Diep 2012

Chris13

ATV, my ps said (to the best of recollection) DIEP only. Of course things got sketchy as I went into the surgery....and of course I signed papers, but I don't recall any options as to type of flap surgery. I guess you can ask what changed in the few cases your PS cited to make it necessary to do TRAM.

 Of course TRAM is not the worst outcome possible, it is just less preferable if it can be avoided, in my opinion. Many women have had it done and others are still having the procedure. I think they are pretty much okay except for a few with muscle issues. And even DIEP can lead to problems...not to freak you out. I guess nothing is 100% when it comes to what we are going through--in all aspects!

 Sounds like your PS is pretty much assuring you it will be DIEP.

 Good luck..

jenlee

I would not have agreed to do anything that authorized a PS to do a TRAM! I'm extremely active and not willing to sacrifice any muscle. They should be able to figure it out in advance by examining you and doing an abdominal ultrasound. For me, neither a TRAM or LAT would be acceptable, but there are various other kinds of flaps (stacked, hip, butt).

Cherrie

Jenlee, I am only 3 days from my stacked DIEP. I chose a DIEP for the reason that no muscle is involved. In Michigan they all wanted to do a Tram or Lat and that was not acceptable to me. I am too active to lose muscle like that.

jenlee

I would not have agreed to do anything that authorized a PS to do a DIEP. I'm extremely active and not willing to sacrifice any muscle. They should be able to figure it out in advance by examining you and doing an abdominal ultrasound. For me, neither a TRAM or LAT would be acceptable, but there are various other kinds of flaps (stacked, hip, butt).

Survivor2Be

Ladies,

I will hopefully be having bilateral DIEP in December. I was considered having the top area of pubic hair lasered to help prevent ingrown hairs and infection post-op. any thoughts?

goldlining

I was anxious about ab muscle and would have preferred flat to TRAM, and one of my key comforts was that the PS himself had been a marathon runner and understood what my motivation was. I told him that I was late to running, and was not good at it but it was good to me, and dammit I wanted to be able to keep doing it. He said that taking muscle was a failure as far as he was concerned, and had only ever had two out of a huge number of cases. I can't recall if the paperwork said the possibility existed, but I would have signed the papers if it did because I trusted the PS and his enormous DIEP experience and that he understood that I didn't want muscle messed with. If there had been a problem on the CT scan, we would have discussed, but no news was good news. I think there's some ass-covering in those forms, i.e., you're going to sign a form that says there's a risk of death from anaesthesia too, but you aren't agreeing that it's okay for them not to wake you up. You have to make sure you and the PS are on the same wavelength over and above the black and white and I really believed he understood my goals and my big picture, and had the clinical experience to make it happen, paperwork aside. That was my outlook anyway. 

bdavis

Jenifer... I think you mis-typed up there... I think you meant to say you would agree to a TRAM.

About the Marena, I did not use it for stage I only because I had drains for 8.5 weeks (I also had hip flaps), and so I didn't want a garment that needed pulling up when I had drains... so the garment the doctor gave me was sufficient. But after stage II, it was perfect.

damoen

wow!  I never considered they could take flap that low in the abdomen! Sounds like a smart decision to have the laser, but I have no experience to share.  Still looking for a good PS...interviewing another one tomorrow. good luck Andrea!

goldlining

Andrea/damoen, for what it's worth, my incision line was just above the hairline and there were no issues with that, but golly, with the stretching that happens afterwards you may want to laser at that point, if it bothers you.

florafarm

Andrea, I am guessing that they Choose to make the lower incision so it is just above the pubic hairline to avoid that because thats how my incision was...very close, but no hair above it. I wouldn't laser it. You'll want your PS to be able to see the hairline.

CookieMonster

Survivor2Be - they didn't go that low on me, didn't have to shave any of the pubic area. I don't know if other PSs do, but since they're taking from side to side, to get to the pubic area they'd have to dip pretty low. If you look at pictures of DIEP abdominal scars, they don't go that low.

OK, just checked my scar and it's right above the hairline in one area, but I have no memory of and saw no evidence of them shaving anything to do the surgery.

sandpiper1

I think we all have different patterns of hair growth

That said I had done some landscaping before my surgery although I would check with your PS as many hospitals prefer to do their pre-op shaving or dont want things done too close to surgery due to risk of infection. Every md is different. My JPs were darn close to my supra-pubic area where there's plenty of stray hairs. There is no hair above my incision line but some strays below it. My final incision is not at the bikini line but a tad higher. You can check for Lot's of different sites to see videos that characterize how the procedure is performed. My PS also made a very detailed drawing of the entire procedure as he was explaining it. Never once did he refer to a TRAM. neither was it written on my consent. In fact I had originally been scheduled for a bmx & chose a umx. Consent had to be redone. My Ps gave me copies of my consent & pre-op orders when we had originally done them in the office.

Purl51

Rebecca:  Just sending you well wishes and great healing from a fellow Californian.

Galsal

Finally...drain free!  Live is good right now.

fredntan

Am soexcited i just set my diep date for nov 7. I just cant deal with this TE any longer than 6 months after rads. Ive almost had it a year and want it out. I want my newboobs! Doing it at johns hopkins. I can still cancel, i never submitted any paperwork to charleston or nola. My insurance aetna says they are not in network. Looks likeDH gets new boobs for our 25 anniversary.

Last time i saw my docs they really couldnt give me any idea of what size i would be. I want B, dh wants bigger.

Should i try to put on weight. I dont have muchbelly fat.

Cherrie

The doctors in NOLA say no to putting on weight. They can get the fat from hips and butt too. I am too thin for just a DIEP so the hips will have to help. Contact docs in NOLA and Charleston and see what they say.

bdavis

Fran... I have Aetna (I may have told you this already)... and even though the NOLA docs aren't in network, it was processed like it was in network... The whole process (surgery, hospital, anesthesia etc) cost me $1800.... and any subsequent surgery (stage Ib and stage II) were free because I had met my OOP maximum...

BirdyRobin

MOnday, monday is my Diep surgery the 20th of Aug. Anyone else going to have surgery soon? I am nervous about how I will look after wards. I do not like the scars I have and I have gained weight since my dmx I feel lumpy and pugy. I just want to have a nice proportionate smoothish breast again.

(((sigh)))Robin

fredntan

I am just procrastinaing again. Need to fax my stuff in. Just so :-)tired of seeing drs. I havnt given up on that ether



Does anyone think it makes much difference waiting longer than six months after rads? My doc said his friends argh chemo brain-that hosp center in texas i cant think of name. But last spring when i saw him he wanted me to wait a year after rads for diep. My skin looks great after rads. Just this TE is uncomfortable. Not alot of pain, but just enough toremind me it is there

cmbear

Everyone has a different thought process. My MO and RO both said AT LEAST one year. My PS said that new evidence says 6 months is sufficient even less with some people. For me, it was what would lend to the best healing process--failure was not an option.

AnnAlive

Fran -- when I was checking into DIEP, I was hearing to wait a year after rads. I too wanted to get rid of TE in the other breast (turns out it developed a capsular contracture), and the rad side had already lost its TE due to infection before rads and looked and felt terrible. But when I contacted NOLA, I found out that their minimum wait is 4 months. Dr. D (from NOLA) on his Ask the Doctor website (http://members.boardhost.com/plastic/ ) explained to me that it isn't necessary to wait a year because the damage is done and won't improve, that it just means going longer without a breast. So I had my DIEP flap surgery last month at NOLA, 4.5 months after the end of rads. PS replaced the radiated skin on the lower half of the breast with abdominal skin and fat. It is healing now.

Robin -- Wishing you a good surgery on Monday. Scars heal and fade, and there are creams to help minimize it. I'm only a month post-DIEP, so I don't know how I'll look after stage 2 in Dec, but certainly better than I was after BMX last year. Take heart! It will get better!

Hoya03mom

Galsal...yea to drain free....5 more days for me....down from 6 drains to one in hip (of course the one that is the most annoying!)

For those looking at DIEP vs TE, I ended up with what is called muscle sparing TRAM....NOTHING as invasive as full TRAM, just two tiny pieces of muscle that  help keep the whole transfer more viable.  MD put a mesh thing to help the small areas heal over.  He has been trained in state of the art at UPenn in doing these and he decides once inside whether to do true DIEP or muscle sparing TRAM and chooses what he feels will provide the best outcome.  I have to say I am really pleased so far.  Boobs look great, not much scaring, some swelling but you can't tell at all in clothes that I even had surgery even low cut tops.  3 weeks out and other than small back pain if I sit at computer for hr or so, no real pain to speak of.  REALLY looking forward to getting last drain out....it was borderline...27ml...but he said better to leave it in so fluid didn't build up inside.  Next Monday is the day.  Had sentinal node biopsies on both sides, but must have taken from someplace other than under arms since no incisions there.  I can move arms freely, he just said not over my head or any other exercises other than steps and walking for 3 more weeks.  Glad to get this all behind me.  I have been lucky in that no chemo, rads or hormones were required and I think that makes things a lot easier.  Haven't gotten on the scale yet...and won't until last drain is out...but whole lower stomach roll is GONE!!  Plus I have been eating really healthy...still nervous since if I haven't lost weight I will be really sad:(...but know once I can really get out and walk...once I can comfortably wear pants...it will be better.

If anyone has questions regarding my surgery, please feel free to pm me.

Kathy

Anonymous

Fran....I just got my surgery date too!!! It's the 9th of Nov so we'll be within a few days of each other



Robin, good luck on Monday! Please keep us posted.....I am SO ready to have "normalish" breasts.......so excited,



Re, the weight gain, I've put on about four pounds since taking Tamoxifen....could be my increased appetite, but I'm blaming the Tamoxifen for that too! My PS said its best NOT to gain any weight before surgery (helps with the skin's elasticity) so I'm trying to keep that in line.

liefie

Hoya03mom, these days the surgeon often accesses the nodes in the armpits through the breast incision, thus saving the patient the painful incision under the arm. Maybe that's why you don't have an incision there.

AnnAlive

Liefie -- I wish my breast surgeon had done that! I had read it is what they do now, but she did not! That incision just below the armpit crease was sore and part of it was slower to close up. Be very glad you don't have that, Hoya03mom! The scar and skin are darker now after rads.

Ralsper

Fran - I had my DIEP 4 months after radiation and they didn't have to replace any of my skin. In fact that side healed faster! I might add that I had a extensive damage on my skin after rads (open wounds for 3 weeks). Good luck!

fredntan

Okay thats it i am faxing my stuff off tomorrow. Four months I could do it sooner. That would be so awesome

fredntan

Update just emailed info in. Does anyone know how far they schedule. Ie could i be on schedule inmonth or two?

bdavis

Absolutely. I have seen 2-3 weeks... if they have an opening, they can schedule you.

Beckers

Survivortobe, that is an interesting question about the hairline. My incision is very close to hairline and doing well. They did shave me but no ingrown hair problems.



I heard a story from my OT who had diep years ago and she said she actually has to shave a thin area of pubic hair at the top outer edge of the breast now. Wild huh?