Diep 2012

bdavis

Chris... the PS is giving conflicting info... if he says he may need to take muscle but he definitely won't convert to TRAM, that is what TRAM is, taking muscle... there is pedicled TRAM and free TRAM, but both take muscle. Perhaps some day you should ask him what he did??

Jannelle... I went to NOLA and lots of women travel from all over the world to go there. I traveled there from NJ. There is a woman on here who originally had her surgery in CA and when its didn't go well, she went to NOLA and is one of their most vocal advocates... Have you checked out the NOLA in SEPTEMBER thread?? You can also always call Liz Markey at the Center.. She will gladly give you all the info you need. I too am almost 50 and wanted it done right the first time... Dr Dellacroce is a perfectionist and looks at the whole body, not just the breasts when contouring... he is a true artist!! Please feel free to PM me, and I'd be happy to talk on the phone as well.

fredntan

How do i really know if my PS is good? They only showed me a few pics last time i was there.

I think i will see what this nola is about. I mean i have 11 months to wait for mine. They also told me there was no garantee that i would have enough blood vessels on each side, in that case they would have to take some muscle.

I was just looking at the nola website. I like the idea of a small hosp. I recieved horrible care during my mastectomy. The sx she was great.

dressager

my surgeon warned me that they sometimes get in there, find insufficient blood supply, and end up taking what he called a tiny bit of muscle. he held up his fingers indicating some space less than a square inch. 3"x3" doesn't sound so tiny to me and i would be concerned as you are. the first thing he did tell me after surgery was that they took no muscle---he knew it was a major concern for me.

women, i have a pre-surg tip that i believe really helps. they don't require special diet or anything near a bowel flush for diep. my instructions were to eat and drink normally up to 10pm the night before surgery. my advice is to just NOT do it. i stopped eating solid foods one day before---it ended up as 30 hours of clear liquids. i didn't do enemas or anything like that but i worked to clean out my bowel naturally (for me, thai lemongrass soup broth does the trick--others drink ginger or lemongrass tea...). obviously, diabetics might not be able to healthfully do clear liquids for so long.

i've had three major surgeries in the last four months and haven't had a second of nausea. also, my bowels come back like champs. i just feel better knowing there's no, um, material sitting around during surgery and hospital stay.

bdavis

Fran.. I can't say enough GREAT things about the Center for Restorative Breast Surgery... The doctors, the hospital, the nursing staff... they have thought of everything. There is a thread on here about traveling for DIEP where I gave a very detailed account of NOLA... I will look for it.

bdavis

http://community.breastcancer.org/forum/44/topic/786241?page=1#idx_22

My post is currently the second to last post.

dressager

WOW. betsy, your experience was unbelievable. now i'm craving a pina colada icee...

Kadee63

I had my DIEP on May 7, 2012.  Ive noticed one breast is getting hard sensitive areas in it.  Does any one know what this is? Does it go away? does the PS have to correct it in Phase 2?  I had an implant that felt great but was cold. At least this is warm but the hardness kinda concerns me. 

rtnyc

I had deip 4/23 here in NYC.  My BS said absolutely no moving of musle. they disect the veins for the blood flow via micro surgery which is why the surgery takes hours longer. And by the way, there is nothing wrong with changing doctors after going for a second opinion. I did it and so happy I did. I not only found htat the second opinion doctor had more experience but she was much easier to talk to which made me feel more comfortable and I trusted her.  She explained all my options from start to finish so I was totally eduated on how it would be done and at that point she didn't know I would use her. So you deserve to be sure, you deserve to feel good about the information your getting from your doctors and only you can know that!!!  Good luck. 

Del11

Is it just me, or does 9" square not sound like a "tiny bit" of muscle?

bdavis

not just you... that is a significant amount of muscle... postage stamp is the norm for TRAM.

redninrah

for those ladies who have already had the diep done, i had mine done in jan, the belly button area is still quite tight/firm and it seems the muscle around it is harder or shall i say more firm. Does this ever go away, anyone else experience this?

sadie5254

Had stage II last Friday.  Breast reduction on the right and dog ear revision on the left hip.  Frankly, this surgery was more painful to me than the "big one" in Feburary.  I guess because the reduction surgery was more extensive on the outside (the diep was more extensive on the inside).  Saw the PS surgeon today and he said everything looks as it should and he'll see me in September.  I went from at least a double D down to perhaps a C - haven't measured.  Because I picked up MRSA in the OR back in February, I opted not to do a nipple reconstruction, lipo of the breast fold or anything else, because my risk of infection is multiplied by the number of skin openings.  I had to do a decontamination protocol before this surgery.  So far everything seems to be good.  Today is my first day with no pain pill (yay!) and I can probably manage now with Tylenol as needed, which is funny, because I hardly needed the pills with the original surgery.  Anyway, they found some thyroid nodules during a routine scan and oncologist wants me to see an endocrynologist.   Kinda freaked out that it could be something there, especially since I am recovering from a breast surgery. Praying they'll just be able to watch them rather than have to hear it's thyroid cancer.  Damn.  But as far as the Diep and recovery, I'm doing really well.  

Jeannie57

BDavis, my understanding is that I have TE's to preserve the skin for the DIEP next year. I had skin-sparing BMX, so we're trying to use as much of that skin as possible. In addition, with upcoming rads I have to keep the skin stretched. You're right, the pecs will be under the new "breast" tissue eventually, PS says they relax back easily. I look forward to having the pecs back under and not constantly flexing like a male body-builder.

Jeannie57

Sadie, good luck with the thyroid issue! You have been through a lot, you are strong. Please let us know how it goes.

CookieMonster

Dr. Tseng told me that he has never (I think) taken muscle. Either never or only 1 or 2 times ever. I'm very happy with the work that he did on me. I have more to come, but so far so good.

I would guess that if you decide you want Dr. Tseng to do your surgery, getting it done by the end of June might be tough, but maybe he has more open time at UCLA Reagan, his time at UCLA SM hospital is pretty limited. Claudia can help you with scheduling stuff and she's great!

If you have specific questions about Dr. Tseng, feel free to ask.

fredntan

Sadie, thyroid nodules are very common. And in the worst case, thyroid ca is easily treated

TJP1071

BDavis...thanks for the info.  I am getting worried about phase 2.  Just want to make sure i am getting across what it is I would like them to be in the end.  My Doc. says he knows, but I get nervous. 

Just had to go see him because of an abscess.  Right breast.(not my problem breast)  now I am packing a hole and waiting for it to heal from the inside out.  I am sure it will not be healed by next Tuesday.(my surgery).  

I have ALOT of necrosis.  Most of my left breast is hard as a rock!  And the underside of the right breast as well.  The left has had issues from day one.  3 surgeries on that side in 4 days as well as 2 weeks of Leech therapy!  UGH!

The upcoming surgery is providing some hope for me.  It has to get better that this!  Hard, leaky, holey, breasts! I am one hot mess!  But a Cancer free one!  Not much to complain about!   

goldlining

jeannie57 I am not sure what the big deal is about stretchin g and preserving the skin. I had one delayed DIEP and one immediate. The immediate uses the breast skin with a "porthole" in the areola position and peeled the abdominal skin off the flap before stuffing it in the hole, and the delayed uses the skin that was on the abdominal flap. Other than a slightly different colouration of the ab skin flap, I can see a day when you will barely notice the incision scars. I don't see any benefit that I would have enjoyed as a result of holding on to the natural breast skin. All the fills and such are time you could be spending doing other things. My 2c.

On the TRAM "postage stamp" switcheroo etc., I can see that in very rare instances, what a surgeon finds when he opens up isn't what was visualized on the CT scan. My surgeon said he considers that a "failure" and having done oodles of microsurgical flaps (not just breasts but faces too), it just isn't an outcome he considers a successful surgery. I read my surgery report, and they described microsurgery of "teasing out" the blood vessels, and comparing the good size blood vessel on the one side with a smaller size on the other side, the anastomisis against a silicone sheet, and so on, and no reference to any muscle cutting. If you don't have your OR report, you can easily get it from the clinic as it's part of the medical record. It is interesting to read, like a narration of what happened in those 10-12 hours while you were sleeping, blow by blow. It's no fault of the patient to have a TRAM, but a lot of the time, these pre-op consults sound like the surgeons are all to ready to cop out and the sound of that "postage stamp" spiel should be heard as "time to at least talk to another surgeon".  NOLA is well established and sounds like a total spa, but there are other centres that do a ton of microsurgical genuine DIEPs, even here in the frozen north.

bdavis

Jeannie... I have to agree about the fills etc... I think some doctors just plop an implant in there to hold the skin away from the chest wall... it doesn't have to be pretty, just fill the space. And to fiddle with the pecs seems unnecessary...

Jeannie57

Well, thanks but this is the road I'm on, I trust my PS and university research hospital and I am fine with it.

Adey

Jeannie-  I had the same thing, though accidentally on purpose.  (c:  I was scheduled for implant exchange and then cancelled and did hip flaps.  I had fully expanded TEs before radiation and so there was a pocket to place the flaps in.  I thought I would have the "football" scar on the radiated side but they were able to use the mastectomy incision.  I felt immediate relief after stage one with the pec muscle back in place.  (c:

Ralsper

Jeannie - I have a fully expanded TE. My PS is Dr. Said as well and I completely adore him (I have a big crush on him!!!) and trust him 100%. My DIEP is July 18.

julianna51

I have fully expanced TEs also...as the original plan (before rads) was implants.  Very much looking forward to some relief for my pec muscles.  Less than 2 weeks....coming up fast now!

Jeannie57

I'm lucky. My TE's are almost fully expanded and my pecs have never bothered me. But I'm pretty small, too. If I'm going to go through DIEP, I just want boobs that are worth all the trouble. Gotta grow more fat, ugh.

Jeannie57

Ooh, Ralston, I'm excited for you and glad to hear from somebody else seeing Dr. Said.



Julianna, 2 weeks! Are you nervous? I'm looking forward to hearing how it goes for you.

Downey30

Hi everyone,  I have mostly been on the Nola site but I will be returning to Nola to add another flap to my right breast.  I had SGAP flaps both sides but have a bony defect on the right which made the right appear quite smaller.  Everyone has said that the Gap surgery is an easier recovery.  I had drains for over eight weeks with the Gap.  What is the average for the Diep?  I'm only 2 weeks away and getting nervous.  I guess I'll end up with a scar almost all the way around.  Oh well, thats not so bad if I'm cancer free and get good results.

bdavis

Downey...You know I had the GAP and DIEP?? The DIEP drains were for like two weeks or so... and yes, the GAP recovery is easier. And the scar does go about 330 degrees around, but it fades and I don't notice it at all. It is all under my bikini panties.

Chris13

Yikes, one month UXM/DIEP today, and healing well. But having a more painful section --maybe deep under my incisions....hard to tell exactly where it emanates from. It hurts when I lie down, and last night moving around had several blasts of pain.

No sign of infection or anything amiss on the exterior. Is this part of the healing/nerve regeneration process? (I don't mind the occasional "electric pops" as I believe they are nerve regeneration.) I do have a section of  necrosis on the other side, could this be pushing against healing tissue?

Kind of discouraging....thought I would be moving toward less, not more, pain. 

Starfyre

I see Dr Tseng at UCLA on Monday for a second opinion and I talked with NOLA after sending my photos and info to them.  Laura the PA at NOLA was so nice and helpful.  NOLA is feeling better and better to me.  I will see what Dr Tseng has to say and go from there.  

I am feeling much better about the whole thing.  The first PS said she does not do stacked DIEP's and that one side would always be smaller, NOLA said a stacked DIEP was no problem based on my photos and that there was no reason why they could not match my non cancerous breast.

 Sadie: A PET scan showed thyroid stuff for me too back in 2006.  I went for ultrasounds every 6 mos for two years but they remained unchanged.  I just had another PET scan last week and they still have not changed.  Not sure what that is all about.  

Downey30

Hi BDavis,  You are really an inspiration with all that you have been through.  Also, you are just great at sharing your experinces.  I only have about two weeks and I guess I'm getting a little nervous about the recovery.  I never really had any pain with the breasts and gap surgery but the donor area drained forever and caused the most discomfort.  I know things will be fine.  It's the buildup prior to the surgery that is tough.  I'm sure you felt the same as me.....hoping to do Stage 1 then Stage 2 and be DONE!  Things don't always work the way we want.  What is the saying "life goes on as you are making plans".  Any extra Diep info or tips would be greatly appreciated. Jamie