Diep 2012

CookieMonster

Dutchy - great info. I'm doing nipple recon and just an areola tatoo on one side, so I'm guessing that she's probably not a good option for me and I probably don't need anything else. It's great to hear about people out in the community who are supportive and helpful. Kudos to them, they deserve some sort of special recognition.

Beckers

Duchy, I find out today if my nipples are going to live or not. Do you mind giving me her info in a PM just in case I will need her? Thanks!

fredntan

As my diep flap nears(nov) I have qustions. It seems i always pick the facility that believescn self care. Ie your on your own honey.

What will they do to prevent blood clots? I assume scd's and ted hose? Do you have foley cath? If the sx can be near 12 hrs do they keep you hydrated with fluids?

And when i go to recovery after sx, what type of pca do they typically do? Fentanyl, morphine or dilaidid? Do any docs do blocks?

I heard the hosp stay can be three days, is first ICU? How often are the nurses supposed to check pulses? Dont they have to check pulses? And when does everyone typically supposed toget out of bed?

And what about compression garmets? I have heard talk of them on here. I think i asked my doc about them and I dont think he uses them. Seems like a good idea to me.

I am going to ask my doc these questions. I plan on having my husband or sister in my room to help to care of me at all times-ie to make sure things are done right. My care during last sx was lacking.

goldlining

Hi fredntan - I had heparin and antiembolism stockings from pre-op to check-out, a foley until the second day after, and of course IV inserted in the pre-op ward that stayed throughout the hospital stay with IV fluids as well as medication as required.

I was in OR 12 hours, then step-down unit on the same floor as the surgical patient rooms (not ICU exactly but high ratio of staff to patients) so they could monitor closely including doppler monitoring of the blood flow in the flaps hourly. They do that with a wand type device that they hold on the surface. It's not a pulse exactly. They are actually listening to the blood flow, kind of like a fetal heartbeat thing if you ever had that. The step-down unit was 24 hours, then I moved to my room for another 4 days. Someone still came pretty often (I forget how often) for dopplering and other monitoring.

My PCA was morphine based. They did not give codeine based because it is bundled with caffeine and they did not want to do that. I also had a block in the abdominal area, where they came 3x a day to inject the secret sauce into it (it was a clinical trial and I don't know if I had the medication or placebo). That was a fine tube that was placed along the muscle before they closed the abdominal incision. I didn't have inordinate pain there so I suspect I got the medication. I was in an appropriate level of discomfort given all the cutting they did on me, but my worst grievance was the massive headache reacting to the germicides in the environment which are formaldehyde based and I'm sensitized to formaldehyde.

They gave me a light diet like fluids the first day I received meal trays then regular food after that. 

My husband visited a bit but mostly he went to work. It was kind of boring, but I had pretty good care from all but one nurse who was just kind of lazy.  

I got out of bed on the 2nd day in my private room. It wasn't any worse than my C-section. By the next day, I walked laps around the ward very slowly, 10 laps = 1 km, and I did 5 sets over the course of the day. The next day I had some infection on one incision and fighting that made me tired until the antibiotic really kicked in, but I was up and at 'em again the following day, and the physio cleared me for climbing stairs (necessary at my home). I had 3 of 4 drains removed by the time I left the hospital, and the remaining one was not draining at all and came out in the minimum 48 hours afterwards because I did not want that homecare nurse coming back to my house bringing germs from other peoples' houses. I was walking on the treadmill by 10 days or 2 weeks out.

My surgeon is a no-garment guy. I had bandages that came off when I went home and then no special garments, no special diet, just no lifting or ab exercises for 6 weeks. Others wear binders and ban chocolate and coffee. It's the surgeon's personal idiosyncrasies that dictate. Or maybe it has to do with their techniques under the skin.

Hope others chime in too to give you some impressions of the variety. Those are good questions to visualize the process. The hardest part will be waiting between now and November.

mimi46

Hi Dutchy - I'd PM you but I don't know HOW (ancient non-techie here!)  Sounds like you encountered some great women in Tustin - too far from me, unfortunately.  I just wanted to ask, since you mentioned tattooed brows/liner, was your semi-permanent makeup a problem in MRI exams?  Cancer has made me braver & I want to finally get some eyebrows(!) but had heard that MRI's could only be done at a lower power if the patient had tattoos.  Thanks for any info & best of luck to all with their surgeries & recoveries.

florafarm

fredntan-My experience at NOLA was similar to goldlining: woke up with cath that came out second day (you don't care because you know you are not up to getting up , ESP with all that's connected to you). To give you an idea of how weak I felt, after my shower on the second day, the nurse said I needed a suppository and asked if I wanted to put it in myself or let her. I couln't believe the words were coming out of my mouth when I said, " you stick it in"! You won't get dehydrated because of the IV, plus they pushed water frequently. Had pressure pumps on legs first day, two Doppler wires in each breast, drain in each breast, and drains at each end of abdominal incision. I Had two "pain balls" on the ends of my abdominal incision that automatically deliver an anesthetic type med. Morphine AND antibiotic in IV. Switched to oral pain meds on 3rd morning post op. They gave me a choice of Diladid and or percoset. I ended up alternating the two initially then dc'd the percoset. I believe they had me sit in a chair first day after surgery and walk the second. I think the best thing the nurse told me was that I didn't need to be afraid of pulling my stitches out if I straightened up, so I tried to get straight quickly by walking a lot and I had had no problems with being bent over as some have described. Was in hospital 3 days. Went back to work and Zumba today at 6 wks post op.

willy5js5

Yippee Zumba florfarm!!! You go girl. I'm heading back to Zumba Wed. Very happy about it too. How did it go? Did you keep up? I hope it will loosen up the tummy tightness I still have.



Fredntan, I was in Nola too and ditto everything florafarm said. I was on bloodthinner. I had shots that continued after discharge as well for 10 days. Wore tedhose for travel flight home only. At home pain regimen was dilaudid and oxy alternated. I had pain and discomfort for three weeks pretty bad. After that I took ibuprofin with tylenol in between if needed. Compression was my choice with my doc because of the heat. I am in compression now for a seroma for two weeks per docs orders.

Galsal

You ladies rock...I can't imagine doing Zumba at six weeks out!

florafarm

Willy5-Re:Zumba-I did not raise my arms quite as high as normal, and did not jump so much, but I kept up! Thought I might be really sore today, but not so much? Just so happy to be back to it.

Anonymous

Wow! Zumba already?!? I'm impressed! I asked my PS what the average time it would take after my surgery (Nov 9th) and she said said 6 weeks!!! ....and that was just for gym stuff...knot Zumba!



Goldlining: thanks for the detailed account of your surgery! As it gets closer to November, the information you all share has been a Godsend!

olgah34

Hello, everyone! My TE Cfailed, so I am between Latissimus and DIEP to decide...I was a smoker for 27 years, then I quit in 1997, but once in a while ...I sinned...sometimes...Does anybody know how bad it is for the DIEP?

Beckers

Olgah34, my PS wouldn't do DIEP if I smoked. He even tested for nicotine. I quit for 8 1/2 weeks before surgery. So happy I did. The stop smoking thread is so helpful. Everyone is very supportive there.

AnnAlive

Olga -- I have skin necrosis on my abdominal incision after my DIEP surgery that was 5 weeks ago in NOLA. It appeared in the first few days, and is healing so slowly -- a big black scab with open granulation areas around it, and estimated to take at least another month to close (and will require repair at stage 2). I have never been a smoker and only had prolonged secondhand smoke exposure as a child growing up. I'm also not diabetic, nor do I have any known circulatory problems, but I am 61 and had the full range of bc treatment. I don't know the real reason it happened to me (incidence is low when performed by experienced surgeons).

In trying to look up info online, I find more about the skin necrosis problem by looking up tummy tuck, rather than DIEP. Same principle. Articles always mention that tummy tuck (or DIEP) is a much greater risk for smokers or ex-smokers, and also diabetics. DIEP has yet another factor in that the perforator vessels must be large enough (and may not be in smokers), but that is for the health of the breast flaps. Some articles mention that skin necrosis can be caused by the abdominal skin flaps being pulled together too tightly -- I'm guessing that may have been the trouble in my case.

Olga, I remember you from when I frequented the TE Trouble thread last year because one of my TEs failed (twice) due to infection then. I still had the other TE when I went for DIEP surgery, and it had developed a grade IV capsular contracture -- very uncomfortable, and a relief to get rid of. I don't know why I have such troubles with reconstruction. I even eat well and take healthy supplements. My DIEP breasts are not yet symmetrical, but that should be fixed at stage 2 in a few months. I wish you well in your decision. I don't know much about the LD flap, except that it isn't nearly as involved as DIEP -- tunneled under skin, not requiring microsurgery to connect perforator vessel.

sandpiper1

An honest open discussion with your PS @ risks vs benefits of each & what your goals for recon are I believe is important. Every PS will have certain criteria. I had mentioned that a nurse in one of the BS offices (ended up going elsewhere) said no PS in the city will do a diep on u or any other smoker. Relayed this info to my PS. He was adament that I did not come to him for an elective surgery.....Further saying you have breast cancer & have every right to know your options. (And made it clear that diep Was an option he & I could pursue) He does pre- op CT scans of chest & abdomen. I am only 46yo. Have never had any other surgeries & do not have any other medical issues. I did stop smoking a month from surgery. Tried sooner but needed help so did Chantix with good results & none of the adverse effects so many hear. No issues with healing & I did have one of those very "tight" closures of the abdomen. So PS & associates wanted me to guard abdomen by wearing binder & positioning without stretching. Everyone has different experiences. I am almost 6 weeks out & walking 4-5 miles per day. Limited to 10# lifting restriction. I did have an infection in my jp site. A normal bacteria that struck me when I was low on reserve. Al healed. I'm just not mentally ready to go back to the stress of work. But hey.........I do count myself lucky I can and I am able to go back so quickly.

cmbear

I was never a smoker but was a bartender for 20+ years--and its been almost 3 months(11weeks) and I still have an opening in my abd incision.  Doc doesn't seem at all concerned and says it'l be  fixed at Stage 2 on Sept 13. I've never had a problem with healing before. No necrosis just a silly hole in my belly. Who knows if its related to all my years as a second hand inhaler. . . 

AnnAlive

Claire -- it's good that you'll get the incision fixed soon, before it has a chance to cause more trouble. Keep taking good care of it.

olgah34

Thank you, ladies very much. I did have a cigarette last time in my life in May 2011, in July I was diagnosed.So... it is more than a year...I don't want any more complications, nobody does, I already had 5 operations last year. I am still onHerceptin till end of September.

olgah34

What is it stage 2? I know almost nothing about DIEP and Lat Dorsi, and I have problems to read a lot, because of chemo head...

SuzyBlue

Olgah34, stage 2 seems to vary according to where you are from (I am in New Zealand) but generally speaking it is when revision is done to the reconstructed breast/s and abdominal incision in the case of Diep. For me I had the ends of my incision redone to eliminate 'dog ears', including a little liposuction, a pocket of skin removed from under my reconstructed breast and a nipple made. I believe other women have fat grafting to infill areas to improve the shape of the breast/s and have the nipple reconstructions as a separate surgery. Hope this helps a little.

olgah34

sO IT IS OPERATION NUMBER 2? Is it absolutely necessary?

bdavis

OLga.. It is not absolutely necessary... depending on shape etc from stage I...

goldlining

Everybody is different, so don't anyone feel pressure, but at the same time, don't feel that you ought to act like an invalid if you feel up to getting out there, as long as you are not messing with ab stuff before 6 weeks. I remembered after my mx, going to walk on the treadmill made such a massive difference to my mood and even reduced the pain, so I decided after DIEP that I would walk as slow as I needed to walk, but I was going to the treadmill at least once a week for an hour. Your body gives you feedback. You're not going to jiggle harmfully because it's not habit-forming. It feels uncomfortable or creepy, and you'll stop. I held on to the sides of the treadmill for dear life and went slower than I can normally bear to walk, but it was a real pick-me-up to do it. Even so, I was not really sure about that half marathon I was signed up for, scheduled for 6 weeks + 2 days. The surgeon knew I was going, and in his opinion, I was only crazy because my time would suck for lack of training. However, I figured, damn it, worst case scenario, I am at Disneyland for the weekend and NOT getting a medal. And bonus, I still have the anti-embolism stockings that I can wear on the 5-hour plane ride to prevent swelling! Like florafarm at Zumba after 6 weeks, I arrived at Disneyland 6 weeks + 1 day post-op, and there was a 5K that night (by which point I had been awake for 21 hours) and I was just going to walk it because, hey, it goes backstage. When the crowd started to run, I started to trot too, and I kept trotting for 3K before I started to alternate walking. That was the first non-walking step I had taken in 7 weeks, and my mood was over the moon. I ran a little bit of the half marathon too. It was my personal worst half marathon time, but I cherish that medal possibly the most. 

SuzyBlue

Olga, it is not absolutely necessary but it is difficult for the surgeons to get everything spot on in the first surgery, as shapes change with swelling going down, sometimes scars don't heal the way you would like, and if you want a nipple reconstruction that is usually done on a separate occasion. These are things you can decide on down the track from the first surgery, you don't have to make up your mind on revision straight away.

RonnieKay

Thanks to all for updating information..I'm soaking it up like a sponge. Four weeks since my last post (8 weeks out of diep on Thursday) and it seems like I have even more questions..ugh!  I also had a 1 inch spot (where drain came out) at the end of my abdominal scar that wasn't healing. Nurses checked it twice, no infection, said just to give it time. At my 6 week check, the ps found a stitch (an inch long) that was hiding. It wasn't deep enough to dissolve and buried just enough to not be easily seen. My body was saying it didn't belong and started healing immediately after they removed it! Two weeks before that, a stitch poked out of my belly button and had to be removed.  All I want to do is swim...like Chris13!  Wondering if I'm the only one that has a very crooked abdominal scar?  I asked ps resident why it was so uneven and he said that they follow the stomach curve, or that possibly it was the way I was lying on the operating table...not to worry, it'd be revised at stage 2 if necessary.  I know at 58 my stomach won't be revealed to many people but at this point, the side that is up higher feels great, no sensitivity or numbness, but the lower side is very sensitive. The scar is closer to my pubic area/groin.  I don't know if the recent sensitivity is due to the fact that feeling is returning to the area, but it's bothersome.  I am envious and happy for the sisterhood doing zumba, half marathons, etc!  In the year between my L mx 6/11 and this R mx & bilat diep 6/12, I had a TE replaced (1st one migrated!), broke my elbow & ankle (fell coming out of AM/PM market getting gas), carpal tunnel surgery (swelling from elbow caused ct), so I'd had lots of down time.  I see PT on Thurs and start back to work next Wed so, time to get moving!  PS...I won't see my ps until stage 2, 11/2. It seems to me he should assess exactly what needs to be done before that (my pre-op is w/nurse), don't you think?   Thanks to all...happy healing! 

CookieMonster

I'm more than 6 months out from DIEP and noticed that the ab scar was getting itchy and painful at times so I asked my PS about it and he said the scar is revising itself. and he's right, it's getting less red and becoming just a thin line. Mine is also not straight but I think after this, it will barely be visible anyway.

RonnieKay

Ah...that gives me hope, Cookie!  I postponed stage 2 by a month, just to make sure my body has time to do exactly that!  Thanks!

Hoya03mom

question.....my breasts feel so heavy...is it just the swelling...I am one month out and they are definitely bigger than the original ones!  have to use extender on my bras.  How long did it take for swelling to go down?  All drains are removed and other than feeling top heavy and having icky belly button, things seem to be doing well.

Kathy

Downey30

Hi Kathy,  mine are not heavy but not very big either.  I know the Dr. that I went to would prefer to have extra in size.  It is much easier to reduce than to try and add fat.  You'll be able to downsize some if you wish. Hope this helps.

bdavis

Kathy.... After stage I, I was large and bra size was about 2-3 sizes larger... after stage II, I was back to my size.

CookieMonster

RonnieKay - You had your surgery on my anniversary this year. I joke that I spent 2 hours on my back on my anniversary this year... installing a new kitchen faucet. It's true! Definitely give it time. Patience with this process is hard, but we all have to try to be patient, at least.

Hoya03mom - I don't know about heavy breasts because I intentionally asked for a reduction with DIEP, so the DIEP side was smaller than the non cancer side after the DIEP surgery (I only had DIEP on one side). That said, my PS says it can take up to 6 months or maybe more for all of the swelling to subside. Why can't our bodies just heal immediately and be done with it?