscle was lost on the right (DIEP).My surgery was Sept 25th and I personally wanted to wait this long for stage II. Now I'm ready. Mine will be outpatient - we're just tweaking the right breast a little (it's a little larger), he's going to break up a small area of fat necrosis near the rt. axilla, nothing on the abdomen, no lipo, going to make two small nipples and he's doing the tattooing at the same time (never heard of that before!). So that should be the end of it. Guess I'll know once it's all healed up.

For those who already have their nipples - how long did it take for them to settle into their final size and shape? I know they start out much larger due to swelling, so I'm prepared for the initial shock.Surprised

Lisa

Stage IV mets to brain 11/2008 BRCA-1 positive Dx 1/24/2007, IDC, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2-
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Jan 30, 2008 11:02PM Abby2 wrote:

BethNY:  Would you please tell me more about using the ab scar for nipples?  Sounds like the perfect material to use and since I'm developing lots of scar tissue, I'll have lots.  Also, thanks for mentioning revising the inframammary fold to lift and round the breasts --- I can see how that would help me too.  I like your outlook --- it's a process and we should not stop until we're happy with the outcome.  I've read many of your comments and you are always very well informed and ALWAYS willing to give the extra support to everyone.  THANK YOU, BETH.

Abby2

Dx 3/16/2006, IDC, 1cm, Stage I, Grade 2, 0/3 nodes, ER-/PR+, HER2-
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Jan 31, 2008 01:13AM SandyinSoCal wrote:

Pulling the remaining skin down tightly can flatten the front of your body and change the shape of the waistline.  Many reconstructive surgeons will not plicate the muscles during Stage I because they are concerned about tearing them where the blood vessels were dissected out for DIEP flaps.    During a cosmetic tummy tuck, most surgeons do "muscle repair" as part of the procedure.  It provides a much better outcome and only adds about 15 minutes to the surgery time.  If you look at the photos on the link below, you'll see how a nice "v" shape is attained when the muscles are pulled back together during a tummy tuck.

http://www.picturetrail.com/gallery/view?&p=999&uid=4638173&gid=9705895&&imgid=138200505&offset=315

I am wonderfully made to do ExtraOrdinary things! (www.girleo.com) Dx 5/22/2007, IDC, <1cm, Stage I, Grade 3, 0/1 nodes, ER+/PR+, HER2-
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Jan 31, 2008 09:47AM - edited Mar 11, 2008 01:26PM by BethNY

Abby, we're updating the web site I work for in two weeks, and I will have an awesome illustration of the nipple from the ab scar, and real photos to give you the link too...

but in the meantime--

You know how on your DIEP or TRAM breast, you have that circle in the middle, (some women have more of an island shape, due the where they had to cut for the mastectomies, but in my case mine we round circles no wider than the old areola)  They do a little snip from the ab scar, and then using usually  C-V flap, or one of the modt popular nipple techniques, they make the nipple.  It will be so easy to show you once I have a picture to go along with it.

Nipples definitely come out differently on implant breasts then they do on flap breasts.  If you've had prior radiation, your PS should talk to you about the high rate of nipple failure.  He may want you to take more time prior to getting the nipple, etc.

So after stage 2, I came home with this over the shoulder boulder holder bra, packed with gauze, and I wasn't allowed to shower-- and the work he did on my hip-- I had a small bandage...

So that was me when I got home.

The bandages came off a week later, but the nipples took time to heal. My body takes FOREVER with stitches.  I swear some of them were still sticking out four weeks later.

here's one month after nipple surgery. Swelling subsided, but they were still more at "attention" then they are now. I thought it was so hot, and I wish they still were this perky... two years later they have flattened out, but still look good...

here's one month after nipples and revisions

Be your own hero
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Jan 31, 2008 10:08AM puppyholic wrote:

Beth,

When I saw your picture that you posted (I would love to see it again, but can't remember where it was) it was my inspiration to look like that! That's what made me decide to have my tummy incision cut open again and have it fixed on Friday and not live with it looking bad for the rest of my life. It hurts a little right now, but I hope my results are as good as yours some day. My PS doesn't do the nipples the same as yours. He cuts an airplane shape in the skin in Stage 3. But he seems as dedicated to make me as happy with the results as many times as it's going to take as yours is. Thanks for giving us as much support and inspiration as you have on this board!

Dx 8/2007, Stage 0, 0/0 nodes, ER+/PR+

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