DIEP Flap vs. Implants

CaitlinB

Hi Ladies,

DIEP Flap vs. Implants--what is your opinion?  Do you have any regrets about your decision?

Nordy

This is a no brainier for me: DIEP! I had tissue expanders in forever, they were always cold & hard. Then the expander on the radiated side started to push through my skin. I had them removed & the rads side was left with really thin skin & a concavity from it pushing my rib cage in. I ultimately had hip flap reconstruction from dr. Sullivan in New Orleans (not enough belly fat for DIEP) & I love my breasts. They are warm, jiggly & all me! So, that is just my opinion...

nora_az

DIEP here, absolutely no regrets. I was very nervous about the surgery and the down time. Those were my "cons"

My "pros" were:

I had been wanting a tummy tuck way before BC and this allowed me to do so

No coming back every 10 years for another surgery to replace implants

Nothing foreign in my body

Other than coming back for DIEP II I was done.

carol57

DIEP, and I second Nora's observations. The surgery is challenging but do-able, and the end result is that you have an 'end' result--no lifetime jeopardy of replacements, surgery to release capsular contraction, etc. Also the look and feel are so natural, it's a bit astonishing. Tummy tuck--a bonus!

nora_az

Yes, I agree Carol. My breasts look so natural. I just had my GYN yearly exam a couple of weeks ago. She had never seen DIEP results. She knew of the surgery yet never had a patient who had the surgery.

She was amazed when she saw my breasts. She said if she didn't know any better she would have thought I just had a breast reduction. The scars are pretty much identical. (I also had nipple sparing)

annettek

I will chime in on how happy I am having gone through the implant route...for me, they are part of me as I "grew them"- everyday that goes by I am more comfortable and there is less any *strange* feeling. I have feeling in my breasts....perhaps not the same feeling as prior to bmx but there is feeling. My doc did one round of fat grafting to layer over and that removed whatever coldness people speak of. It is a personal decision and one that must be based on your body and whatever it had gone through.

Like anything, different results for different people. I don't believe one method is any better or worse than the other. My breast surgeon works closely with plastic surgeon and like Nora stated above, it looks like I have had a breast reduction, as my scars are verticle down from my nipples...which were created back in July. I am nine months out from my exchange. My breasts are soft (again, not as soft as pre-bmx) and I feel great. As far as having them replaced every 10 years....and the other risks- well, not everyone has to undergo that and I will be monitored by my BS anyway once a year to check for any recurrence. All procedures carry risks. The good news is that there are so many happy people who have had so many different procedures!

Good luck with whatever you choose and just make sure you are comfortable with docs doing it since I believe that is the difference....the doctors and how they view a woman's body. I look at the pic of myself a month out from the BMX with my tissue expanders in and cannot compute in my brain how I got to where I am today....truly amazing what we have available to us

Whatever you decide...I wish you the best result

carol57

I sure do agree with annettek that there is no 'best' solution and what's right for me may not be right for someone else.  We are so fortunate that we HAVE options, and that forums like this one bring access to lots and lots of insights from so many women's experiences.

nora_az

totally agreed! All I know is before I even knew DIEP was a possibility I was willing to have a double mastectomy without immediate reconstruction and just not have breasts at all. Hearing about DIEP from my breast surgeon was a bonus for me. For me it was the right choice. I am so glad we have the options to do whatever we feel most comfortable with instead of no choices at all.

best of luck!

carol57

My mother, her sisters, their mother and their maternal grandmother all had BC and they all had ZERO choices for reconstruction, not to mention a crappy survival rate and the one who did survive more than a few years--my mother, now 82 and a 44-year survivor--endured some pretty awful and permanent collateral damage from rads that were not nearly as precise as what we have now. 

It's easy to lose sight of how amazing it is that we have such good recon choices, and treatments that might have given our mothers and grandmothers better survive-and-thrive odds. Caitlin, there's a special triumph with whatever choice you make.

(Of course, I want my daughter and granddaughter to be able to skip the disease entirely...hopefully the vaccine trail bears fruit before too long. )

CaitlinB

Ladies, you are awesome!

My grandmothers both had bc and also faced umx and bmx without any reconstruction.  We are so fortunate to have choices.  What an inspiration your mom is, Carol.  

I think I would be okay without boobs--they don't define me, however, I think it would be a bit shocking at first.  I guess I need to find a good plastic surgeon.  I might have to go to a bigger city--not sure how many there are here in Green Bay.  

??? though.  If you have DIEP, can you get pregnant afterwards?  I have heard that tummy tucks (I could use one after my son--he was over 8 pounds) aren't a good idea if you plan to have another baby.  We would like to have another child (I am a late bloomer-lol!).

AnneW

This question comes up ALOT!! It's a very personal decision you have to make, and usually involves emotion and inconveniences.

I chose implants first, due to not really wanting to travel, not wanting a long surgery, not wanting extra scars. Then I had trouble with the implants (as 50% of all pepople do at some point!) and had bilateral SGAP anyway. And I wish I had just allowed myself to do it in the first place. Well, that's my jounery...

I'll echo the sentiment that you do lots of research. Not just asking people what they would do, but looking at the surgeon's success rates, your surgical choices' success rates, how much time you can take for recovery and repeat surgeries...Get second and third opinions, do phone interviews with surgeons if you can't meet face to face. then trust your gut on what's right for you!

RetiredLibby

Caitlin, I think there might be someone (or more than one) in MKE... Not sure where the big breast center is there ... Froedert, maybe?



Re: DIEP vs implants, when I recurred this year, I had originally intended to have a BMX with no recon. I didn't even consider implants for several reasons -- I had intense rads to my left breast and was not a good candidate from the start; I hated the idea of pulling the pec away from the chest wall and putting a bag of silicone in there; and I have a lot of allergies and auto-immune issues and didn't want to give my body any more excuses to get crankier. My breast surgeon insisted I talk to a PS. I was familiar with DIEP and was not really leaning in that direction, but the PS was so amazing and I had such confidence in him that I decided to go with DIEP. I am thrilled with the results. I'm not sure about the pregnancy afterwards - I'm 54, so that was not a consideration for me.



Good luck with your decision!



Layne

Fearless_One

I have no regrets (yet) about my implant recon.   My only regret is he screwed the nipples up, but that could happen with any kind of recon.   My implants look fine so far.

CaitlinB

Great advice!  I would like to lose a significant amount of weight too and I have heard that implants are not the greatest choice for that.  I will do lots of interviews and research plastic surgeons...my husband has already done some. 

Fearless_One

The best candidates for implants are those that have not had and will not need radiation.    It can still be done, but much lower complication rate if you don't have rads.

gizmostar

hi deciding between diep and implants and wondering about the severity of scaring ? Annie B

Carol99

hi there, I had nipple sparing BMX with immediate recon in Nov. 2013, over the past year I've had 4 revisions. The last one being an implant exchange. I hate them, I hate the feeling of my muscle contracting & the look of it! My right side is lower, it kind of falls to the side & I can feel my breast none, it's a bit concave. I've had fat grafting but it still is flat. My PS said it will always be like this.

I'm going to have the DIEP flap in September. I'm nervous about the surgery naturally but in reading through the boards I'm hearing of stomach swelling? Can anyone comment on that? Also, Is the belly really flat after? I'm not really that overweight but after I had my ovaries out 2 yrs. ago (brca1) & chemo I have more belly.

Thanks,

Carol

carol57

Carol, I'm three and a half years from my bmx/diep, and my stomach is quite flat. I find that when I gain a few pounds, I put it on in my arms, and I get 'love handles,' so the fat finds a place to go that is definitely not in the diep flap area. When I press my hand slightly into my abdomen, I can feel a firm ridge that I interpret to be the 'joint' where the tummy was sewn back together. But it's not at all visible. I'm very satisfied with my surgical outcome.