Diep 2012

sassy43

florafarm- I too am confused by the pre-payment at NOLA.  I have also met my deductable and out of pocket expenses and they told me my insurance would cover it as OUT of network which only equals 80% of the procedure, leaving me quite a hefty bill. I too am looking for answers.  Any help would be greatful, and good luck with your procedure.

jenlee

It is very confusing. I called Dr Massey's office at one point and was information that would have meant I would have to pay an enormous amount of money, yet my coverage was incredibly good with the Nola docs, not sure why.

Ralsper

I was told "Wear something that is supportive that does not constrict your breast for 3 weeks after your operation" Do I really need breast support? I'm having problems with hot flashes and sweats (Tamoxifen).   I prefer just to wear just my pj's (without camisole) and clip the drains with safety pins on my pj's, but if I have to wear a camisole which one offers support but is not constricting?

Also they recommend wearing high-waist bike shorts for the first 4 weeks. Any advice?

How many times a day do you change your dreesing and for how many weeks?

Thank you

bdavis

About the insurance... I have Aetna which is OUT of network, but I also have Three Rivers... I had to ask a lot of questions because this was foreign to me... So apparently the docs have a contract with Three Rivers who is like a third party company that processes the claims for Aetna... I had met all deductibles and had $800 remaining on my IN network OOP and $1800 remaining on my OUT of network OOP... so the way this works is that the rates are negotiated and under contract with Three Rivers (so no balance billing which is very important), but it works off of your OUT of network OOP... so for me, a bill that might be billed out at 70k, is negotiated down to 50K, and my portion is my percentage (30%) up to my OOP max, which was $1800... Everything after that was covered 100%... So the doctors had wanted me to pay the $1800 up front knowing I would owe at least that... in the end they agreed to the $800 because they said sometimes the insurance company will work off of the IN network... depends who processes your claim... so I paind $800 and then later paid $1000.

Hoya03mom

i had my first consult with Plastic Surgeon (Dr. Fusi in Guilford, CT) and he was pretty thorough describing both options - DIEP and implants.  He said that the time in the operating room and said that the recovery time is less than in past years and recovery time would be similar to the expanders.  More time in hospital following surgery (4 days vs 1 - 2.   I actually talked with woman in his waiting room who drove herself there and was on day 25 post surgery.  She said she was very pleased with results. 

Dr. Fusi does traditional DIEP while second surgeon I am consulting with (Dr. Au, who did fellowship in U of Penn Plastic Surgery and is now head of breast reconstruction at Smilow - Yale New Haven) does a slightly different variation.  I will learn more about that on July 2nd, but something about taking a very small (postage stamp size) portion of the muscle as well.  Not sure why or impact.  Anyone know anything about either MD or that procedure??

Thanks!

MondaysChild

Hoya03mom,

If the other surgeon is taking a postage sized portion of muscle, then he is talking about a Free TRAM and that is not a variation of DIEP.  The both use tissues from the tummy area but that is all they have in common.  A DIEP uses no muscle, ever ever.  With Free TRAM, you face the same issues as pedicled TRAM due to the muscle being removed.

Again, this is not a variation, and especially not a slight variation.  Free TRAM is what surgeons who cannot do the DIEP start with. And Free TRAM is what a DIEP surgeon has to fall back on when, during surgery, they find a DIEP is not possible because of issues with the blood vessels.  But these days they normally run scans prior to surgery and know the condition going in.

bdavis

Hoya.. Mondays Child is spot on... any muscle taken is called TRAM. And if your surgeon who is offering a DIEP asks you to sign a waiver saying they can do a TRAM if they get in there and feel they can't do a DIEP, then I would find a new surgeon. My surgeon NEVER converts to a TRAM, and that is what you need to look for.

jenlee

Florafarm, check your policy to see what your out of network maximum is... I have a 30% co-pay for out of network, but my out of network out of pocket maximum is $6000. So in my case, theoretically, I was to be responsible for $6000 at the most, and it was substantially less in the end because I'd already gone out of network earlier in the year for some unrelated services. I had forgotten about maximums and was originally thinking it would be twenty or thirty thousand or even much more ( i actually have no idea about cost of the entire procedure) which would have taken a bit more thought before proceeding.

Beckers

Hi ladies. I have read so many of your stories and I thank you. I had the dreaded naked photo shoot today when meeting with PS. Lord willing I will have double mastectomy and DIEP by end of August, hopefully sooner. I just want to get this over and done with. I never imagined back when I went for my mammo in Jan that 2012 would become such a blur. I look forward to getting my life back. In the meantime, I love this site and following your journeys as I make my way. I don't feel so alone on this road.

Silia

I've mostly lurked here but am scheduled for my bilateral flap surgery at Penn on Friday.  I'm self-employed and just got a call about a possible project which would have me presenting/facilitating at an all-day meeting on August 1 (which is 4 1/2 weeks post surgery).  For those of you who are a few weeks out of surgery, do you think this will be do-able or should I not try to get this gig?  Any advice appreciated!

Chris13

Hi Silia,

Based on my own experiences at Bryn Mawr with Dr. Serletti from Penn, you should be fine. I was up and about by the second week. Not for a full day presentation, but one month out I think I could have. Baring any problems.....which occasionally occur but not often....you will be dressed normally and able to stand for a while, maybe switch to a chair ("I'm recuperating from surgery.") You will have more difficulty reaching up if that is involved, due to node removal.  You should be well off the major, druggy, painkillers by then.

 Hope that helps...

bdavis

Silia... I assume you already had a BMX?? So this is just the DIEP?? If so, I think it is no problem.. I went back to work at 5 weeks and also attended my weekend long 30 year HS reunion... I was off pain meds at one week, driving at 2.5 weeks...

jacee

I'm not sure I could have, definitely wouldn't be able to stand all day. I had a hip drain for 7 weeks. That could be hidden, though uncomfortable. Hopefully that won't be the case for you.

bdavis

I had hi[ drains for 8.5 weeks, but that was from my hip flap portion of surgery... I was done with my DIEP flap drains by 2 weeks I think.

Beckers

Question: After bilat MX and DIEP, would I be okay on my own in daytime some days? How much assistance did you absolutely require and for how long?

bdavis

After my BMX and Hip flaps, I had someone with me for a week and a half.. and then I was alone during the day.  At one week and one day (8 days post surgery) I was doing all of my own drains, dressing with no assistance, showering etc... But I did have friends bring dinner for a couple of weeks after hospital discharge and hired a cleaning lady. You want to rest for 8 weeks, so no heavy lifting or anything strenuous.

cmbear

Silla, I'm 3 1/2 weeks out and I can get around ok,dress myself but I'm still fairly bent over because my belly was pulled pretty tight. My back has not handled the whole bending over very well, so that is where my pain comes from. If it weren't for my back, this whole process would have been a breeze. So, I can't stand for long cause it kills my back. Hopefully you won't have that issue.

Beckers, you definitely will need help for at least for the first week. And then after that, it helps to have someone do your cleaning and cooking--hopefully!!! I have 2 teenage boys that TRY to help out. I'm really glad they can do the vacuuming and the laundry.

bdavis

cmbear.. I think back pain is quite common... It was for sure the biggest problem I had. I took Flexerall, and I think it helped.

Irina777

Beckers - I came hone on the 8th day post op. Next day I was home alone from 9am till 6 pm. I was fine mainly because I have a recliner/power lift chair that made it possible. I would not be able to get up on my own if not that chair that practically stands you up. I was able to get up and go to bathroom and also get my food. My dh had food in containers on the low shelf in the fridge for me, so all I need to do grab it, microwave and eat. Also, by my recliner I have a night stand set up. I have water, meds, my glasses, my phone, iPad, little mirror and chopstick, and pen and notepad on it. What I am trying to say that you can survive for some time alone during the day if you are able to get up and lay down on your own.

Beckers

Irina- were you 7 days in hospital after DIEP?

florafarm

That is really helpful to know because they are asking me for over $12,000 up front even though my insurance says I will be covered at 100%!

florafarm

I will be coming back from NOLA (if all goes as planned!) 8 days post op. Are you gals that have had DIEP saying I wont't be able to get in and out of a chair on my own at that point? I was thinking I'd be ok on my own during the day at that point....

jacee

I was able to get up (slowly) without help after leaving the hospital on day 4 after DIEP. I needed help the first couple days putting on my compression garment.....other than that I was fine. Home by myself during the day. Did everything, just much slower and with more care.

goldlining

florafarm, I walked 5km in the hospital 4 or 5 days post op. It was slooooow walking, and just 1km at a time (10 ward laps = 1km, I measured). You can definitely get in and out of a chair. Other than the homecare nurse that did the drain care until I got that out, I had nobody home with me most of the time. I didn't need people helping me up out of the chair or anything. I would have liked more coddling, but it is what it is. (I have a husband and a 16 yo daughter and am not going to beg.) I simply didn't do any housework that did not do itself. I could easily microwave myself some soups and make toast and such. If people were home and they could bring me beverages, great.

I started getting driven to the gym and walking on the treadmill very soon after I got home and got the drains out. I knew it would help me and I did about an hour once a week to start, and went for longer durations rather than faster speeds as my goal was to get back upright again.

Silia, I was working within 10 days. I was doing a LOT of hobbling, but most of the work was sitting and once I got there, I was fine. I was not "cleared to work" for 10 weeks, but that was bungled paperwork. I felt okay to go back in about 8 weeks, but there were things I wanted to do that I did not want to lose momentum on, but I couldn't perform on a full time basis for about 8 weeks. (The surgeon would have signed off on longer, but I was ready to stop the skunk-eye I was getting.) But in relation to your facilitating a meeting at 4 weeks, I would say that about 3 weeks, while my regular work was even still on holiday break, I did a pretty high stakes extracurricular client meeting over webcam, about 2 hours long, plus prep and post mortem with my colleague. I remember feeling my words sometimes hard to find, but I think it was within a reasonable range, and the client was completely happy with the meeting. I did not elaborate on what the issue was, just that I'd had surgery and was on the mend. If I did it over again, I would have made more "cue cards" to prop up my concentration during the meeting.

I had all but one drain out by hospital discharge at 6 days, and the remaining one out 48 hours later so there were no drain issues, but I was not wearing my business wardrobe yet. I tended to wear a simple cardigan as it was soft and not clingy and did not require me to put on anything underneath (my surgeon was a "non-binder".) 

Good luck to all the new DIEP peeps!

mags20487

I am considering NOLA and wonder how many days I should stay in town before heading home to Central FL?  Just trying to get a feel for what  to expect.  Did any of you fly home?  We are probably about 12 to 14 hours from NOLA so guessing a plane would be the best bet for us.  Still waiting to see what the insurance will pay and what I will be responsible for.  The $12000 is a scary total

Maggie

rtnyc

Silia my problem was sleep or lack of which put a damper in my plans of being back to work in 4 weeks, I am at 8weeks and just starting to sleep on and off it's now 4:46and here I am! The neves are regenerating from diep and keeps me up no meds are working. Everyone is different

Chris13

Silia,

Goldlining's post does remind me that I had "surgery brain" for several weeks. Nothing extremely noticable, but I think the major pain meds, even when you stop them, remain in your body a bit longer. I would have a little problem finding the right word sometimes--that was about it. Just so you will be prepared if that occurs....

jacee

Mags, My surgery was with Dr Massey in Charleston, but she follows the same protocol the NOLA docs do. I'm sure bdavis will be along to give more specifics, and insight I may not have. Most ladies fly there and back home again. The day before surgery you will have a scan to locate blood vessels. Then that same day / afternoon you see the Dr for markings. If there are no issues and you are ready, you will be released after 4 nights in the hospital to a hotel in the area. You will then return one week after your surgery date for a post op, then most will fly home the following day. I would say the minimum stay is 10 days in the area for a Stage 1.



Silica, I agree fully with the whole "surgery brain" effect. Sometimes forget that it happened, but I remember it being frustrating not being able to find the words to say at times!

Lavendarlady

Hi all, I have been popping around these sites since January....you are all so helpful. I am 9 days out of my diep. Both breasts. I feel great, no pain...but feel like a baby is moving around inside! Weird sensation. Felt it off and on since I was in hospital. Can anyone tell me what this is? I've read a few things but no answers...I'll see my dr next week for my first check up, but just thought I'd ask. Thanks ladies

jacee

Lavender, I haven't heard of that. Do you still have drains?