Diep 2012

Hoya03mom

my surgery was 13 hrs....off pain meds once home day 5 except for tylenol.   Walking laps around house first week home trying to do every half hour or so.  Since I had plenty of fat/skin to donate from lower stomach, I was able to stand upright almost immediately.  PS still won't allow exercise...just walking and climbing stairs.  I have some swelling in both hips where drains were and boobs are definitely swollen although they have gone down some...initially it was hard to write or type as arms were pushed out by sides of boobs.  I can lift my arms over my head with a little stiffness, but am not allowed to lift anything else.  PS suggested valium for back pain which was pretty constant first couple of weeks, but I tended to use heating pad instead (just have to make sure it doesn't come near incision areas!!  I do use valium for long rides to MD office and it helps.  Still can't sit at computer for more than 3 hrs at a time, even with back pillow and hotpack, so I think it will be a few more weeks before I actually go into the office.  I can do most things at home and am self employed, so that helps...also not having little ones to deal with helps.  My heart goes out to the young ones who are dealing with this and mothering at the same time.  Hang in there, those at the early stages.  Each day does get better.  My brain actually feels like it is working....just took an hr long insurance exam and passed, so memory cells are improving.  Hardest part for me is my sister, Dianne, has very few days (or maybe hours) left and I would like to be in Wisconsin.  She has done many videos for Mayo Clinic http://www.youtube.com/watch?v=Wy3-bTo8Vd0 and if you google Dianne Rhein + Mayo her links come up.  Please keep her and her kids in your thoughts. 

florafarm

My surgery was 10 1/2 hrs.,but it seemed like I was only out briefly when I woke up.

fredntan

How on earth does one guy do that for so many hrs. Do they at take a break in middle of sx

Beckers

Bdavis, I'm on day 19 so I'm wondering if I'm still needing pain meds because I'm not moving enough. :-/

sandpiper1

Hoya, Ty for sharing the link.

My thoughts are with you & your family.

I wish I could somehow make it so for you to be with Dianne.

what an incredible woman. Intelligent, compassionate and she exudes such strength.

Warmest of hugz to you

cmbear

Rebecca, if you slow down on pain meds and move more, you'll feel better soon. They keep you from "wanting" to move. I was so slow to move because my back was really hurting, but once I kicked it in gear and laid off the meds, I started feeling so much better. 

Downey30

Hoya,  thank you for the link to your sisters video.  What a brave and lovely woman.  My prayers go out to your sister and you and your family.  Hugs

Ralsper

My sx was 14 1/2 hrs. My flap on the right breast failed twice during sx, but my wonderful PS didn't gave up on me. I woke up with two wonderful breast! I took it really slow for the first two weeks because one of the drains agravated a nerve in the hip. I developed a blood clot the second week (Tamoxifen), so I had to walk around the house every hour and at least 1 hour around the park since then. Moving around really helped with the back pain. At the beginning I walked really really really slow and I used a walker to support my back, but on week 4 I was already doing way much better. Today (week 6) I am walking straigh, fast, no back pain (or any pain), my life style is almost back to normal, except for the lack of range of motion in my arms, but I have appointment with the PT on Thursday. You will get there!

CookieMonster

my sx was 14 hours and it was a UMX. It came out beautifully and all the nurses oohed and aahed over it (that was a bit strange for me). PS took his time and worked hard to make it right.

They do take some breaks, but they also work in teams, at least 2 PS plus assistants etc... I suspect the PS takes a break while someone else is stitching things up or something similar.

Galsal

Beckers, you're fine.  Do what they tell you.  Every PS works their cases differently.  Me, they did not want me trying to straighten in the time frame you're talking about.  Sx was 7/9 and I'm now standing almost fully straight and can maintain that when walking, if I don't walk swiftly. 

Today I was given the go-ahead to return to work on 9/4 four hours daily for two weeks, then six hours daily for two weeks and then back to full-time.

While at my follow-up appt today, I saw an entirely different PS than have dealt with previously.  However, I knew of her as my hospital room mate when my BMX was done had this PS as her Surgeon. She entirely knew of my case and what had occurred, she shared with me that when she was in another State she'd worked on a Tram Flap that had failed.  It bothered her so very much that she would not perform another one until the process of the Team became better.  This discussion came about when I spoke of how disappointed at the outcome one of my PS Team was when he'd come to see me not long after awakening from surgery.

Good thing we both had quit smoking!

Cherrie

Hoya, thank you so much for sharing that beautiful video of your sister. You are so lucky to have that. She touched me as she has many. My prayers are with Dianne, you, and your family. Again, thanks for sharing.

bdavis

Beckers.. as you know everyone heals differently, has different pain thresholds and every surgery is indepenent of one another... Also, some people are pulled tighter cause they didn't have excess fat. These are all individual things to consider... take your pain meds if you are in pain, and try to move around, and between the two, you should heal fine.

Beckers

Hoya, thank you for sharing your sister's video. My heart goes out to you. I wish you could be with her.

cg1234

Hello to all you wonderful women! I've been following several of the posts, but am now waiting on my surgery date for bmx for hi grade dcis with immediate diep.  It helps so much to know what it's like on the other side of things, so the information is much appreciated. 

btw, I was told to expect 12-14 hours for surgery...a friend who had delayed bilateral diep 3 weeks ago was under for 17 hours.  Our ps, who is wonderful, joked that it's a sign of weakness to step out of surgery, but he did admit that they take a quick break when the flaps are in. (They're just monitoring them at that point, and the fellows and residents are with you.) Still, you have to admire their dedication and endurance!

I do have a question about whether any of you had to use a bit of muscle with the diep procedure.  My ct scan indicated one flap would be fine, but the ps said he would probably need to take a small bit of muscle (postage stamp sized?) for the second because of my vasculature. If any of you had a similar situation, did you notice any issues with abdominal strength, etc?  Also, any issues with losing a portion of your rib? Until I saw a post here, I had no idea they cut through the rib to access the blood vessel in the breast.

I'm 43 and have a very active and wonderful 3 yo boy, so I want to stay as healthy as possible for him!

Thanks for opening your hearts and sharing. I am wishing nothing but the best for each of you!

goldlining

I had no muscle taken and none of my post-operative comfort or lack of comfort suggested any messing with my ribs either.

The OR report indicated that one side blood vessel was smaller than the other but nevertheless they made it work. I am not sure how much is legit anatomy and how much is the experience and skill of the surgeon when dealing with smaller blood vessels.

Quite a lot of strong feelings here about touching muscle at all. My surgeon said he never did it.

I am very happy with the surgery - the long OR time was only hard on the medical team. For me, it was just a nice nap. It was slower to wake up from than shorter surgeries, but the long time for me was the run up to surgery day. Once I was on the table, it was great. 

cg1234

Thanks goldlining! Where did you get your surgery?  I'm at Ohio State, which has an excellent breast cancer center. (Not sure I can go elsewhere since I work at the university and have their insurance.) I agree about the feelings regarding use of muscle.  My ps said this is not like the old trams where they took much more, but when he has to, he will take a little bit to ensure no damage to the vessels and viability of the flap. I guess I have 3 vessels that converge and would make disection riskier.  That being said, he thought he might also need to use a tiny bit of muscle with my friend, but he spent the extra time (hence the 17 hr surgery!) to make sure he didn't use it.  I think he's pretty upfront and maybe errs on the side of worst case scenario to prevent any surprises. 

As for ribs, he would cut a 1 inch section in the cartilege that connects it to the sternum on both sides since I'm having bilateral reconstruction?

It wonderful to hear you're happy with the results!  I think you're right that the hard part is the wait before surgery.  I also hate to think of my family in the waiting room so long!

julianna51

@cg1234 - I had delayed  bilateral DIEP in June and my PS had to take a small bit of muscle on one side and I can tell you I would never have been able to tell if I didn't know.   I went back to Bikram Yoga at 10 weeks which includes the need to use your abdominal muscles a lot and have never had a problem.  I know you will find a lot of opinions on here about this....try not to worry about it too much.  Oh, my surgery was almost 13 hours long due to problems with my radiated side and then completely unexpected issue with an artery on my other side.   I spent a full 7 days in the hospital which was the toughest week for me.  Once home and off narcotics every day I felt better and better.

bdavis

cg1234... Everyone has a little rib taken. Its called rib resection. They don't mention it, as its just part of the surgery... But taking any muscle at all makes the surgery a TRAM.  Its a free TRAM, but still a TRAM. My local PS said he would never recommend a TRAM because of the risk to the core, and my MO has said the same thing. I think a skilled enough microsurgeon will never take muscle and convert a DIEP to a TRAM. That said, if this is the only place you can go, then you need to decide if its worth the risk to your core. Ask the surgeon how many of these he does per week. You want to hear him say around 10... If he does 10 per year, then you may want to look further.

Janetanned

bdavis - I'm not sure its possible for a PS to do 10 DIEP surgeries per week.  If each surgery takes around 8 to 10 hours, how could one surgeon possibly do 10 and have time to see patients for consults and follow ups?  I would worry that a PS who does 10 DIEPs a week is actually juggling patients or passing the work off on another dr in order to average 2 surgeries per day.  My PS does not operate everyday.  He has clinic days where he sees patients and he won't schedule more than one patient per surgery day.  He also is involved in research and is an assistant professor of plastic surgery at UPenn. 

goldlining

cg1234 sent you a PM

goldlining

Janetanned Not to put words in bdavis's mouth but not all microsurgical flap procedures are 12 hour bilateral DIEPs. Unilateral DIEP doesn't take as long, and the surgeon I had does microsurgical flap reconstructions on faces and whatnot also. (Once you're looking in a microscope sewing tiny blood vessels together, it doesn't matter if it's a chin or a frankenboob.) That's the way I think the surgery-experience math works out.

Janetanned

I guess I'm reacting to the fact that others have also implied that in order for a PS to be considered, he/she must have completed an almost impossible number of DIEP procedures in a given period of time. I'm just wondering how it could be possible for any PS to live up to that expectation.   I know my PS couldn't possibly keep up that pace and fulfill his other responsibilities.  It would be a shame if a patient ruled him out as a potential PS based on his number of DIEP proceedures per week.  He is a terrific micro-surgeon with wonderful bedside manner.

bdavis

Janet... I know that surgeons can do many procedures per week (DIEP, Uni DIEP, GAP, revisions), so yes, 10 procedures (that involve microsurgery) is what I mean, but perhaps not 10 DIEP that last 10 hours. I also know that a surgeon can handle more than one surgery per day, even when they are long... They may have a BMX stage I surgery and a revisional surgery in the same day and schedule the surgeries appropriately... like do a revision while a BS is performing a MX. MY POINT is that 10 per year is not enough. 3-5 per week is ok, 10 is stellar, but less than 1 is not a good sign. And all these doctors are busy and have other things to do like clinic days. In addition, a 10 hour surgery should be the exception. Most DIEP surgeries with my doctor are almost half that time as he works with a team.

jenlee

Hello all, Wondering the specific reason that some P.S. say that they might need to take a "postage-stamp size of muscle..."  Not sure how that tiny bit of muscle could be "needed."   Like my eight year old, I always want to know WHY? So I'm curious if anyone could explain...

Hope you all enjoy the last precious days of summer!   

Beckers

My PS took a small amount of muscle but so far I can't tell any difference. He said it was about 1/2 long of 2 fingers width and he put mesh in there. I'm able to sit up or forward from a reclined position.

CookieMonster

Because the blood vessel they take to attach the flap to the blood supply up top goes through the muscle, sometimes some doctors feel it's safer to take the muscle surrounding the blood supply vessel rather than take all of the vessel through the muscle. At least that's how I understand it.

I hope that made sense.

Janetanned

bdavis - That makes more sense.  I think that is an important clarification.  My PS specializes in microsurgery and is not limited to the DIEP proceedure.  I guess he 'meets' the criteria suggested if one takes into account revisions and other surgeries.

Beckers - I too lost a very small piece of muscle due to an unusual configuration of blood vessels.  In order to harvest the flap and be certain that it survived, it was necessary. I have absolutely NO problem with my core muscles or any other muscles and no hernias.  I've been working (in a study) with a group of PTs in a program that promotes strength after breast cancer and I am flying through each session.  No loss of strength or use can be found.  In fact, I am in better shape than I have been in years.  I have no regrets that this procedure was necessary.  In fact, that flap, while touch and go at first, looks a little better and has more volume than the other flap.  I am happy with both sides, so I have nothing to complain about.

Chris13

Hi Janet,

The study sounds interesting. Is it still open? I'm nearby Media in the 'burbs. BTW, Dr. Serletti at UPHS was my PS. 

cg1234

Thanks to all of you for your input on the muscle issue!  I'm glad several of you have had no noticeable effects. I plan to talk with him more about this though. He has done a lot of surgeries and has a 1% failure rate, so I feel good...although I know it's not the same as going to nola or a place where this is all they do. I like the team approach to having several ps doing the diep at once to cut time in the or, but I also feel very comfortable with him.  We'll see how it goes! Any other advice is much appreciated though!     

fredntan

I have narrowed my search for a diep Sx down to prmi in san Antonio-they take my insurance &the the lady I spoke to over there said after all my stuff in that they would probably be able to schedule me in a month!!! I am thrilled. I am so over this TE. I wouldn't allow myself to think about my Sx until time got closer.

I know all to well how to diet or way healthy. My younger dd has type 1 diabetes. And I can count carbs like crazy. I lost weight while in tx. And I would say I am at near ideal weight. My bmi is 24.

My last p-who I am letting go- could not give me any idea what size I would be. I am working on my core. But maybe its okay to have that chocolate shake without guilt now?

Do other ps give you general idea of cup size?