DIEP 2011

dee7493

Vmarie, good advice to do best taking it easy. I pushed it too much with work and visitors, and housestuff the other day and really felt it.  Yesterday I forced myself to rest and feel so much better.  I am getting two more drains out today

blondie45

dee7493 - how many drains will you have left after today?

vmarie - i know what you mean by yeah the last drains came out, can't wait.

dee7493

x-raygirl   I had three surgeons one microsurgery expect, two PS w/ DIEP experience that cut down the op time.    When I went for my  marking the day before, my questions about location of incisions were answered. I asked about breast projection and found their approach was more on flap success and did not want to manipulate shaping too much to interfere with new blood vessel profusion. Stage 2 on would be contouring revisions etc.

 I asked my husband to watch the video of the surgery and discussed the post op protocols etc. I felt better in case I was out-of-it that he had my back.

They werent' kidding when they said the ab incision will be hip to hip> PS indicates scar should be more minimal than expected.

 I have a post question,  wondering how they know how much tissue to harvest?  could they take too much or too little?

XRAYestInMA

@dee Re: your question on how much tissue to harvest.... Do you mean could a PS take too much and therefore not leave enough on your abdomen? Or not take enough and say you were hoping for full B cups and only ended up with smallish almost-B's ? Now this is my opinion only, so here goes: I am thinking that if you have excess fat in your abdomen (as I do), and I simply exercised it away, then it would be gone. (not likely for me, but do you know what I mean?). During a DIEP, the PS basically dissects what he feels is extra plentiful fat and whatnot, and moves it up to recon the breast mounds. This leaves a flatter abdomen, but it is not the exact type of "tummy tuck" (abdominoplasty) that is done if you were going in only for that - abdominoplasty usually includes some tightening of the abdominal muscle fascia.

Now if too little is haversted, and your results are not as big as you had hoped, then I suppose you could discuss fat grafts during your stage II surgery.

I think the trick here is to develop of good repore with your PS and make your expectations known.

Did you watch the video on OR live? It gives you a good idea of what goes on during a DIEP.

Question for anyone who was already consulted with a PS:  When you asked your PS how many DIEPS he/she has performed, how many years he/she has been performing them, and his/her failure rate, what were the answers? I wonder how the one I met with yesterday measures up. This was his answers: He has been performing DIEP's since 2005. He has done greater than 500. He has seen a flap-failure rate of 1 to 1.5 percent in his patients. 

He also said I was a "Type A" personality and he claimed he is one also. Not sure how I should take that. I asked my DH what he thought that meant as it refers to the PS and he said' " It probably means he is a bastard to work with in the OR."  Okay then. I have worked in many an OR with different surgeons and sure enough some are bastards. I'm hoping it means he is a perfectionist and prides himself in how his "work" comes out. BIDMC is a teaching hospital (of Harvard Medical School), but the PS did tell me he does not allow anyone other than him to operate on his patients, with another PS from his office (there are 3 and all do DIEPS) assisting, that is. I guess he meant no students, interns, residents...whatevers.  

Off to google what this "Type A" stuff is all about.

XmasDx

XRAY - I would assume "Type A" coming from a doctor means you ask lots of questions.  You'd be surprised how many patients don't even understand what they're having done.  Contrary to what I was always told, I don't think doctors really DO like informed patients!    Or at least REALLY informed patients, like the ones coming to them from bc.org!  We know more than they do about the things that can go wrong I think sometimes, because we learn from each other first-hand!

I told my ps that it would be hard giving up caffeine because I drink a lot of it, and she looked at me and said "No kidding."  I took that to be the same comment as your "Type A" comment, but I could be wrong.   Whatevs. It's my body, and I only have one.  I'm gonna ask questions.

And although I'm very pleased with her work, when I asked her how many she had done it was very clear that the number was LOW.  But I had faith in her and her team, and I don't feel it was misplaced, she did her homework with me (abdo CT) and I'm happy with my results so far. 

XRAYestInMA

@Xmasdx Perhaps the notebook that I brought with me freaked him out a little. No person should ask another if there are "any questions" after they are finished with their spiel unless they welcome the questions and try their best to provide answers, IMO. This PS was very articulate when he explained the procedure and answered my questions without a blink of the eye. Not to mention that I could picture him sitting between Christian Troy and Sean McNamarra while they asked me, "So L, tell us what you don't like about yourself?" I was a little freaked out by the young man who accompanied the PS into the room, whom he introduced as "Doctor So-and-so". This young man looked like a kid. My DH said this young doctor kept making goofy faces while the PS and I were chatting. I asked if he (DH) thought the guy was making faces at me, and he said NO, it was more like a facial tick or something. That's good 'cause if I noticed it, I would have had to ask him to leave the room.

XmasDx

@XRAY - I bring a notebook too.  I try to hide my page long list of questions, but you know everytime I do that when I leave I realize I forgot to ask a couple. 

More than 500 DIEPs, flap failure rate of 1 to 1.5%, those are good numbers.  Sounds like you're in good hands, assuming you got a good feeling.

scubacat

Regarding if you end up much smaller than you want or expected; my PS has already offered me a small implant behind the new tissue, but I'll know more after Stage2 consult. Not that I want to be bigger, but it's an option and always has been.

XRAYestInMA

@XmasDx Yes, I def. got a good vibe from this PS. I wasn't insulted about the Type A personality comment - more like amused. He gave me the number and email address of his nurse and told me if I think of any questions between now and when my surgery is scheduled, I can contact her anytime. He also said I would not see him again until the morning of the surgery. I suppose that is fine since why would I need to see him again anyhow.? I was a little weirded-out when I had to stand in the exam room against a lovely dark blue wall naked from my waist up while he took several pics of my self from waist to hopefully neck  (and not face). Dh was in the room, along with a medical assistant (female), the PS, and young doctor so-and-so, so it was like I had an audience or something. Can you all relate to these "before pics"? 

blondie45

Xray - yep had to do the before and after photos also but where I go they use they lovely silky throw away tong underwear. I couldn't wait to get them off and throw them away, just not me.  Sounds like your ps has done more than mine. If possible try and find anyone (best change is on here, bc.org.) that has had this procedure done with the doctor you want to have it done with. I had 2 people who have already had it done with my doc and 1 who is going to in a few months who I could ask questions throughout this whole thing and they have been such a piece of mind helping me know all that I was in for and all that I still may be in for.

XRAYestInMA

@blondieOMG, I would have just about DIED if I was asked to stand for the before pics in a thong! I mean - no coverage over the butt? No way.  Especially in front of the ME and the young doctor (intern, or whatever he is). I felt exposed as it was, never mind if I had to have my slacks and clogs off too. I hope the PS's office doesn't peruse these boards since if they read about these thongs, it might give them an idea for future consults.

There is a woman who had her DIEP procedure with this PS and I believe she posts somewhere in the boards. She has a whole blog that she wrote about her experience, complete with pictures of the PS, his ME, nurse, and very detailed. I have skimmed it and plan on reading all of it.

pupfoster1

Hi girls,

@dee---they will take the entire ab flap as they can't just leave part behind.  It would be lopsided if you imagine.  If they don't (or can't because of the way the blood flows) use both sides they will discard the excess.  Don't worry about them taking too much.  And yes, it is a long incision, but it is definitely low enough that unless you plan on wearing a really skimpy bikini it shouldn't show.

I had some pics taken along the way too, can't really remember who though---pretty normal stuff for PS prep.

I'm curious about others DIEP going into Stage II.  Mine is a bit lumpy, uneven.  My doc didn't mention fixing that at my last visit, just lifting the other side to meet the new side.  Do you all think I should contact her with those concerns?  Also wondering about the tattooing.  Did any of you have your nipples done BEFORE stage II?

Thanks,

Sharon

Snobird

My abdominal scar is right under my navel. It will definitely show in a bikini but those days are over for me. I would talk over the placement of the scar with your PS prior to surgery so there are no surprises.

blondie45

Xray-i do not think the underwear they gave me was supposed to be thong but they ended up that way on me if ya know what I mean LOL. They only took front pictures.

XmasDx

@Blondie45 - I too had to stand before a nurse with a camera, a blue background, spotlights, and be photographed in the beautiful blue thong from EVERY angle.  Fortunately, I did NOT have to watch anyone view my pictures.  Horrendous.  Truly.  Front, 45 degrees, side, back... the works.  The whole 360.  And I do NOT have a body for a thong.  At all. 

But the most humiliating part was right before surgery.  Two ps's, my DH, two PS assts (both young men I had never met before)... all with purple markers (well, not my DH, he just go to be an onlooker), with me standing up buck-naked, IV in my arm, listening with doppler all around my belly button, making marks poking me hard with their purple markers, drawing all over my fat belly, drawing all over my left breast... talking about the best places to cut me... which sections/side would be the best to use... 

And the real kicker is that knowing the nurses were going to have to shave me "down there" I had tried to do them a favor with my new electric bikini attachment and had shaved off "most" of everything for them in advance, but it was all uneven etc.  And of course had not mentioned that to DH.  I know this is LOL funny right now but omg it was embarrassing.  I was like "PLEASE START THE ANESTHESIA, NOW!" 

Snobird

I feel very lucky. I only had the primary PS, his nurse and my DH in the room for the marking. Also I did not have to shave anywhere, in fact it was recommended to me to stop shaving everywher prior to surgery to avoid infections from ingrown hairs when it started to grow back. I was also wearing my own underwear for the photos which the nurse took. My husband was taught how to take additional photos to send to the surgeon every 4 weeks during recovery since I lived 5 hours away. When the scars heal more I will go back for further stages.

XmasDx

By the DIEP girls, don't read the thread "Fortunately, Unfortunately" until your abdominal incision heals.  It's in Humor & Games.  Those are some funny ladies, but now my stomach hurts! 

goldlining

Thanks so much for those funny stories, ladies! 

I had a breast reduction at 19, so it brought back memories of the photos -- not by the PS mind you, but by the Medical Photography unit! Some additional perfect stranger whose only relationship to me was "disrobe please". (No thongs involved though.) Also the purple marker. I was really comforted by that. He did it the night before, back in the days when people were actually admitted the night before surgery. I was glad to have the time to process in my head. I was a little freaked for my mastectomy that there was no purple marker and he was just going to "freestyle" it.

I'm waiting on DIEP consult and OR date and as I'm uni-mast (Dec '10) and prophy mast with immediate bilat DIEP to schedule, I'm getting various other things out of the way through Labour Day. (So watch for my turn at the "eeeek, tomorrow" posts in about 6 months.)

I looooved the funny stories about the thongs and all our bodily insecurities, but I'm now taking the position that I'm not flabby, I'm tissue farming. 

marxi

Finally got out of hospital this morning.  My surgery was 11.5 hours on March 1.  Second surgery March 3 to try to save left flap.  Within days, it was clear that surgery was only option again - to remove flaps.  I was not strong enough as I was so ill and so my PS asked if I would consider using leeches.  Leech therapy (2 leeches on left flap every 2 hours) for 7 days did save the flap but took me to a place physically and mentally that was exhausting and challenging.  Had all kinds of problems.  12 blood transfusions.  Got off the IV meds this morning.  Left side is swollen, needs a third surgery.  No problems with abdominal wound.  I would not do it again.  However, I am very grateful to the dedication of my medical team and my focus is on healing and moving forward.

XmasDx

MARXI!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

You're back!  We were all getting worried, and now I see why!  You have been put through the wringer!

 I'm so glad to hear from you though.  I'm so sorry it has been such an ordeal.  But I'm glad to see you back posting!

blondie45

I am so sorry for all the complications. I will be praying for you.

dannade

Hi everyone,

It's nice to hear a lot of upbeat comments today (after all we go through!).  My original PS for my immediate reconstruction (implants, but left one failed) was in private practice and was the nicest woman.  I was in full cancer shock mode at the time and cried a lot.  She always sat down with me and asked me to tell her what was wrong.  I miss seeing her.  She always took pictures every visit. Because she did not do DIEP flap and I was changing insurance, I sought out another PS for my left breast reconstruction which had to wait till radiation healed, so I was without left breast for over a year.  I did go to Loyola Medical Center in Chicago for a consult with my current PS.  I had my list of questions which he answered and threw in a little joke type remark here and there, but not enough to be silly.  I immediately liked him, found him knowledgeable and comforting and patient.  His nurse was always in the room with me.  He does not take pictures till the end.  Well, I'm one for pictures, so I had been taking pictures of myself from the night before the dmx (kind of droopy uneven boobs), through just a few weeks ago (DIEP done on Dec. 7, 2010.)  I gave a copy of all my pictures to the PS and he really looked at them and had them scanned into my file.  He made a comment about my radiation pic which was very burnt.  He said, "and they say radiation does not damage skin?"  My PS had his Fellow (one who has done surgery but is now specializing in vascular surgery) assist him in surgery.  A young resident marked me (he could have almost been a grandson of mine).They said they took pictures during surgery, but I'm not sure.  I wanted a video, but they did not take me seriously and said it would be too long anyway.  I watched the one on or. something everyone has been watching, so I got the gist, believe me.   I always bring a paper with questions on it and even then I forget something.  PS always says, "ok, what else is on your list there?"  He and his nurse keep saying, "Be patient."  I know I have some stage II stuff to be done, he's just waiting for things to settle down, but the top of my new breast is raised up, swollen and hard (my own tissue).  I think this should be addressed sooner than later.  I see his this coming Fri.  Not one of us has had an exact duplicate of the other, but it is good to hear all the possibilities, good and not so good.   Comment, I did not have to shave, nor did they shave me.....

dannade

@Marxi - My prayers are with you.  You sound exhausted and rightfully so.  It has to get better.

goldlining

Marxi we've been thinking of you while you were going through it all, wondering how it was going. So sorry for your complications and much admiration for your strength in fighting back. For all of us on the pre-op side, it's probably all of our darkest fear, all the sideways things you can't control. Thank you for sharing and letting us know you're home. Hope to hear that you're fully out of the woods soon and end up with the best outcome in the history of outcomes for all you went through.

XRAYestInMA

@marxi Oh my, what a long road you have been on lately. It is clear from your post that you are one strong lady - emotionally and physically. I am so sorry to read that you have had so many complications and I hope that you are now on the mend and will continue to feel better soon....

marxi

thanks for all the well wishes. your support means a lot.

Iamstronger

Marxi!!!  So glad that you are back.  I was worried.  So sorry that you had such a rough road.  YOu are in my thoughts and prayers and hope you are feeling better soon.

pupfoster1

WOW, Marxi, you have literally been through the wringer!   They had me very worried about my flap for the first 24 hours as their new SAT monitor kept showing the O2 levels dropping considerably which is a sign of flap failure.  They literally were in my room every hour for the first 24 hours checking it.  All ended up being fine.  I am SO sorry you had to go through all that additional pain----physically AND mentally!   It's like adding insult to injury.  It's bad enough to get the BC dx, then to have to endure what you did---whoa.  You must be one strong cookie!  God love you for it.

(((HUGS)))

Sharon

marxi

God was with me and through it all, I hung onto Him.  Horrible experience but I am hopeful the rest of the fine-tuning will go well.  The left side is very swollen and huge! 

XmasDx

Hi Marxi,

You do have a good drain(s) in the left side, correct?  Is it ouputting a lot? It is not clogged, is it?  I can see where it would be swollen and huge, I had surgery 2/28 without the complications you had and it is still very swollen, so I'm sure it's normal.  I just wondered if it is draining well.  Because if it is not, that won't help matters!  Have the doctors suggested heat or anything to ease the discomfort and help healing?  I know normally it's ice for swelling, but our flaps love to be toasty, right?  

You get some good rest, you deserve it!