implant after diep flap reconstrcution

Neta69

Hi, just found this thread and I'm curious if anyone has updates? I'm talking to my PS about reconstruction and she wants to do implant on my good side and a diep flap on my cancer/radiated side. I don't have enough good skin and tissue on my tummy for 2 foobs and I don't want scars anywhere else on my body. I'm concerned  with the implant vs flap my foobs will look and feel really different so I've been looking at a combination diep + flap. What's the sequence (flap first, implant after or expander first, implant after then flap? Can flap and implant be done in one surgery or are they separate procedures? I found a team of Drs in NYC (Keegan and Vickery) that do a version of this they call a hybrid reconstruction. Looking forward to hearing from you ladies. Thank you!

bdavis

Neta... I don't have implants, but did discuss it with my PS. He said he'd do the DIEp first and then implants st stage II. In the end, I opted for GAP flap where I had enough fat for two boobs. I then had an issue with one side and he did the DIEP (stacked) on that side. So I have a 360 degree scar, but barely visable.

mammalou

neta.. Are you talking about a flap on one breast and an implant on the other breast?  The hybrid is a flap and implant on the same breast.  I do have that and it looks and feels good.  The implant came 6 months after the flap and is under the flap.  I had to do that because I didn't have enough fat for the breast and I was matching a non MX side.  

Neta69

Thanks for your responses and sorry for not checking back sooner! So the implant is put in at stage 2 under the flap but above the pectoralus muscle? No TEs? Is that what you had done mammalou?

mammalou

Yes, that is exactly what I had done.

Neta69

Just met my PS today and the good news is the plan is to do exactly what you had done mammalou, first little foobs using my tummy for a bilateral diep, then after they heal implants to get the right size. I'm happy with that plan. Bdavis, like you I'll have the option to use my hips if something goes wrong but for a start I won't have to have more scars, just a longer one where my C section scar already is. I'll keep you posted how it goes. The bad news (for me) is my PS is going on maternity leave. She wants me to see the new PS instead but the new Dr is so young and just finishing a fellowship. I have no idea how skilled she is. 

sweetpeakisses

hi neta! did you have your surgery yet? I am scheduled to have a similar surgery on June 6th. My PS said I didn't have enough fat to make DD breasts. He said at best he can get a B cup for both (im having a BMX). However, he is putting in the implant at the same time as my mastecomy and reconstruction surgery. He is using the Becker 35 adjustable implant which serves as the tissue expander and the implant. Im getting anxious about my upcoming surgery. Everyone else any updates? Mammolou? How are your new breasts looking? How was recovery and do they feel pretty natural?

mammalou

hi sweetpeakisses, my breasts look great.  The implant/DEIP side is a little firmer than my natural side, but it still feels squishy,  my nipple are a little uneven and that is bugging me..  I don't really care that much, but I'll see what they say the next time I go in.

Good luck with your upcoming surgery.  I will be a year out on June 26.  It's a tough surgery, but I'm so had I did it. 

Neta69

How was your surgery and recovery sweatpeakisses? I didn't know you could have the expanders put in at the same time. I'm really curious to hear how it went and so hope you are well and happy with the results.

Neta69

So after almost a year and a lot of research I had my DIEP in NOLA. I'm recovering now, 2 weeks out. My PS will add small implants in stage 2 if I want to help with size and projection. He said the implants have to be small diameter and can only take me max one cup size bigger so as not to risk interfering with the flap blood supply. Also, if I have implants put in I'll be stuck with them as it makes the flap thin and flat should I decide I don't want them at some point.