DIEP Surgery in Seattle

golfer779

Finally got the nerve up to chat with a PS in regards to recon.  Had a mastectomy in Nov 07 .... at the time said "no way".  As time passes ... looking for that new norm more and more each day.   Consulted with Dr. Paige at Virgina Mason, and decided to go forth with the DIEP procedure, expanders are out due to radiation  ... bummer is that the waiting list for surgery is almost year out ... any thoughts ?????

AnneW

I cannot imagine a waiting list being that far out! make sure your surgeon has been the primary on TONS of these. I only had to wait about two months for my S-GAP--most of that was my own scheduling conflict, not the surgeon or the insurance. I do not understand, not would I accept, that long a wait for this surgery.

Anne

Dragonfly1976

Wow, that's a long wait! However there aren't many DIEP surgeons here on the West Coast. I know Oregon has none, and I've been looking at some in Washington. I better pick one soon it sounds like! There are a couple other DIEP surgeons at Virginia Mason I believe, I also found this site online www.becauseitspersonal.org

Nordy

Ladies - this is a pretty up to date website that lists all the free flap surgeons by state and tells which procedures they perform. I hope this will help in your quest. Dragonfly, I am going to post to your other message board in regard to expenses.

www.breastrecon.com/id10.html

NIC

I had DIEP at UW in January 2008.  I had to wait about two months for a surgery date.  It is really hard to have to wait, once you are ready to move forward.  But, you need to remember that these surgeries can take all day...mine was about 9 hours...they can only do one a day, and most surgeons are not in surgery every day of the week.  If you do get scheduled, and your own schedule allows, you might ask them to consider you if someone cancels.  I was offered an earlier date, but couldn't get off work to take it.  Best of luck to you!  It is worth the wait!

Nancy

Dragonfly1976

Nancy who was the surgeon that did your DIEP? How happy were you with the overall treatment you recieved at UW. I have heard mixed reviews. I'm not sure what to do now as my other stread stated the skin sparing mastectomy was told is a possibility when I checked with one breast center, that does the DIEP. However since there are no DIEP surgeons in my town, can a local ps put the expanders in? My breast surgeon doing the mastectomy can't, right?

jseda

Go to the plastics dept at the U of Wash. I'm seeing Dr. Nelligan PS and will have my DIEP in Sept.

Jseda

golfer779

Jseda ... had my original surgeries (mast and axilarry node disection) at the UW back in 07 ... I take it your pleased thus far with Dr. Neligan ... thinking I will chat with my insurance to see if I can be refered to him (I'm not too thrilled about waiting more than a year to have surgery).

NIC

Dragonfly,

Dr. Said did my DIEP and I am very happy with the results.  I had a delayed reconstruction, almost 5 years after a unilareral mastectomy.  Dr. Said has a little bit of ego, but very well skilled.  All the support staff are terrific at the surgical outpatient clinic, and the surgical and recovery staff were terrific...I had wonderful care before and after surgery.  If I had any complaint, it ss the appointment scheduling is not very good....When I first started seeing him I sometimes waited hours beyond my appt time.  It improved a lot, but can still be poor.  

 I had the mastectomy at the U also, Dr. Byrd was the surgeon...also terrific!

Nancy

golfer779

Nancy ... couldn't be happier with Dr. Byrd as well.  Have seen some pics of mastectomys and I'm thinking Dr. Byrd did an AWESOME job !!!!

Katie123

I am two years out from a left side mastectomy and planning for a DIEP.  I met with one plastic surgeon in Seattle and he said he would require that I consent to both the DIEP and the TRAM as a condition of scheduling the DIEP procedure, i.e., he would  not know until he started the surgery which procedure he would do.  He also said he always removes part of a rib, and that preserving sensation (achieving some in the reconstructed site, losing it in the abdomen) is not part of the equation.  I am not interested in a TRAM, and the other items also gave me pause.  For those of you who have had surgeries in Seattle, what has been your experience as far as being required to consent to both procedures?  Has anyone anywhere been successful in getting out-of-network coverage for an out-of-area plastic surgeon based on these or other differences in what is available locally?   

jseda

Seeing most of you c/o of the time frame for DIEP procedure, namely 1 yr out. I hate to say this, but get use to this if the healthcare reform bill goes in. Actually, I predict it'll be worse, especially if we're all on the same plan. So scarey!! Try to get your procedures done prior to all this. I know the medical codes for the system change is mandated for 2013. Good luck to us all!

J.Seda

jseda

Good site for insurance coverage;

http://www.plasticsurgery.org/Patients_and_Consumers/Planning_Your_Surgery/Insurance_Coverage_A_Patients_Guide.html

Good insight into your rights/coverage etc.

Katie123

I am not sure I understand your post.  What do you mean by "c/o of the time frame for DIEP procedure"?  I have understood that a DIEP procedure can be performed whether immediate or several years out.  Please clarify.   

Dragonfly1976

I'm not sure what C/O means but I too am under the impression the DIEP can be performed immediate or later

AnneW

I think the poster is talking about waiting times to get your reconstructive surgery. Scare tactics. As in don't ask for health reform because it will be bad for you and your personal needs.

I'm sorry. Didn't mean to continue the hijack of the thread. We have separate threads for gripes and fears and hopes for our health insurance/care systems.

Anne

Miserable1209

I've done extensive research to find the best breast reconstruction folks in the Seattle area, searching the medical literature and checking with both doctors and med mal lawyers I know.  The one name that came up in EVERY conversation was Drew Welk at the PolyClinic (does surgery at Swedish).  Nice guy, great results, etc.  Unfortunately, he now does only implants and TRAM flaps, having given up microsurgery a while back.  However, he mentioned that his partner, Frank Isik (Iss-ick), does do DIEP procedures.  I seriously considered a TRAM flap procedure, but just couldn't wrap my brain around the limitations/risks associated with losing even one of the rectus abdominus muscles.  For those of you who have not seen photos or videos of the procedure, Dr. Isik discusses the procedure in a video available on his website (http://www.drfrankisik.com/).  Dr. Welk felt that I was an excellent candidate for either the TRAM or the DIEP so I am going to see Dr. Isik in the next few days. 

Dragonfly1976

I just met with my breast surgeon today, and we were talking about Virginia Mason because I had originally expressed interest in going there. My surgeon called and talked to Beshilan's nurse (not sure I'm spelling that right) who was great she said.I guess his nurse was very informative, and offered all kinds of information to my surgeon. HOWEVER, he is supposedly booked for surgery for ALL of 2010. So if I chose to go to him, I couldn't even get in next year!

jseda

Dr. Neligan at U of Wash does DIEP procedures as well.

J Seda

jseda

Hi Katie: Depending on your insurance and whether or not you have the freedom to go to any facility for the procedure, DIEP's can be done immediate or delayed. In my case, U of Wa was out of network, therefore, my ins GH NW options, requested I go to Virg. Mason in Seattle, As some of you know, they're scheduled 1 yr for the procedure, meaning you are not able to have an immediate done. This to me was unacceptable, therefore, I and my surgeons appealed their decision and were able to overturn the appeal, therefore, allowing me to have my procedure where I want and with the doc I choose. As per Anne W's comment that I, the poster, am using scare tactics to make women feel like they better get this done before healthcare reform. Well, after being in the medical field 35 yrs as a nurse and married to a physician, I am worried. I've seen enough that I'm praying people keep revolting and standing up for their freedom of choice. I've experienced lack of choice with my insurance company and managed care and if the gov. runs healthcare and limits their plans, we are all in for a big surprise. Kind of like how surprised america is with how our president is leading vs what he promised during the big campaign. Enough said.  I'm a realist and believe in what I see, not what I hear. Take it for what its worth!

J. Seda

jseda

Katie:

C/O means complains of (medical abbreviation used in charting). I've read a lot of blogs from women waiting for reconstruction and a lot of them are having to wait to have their procedure done. I have seen more having to wait then those having immediate reconstruction. Hope that clarifies any confusion.

J Seda 

jseda

Just got off the phone to my breast oncology surgeon who just got back from doing research in Chile. He tells me their government is trying to figure out how to set up standards for treating breast cancer in women. Ladies, this country is on socialized medicine. My concern is that If socialized medicine ran by the government is so wonderful, why hasn't this been addressed before now. This is what our healthcare will become if we allow the gov to take it over. Instead of having the best healthcare in the world, we will become like the other socialized med countries; behind the times. Think of how many women have died because of lack of care. Do your homework and educate yourselves. Read up on socialized med in other countries and how they address their issues. Don't just listen to the talk. No more politics. I can't stand back when I'm seeing what's going on. We are important and need to stand our ground in being treated.

J.Seda

Nordy

I have to agree w/you jseda. This is why I pushed so hard to get my reconstruction done this year and did not wait any longer. A very good friend of mine had a brother that died of esophogeal cancer in Canada while awaiting surgery. My step-mother's Mom could not get into a specialist in England for 8 months when she was diagnosed w/cancer... that is until her husband slipped some money to the referring physician and he was able to pull some strings. These things are very real, these stories aren't the ones passed from person to person that you never know if they are true, these are my friends and my family. So, sorry if people disagree - you have that right - and I agree that there needs to be some type of health care reform... but NOT socialized medicine. Unfortunately, I don't have the answer either...

kaye45

Hi all - I know this is a thread about DIEP in Seattle, but can I add a point about health care in Canada? I live here and we do not have socialized medicine. This is a single payer system, the doctors are all independent and are paid by the govenment for their services like the way Medicare works in the US. The government does not run the health care - they do not dictate care nor do they proscribe care. I am sorry to hear your friends' brother died waiting for surgery, Nordy. I hope you do not assume this is a universal experience however - I have had cancer here in Canada and my care has been exemplary from beginning to end - I had surgery 2 weeks after diagnosis, it could have been 2 days after but I needed time to process the whole business  so the 2 week wait was my choice. I was able to schedule my DIEP, an elective surgery remember, 5 months after I requested it. This is alot sooner than others I hear about on this forum. And my care was all free, no co-pays, no deductables, I had a private room and I was hospitalized for 5 days. I had a nurse visit me at home for the 3 weeks afterward. I have had as a support and resource a specialist Breast Nurse Navigator work with me the whole breast cancer journey. I work as a nurse here in Canada and the care is excellent. Urgent surgeries never wait - they really don't. There are problems, yes, but please don't generalize about a system Canadians overwhelmingly love and would never change.

jseda

Hi Kaye: I'm happy to hear this about your experience. I'm not trying to be the devil's advocate but I do know several people living in Canada not having such good experiences. I also know several people having come down to the states to have things done to get them done sooner. Maybe its where you live or what the gov. puts its main resources into. I also know several docs who have come to the states to work since their pay is so much less. I don't know the perfect answer either, but I'd rather stay in a system of choice.

J. Seda

AnneW

Choice is a good thing. Some people in our country, in fact MANY of them, have no choice. They can't afford a choice. Or they have no choice to choose from. Why can't there be an option for them? think of all the women who can't even get a mammogram here, much less a quarter-million dollar surgery simply because they have no health insurance? Or that their insurance requires $30K up front for the surgery?

Our country has a moral issue here...

And I think waiting a year for an elective microsurgical reconstruction stinks.

Anne

jseda

Dear Anne: I agree. We do not live in a perfect world, but we do have a choice. We can put out effort, work hard and get a good job to be able to pay for insurance of choice. We need to keep that right. Our country was built on freedom of choice. We also need to help those who can't help themselves, such as the aged, sick or very young. In a socialized medicine environment, the chance of the underprivileged being able to have access to these extravagant procedures will most likely not be available. Its something we will have to get use to if we go to a one insur healthcare ran by the gov. We will have less freedom and less choice as the gov will not be able to pay for these procedures for everyone. It'll be more like the managed care we already have in this country where your case is reviewed and you are put on a list to wait. It is unacceptable, but we get what we pay for. There are resources out there, it just takes research and time to uncover them. I do wish that there was a simpler solution but giving up freedom/choice is not the solution.

 J. Seda

jseda

Dear Katie:

Look at this site. There is an appeals letter that addresses the issue about DIEP not turning into a Tram procedure....

 http://www.breastcenter.com/support/insurance_letter.php

j.seda

Dragonfly1976

Golfer I hope you're getting some information that is related to the original question you posted!!!

Miserable1209

As a followup to my previous post, I met with Dr. Isik yesterday regarding a possible unilateral DIEP.  (He is extremely experienced in doing DIEP's and was the first and only doc doing them on the West Coast for a number of years.)  I was astounded to hear that after hundreds of successful procedures, he has recently decided that the much longer and more complicated surgery, increased risks and increased cost of doing a DIEP is not warranted in most cases.  His conclusions are based on a new long term study that found that the TRAM flap results in "no significant difference in postoperative outcomes or in the subjective ability to perform activities of daily living compared with the DIEP flap."  He acknowledges that there are bad outcomes and outright horror stories for all of these procedures, but many bad outcomes can be related to the skill of the surgeon and/or poor patient selection (smokers, too obese, etc. etc.)  He also told me that he almost never does a unilateral DIEP and recommended that I undergo a TRAM.  I am now rethinking the entire TRAM vs. DIEP thing, but plan to see Dr. Said at the UWMC for a second/third opinion.  He has an awesome CV including a 7 year Integrated Plastic Surgery residency at Northwestern and a 1 year fellowship in Reconstructive Microsurgery at MD Anderson.  We will see what he says.

As an aside, both of the highly qualified and frequently recommend Plastic Surgeons I have seen to date refuse to do immediate reconstructions (both TRAM and DIEP) stating that the complication rate (ranging from minimal to total flap failure) is 50% higher with immediate reconstructions.  One wants to wait a week and one would require a month. I'm not sure I can survive a week, but know that a  month would be impossible for me. Has anyone else been refused immediate TRAM or DIEP reconstruction?

Dragonfly1976

Well thanks to needing radiation, I will be waiting about 6 months from my up coming mastectomy. Waiting a month sounds so wonderful. If that's what you're referring to?

 What are the main differences between the TRAM and DIEP? I thought one compromised the abdominal muscles and one didn't? 

I've heard good things about UWMC, do you know what Dr. Isik's timeframe is for surgery if you wanted to schedule it right away? I know Dr. Beshilan (sp?) is booked through 2010 according to his office /nurse.