Interesting Comment from PS

Galsal

I would dearly LOVE to hear from those who know LE so much better than I.  Yesterday I met with one of the PS team to learn if I was a candidate for having a Diep.  It appears I am and we're scheduling the pre pre-op tests for confirmation.

He made a statement that this flap procedure could help with my truncal LE.  Does this make sense and why?  Is it because of the microvascular surgery nature?

carol57

Galsal, the flap has some lymph nodes in it that are moved into your reconstructed breasts.  Some PSs say this helps truncal LE.  It does make sense, but I've never seen a study to confirm this.  It will be interesting to hear from others here who had LE prior to flap reconstruction.  I had bilateral mx with immediate diep and developed truncal LE under the arm and in the arm afterward.  Was I destined to develop LE and having flap recon helped keep it pretty mild?  I'll never know.  

Anonymous

Dr. Massey does various forms of flap surgeries, follows all of her patients and keeps a record of LE involvement prior to and after surgeries. There is no formal study, just tracking of cases. She is very interested in node transfer surgery as way to mediate compromised node areas and has a whole process for this. Carol, you can probably confirm, but she basically said that with DIEP surgery they have been doing node transfer surgery for a while but focus wasn't on that element. The fat (flap) transferred from donor site to create the breast will contain several nodes (number varies by person). Within the fat is a natural growth hormone that helps the nodes "take" to new site within the created breast. Having new nodes in compromised trunk area may aid in moving fluid. However, whenever fat/nodes (flap) are taken from the lower abdominal area, there is risk of LE in that area, yes? And I believe we are talking muscle sparing DIEP.




I haven't had DIEP, but I attended one of Dr. Massey's recent presentations, and this was mentioned in her talk. Please correct me if I have anything wrong, Carol.

mrsnjband

My PS said the same thing about my arm LE.  It has been somewhat better but I still have a small amount of swelling.  It does make sense since there are some lympe nodes in the transferred tissue.

The surgery, after I was recovered, has reduced the pain I was having from the rads damage. That alone has made it worth having the surgery.  It really wasn't as bad as I thought it would be.  The first few days are a little rough but sooooo worth it!!! NJ

Galsal

WOW, thanks ever so much folks!

carol57

Tina, I recall Dr. Massey explaining that after 30 years of TRAM flap and other autologous reconstructions, the safety of the procedure has been demonstrated, from the standpoint of not causing LE at the donor site.  I also remember her saying that a transferred node takes very readily, as you explained, but I thought she was talking about node transfer from groin to axilla--not the incidental node transfer that occurs when abdominal fat is repurposed to form reconstructed breasts. I don't remember anything in her presentation that suggested there is a track record of documented truncal or arm LE reduction after forming breasts with transplanted fat that includes nodes.  But perhaps she mentioned that and I do not recall?  Nordy, Lago and Kcshreve have also attended Dr. Massey's sessions, and they check the LE boards.  Perhaps they will help out with some additional recollections. Dr. Massey did cover a lot of ground in her day-long session.  I know for sure that I did not capture it all in my notes.

Carol