Help! How do you decide between DIEP or latissimus dorsi flap?

cedee

I have a radiated breast and now have a new cancer. I need to have a masectomy and have decided to do both sides. How do I decide between a DIEP or LD? I am a wreck trying to decide!! Any advice? Thanks so much

EstelaLorca

Hi Cedee,

Does your PS think that you're a a candidate for both LD or DIEP? I don't know much about the recovery time for an LD. I was quite thin though but was able to get DIEP. It was nice to get a bit of a tummy tuck I must admit aesthetically speaking. Recovery was hard, but I'd lie on a wedge pillow and watch movies and try to rest.

I hope that you found lots of info on both procedures, pros and cons....

Good luck!

besa

I had a DIEP reconstruction (and later an sGAP on the contralateral side). My personal feelings about things-- I wasn't at all interested in an LD flap because sacrificing the muscle would cause some shoulder weakness and I also wasn't interested in having an implant (which would be part of the LD flap reconstruction.) At facilities where doctors are technically able to offer both DIEP and LD flap, the LD flap is often considered a "second line" surgery. (see "Breast Center" and Hopkins links below for examples)

For any type of reconstruction- you want someone who does the specific type of surgery you are interested in multiple times a week and has done it (on their own when not in training) for many years. Also know that cosmetic enhancement is a different skill set than reconstruction. You want a ps that does mainly reconstructions.

http://www.breastcenter.com/breast-reconstruction-...

http://www.hopkinsmedicine.org/breast_center/treat...

(at Hopkins link see section on "Types of Breast Reconstruction")

For help deciding on the type of reconstruction that is right for you, and also info on how to choose a skilled ps, consider getting a copy of the latest edition of Kathy Steligo's "Breast Reconstruction Guidebook." The best I have seen on the topic.

http://www.breastrecon.com/index.html

http://www.amazon.com/The-Breast-Reconstruction-Gu...

cedee

Yes, I have seen 3 PS opinions.The PS that specializes in DIEP said I was a good candidate for LD and DIEP. He said that I have the perfect belly tissue to do one perfect breast. But since I am getting a bilateral mascetomy, he said I could do both breasta, but that they would be more on the smaller size between a and b, instead of my current full size b. Having LD for some reason sounds awful having back muscle moved.

cedee

I feel the same way about losing back muscle. But all 3 PS talk about LD that it doesn't impact mobility or functionality unless you are a professional althete. I just can't seem to believe that you wouldn't be impacted

besa

Cedee- If you are interested in more volume one option would be to consult with one of the microvascular ps that are able to stack or combine flaps. of add a T-DAP flap to a DIEP (T-DAP does not take muscle). The ps at the Breast Center (very first link I posted) are able to do that and there are others.

http://drmarga.com/TDAP.html (for a description of TDAP surgery)

Anothet option - there are microvascular ps who are able to add a small implant to a diep reconstruction.

Also for more info -a place to post reconstruction questions and have an experienced microvascular ps respond - Dr. Dellacroce's question and answer board. (He is one of NOLA ps at "The Breast Center" --and also the ps who did my sGAP reconstruction) http://members.boardhost.com/plastic/

I am a fan of pubmed to search medical issues. I just did a quick search on "LD reconstruction muscle strength" and quickly came up with these articles.

http://www.ncbi.nlm.nih.gov/pubmed/25089217

http://www.ncbi.nlm.nih.gov/pubmed/20633032

Use this web site below to search- possibly try to vary the search terms for more articles- the database contains abstracts of published medical journal articles in peer reviewed journals.

http://www.ncbi.nlm.nih.gov/pubmed

cedee

Thanks so much for taking the time to provide the info and links

cedee

Great link to help make an informed decision:

http://www.campbelllloyd.com.au/blog/the-breast-re...

besa

I feel that, though some very good points are made in the above link, there is also (in my opinion) some inaccurate info. The info should be fact checked against other sources.

For example - the link describes the consistency or feel of reconstructions made from sGAP donor tissue as "stiff and inflexible."

I have bilateral reconstructions - one side diep and one side sGAP. I honestly can't tell the difference in the tissue. Possibly there is some very small difference- but it is not anything noticible to me. Both sides feel and look natural.

sml

Hello,

I too have a radiated breast from 3 years ago and the DCIS is back on that same side. I am scheduled for mastectomy (left side only) on May 10th and I have agonized for two weeks whether to do the lat flap reconstruction or diep. I really like the plastic surgeon I chose but didn't realize, until today that he can't do the diep, I would have to see one of his associates. It was obviously a misunderstanding on my part but it did help me decide that I was happy with my initial decision to go with the lat flap. I didn't want to choose another surgeon . I wanted my surgery done on the date that was scheduled and I want to move on. Good luck with your decision. I know how hard it is to decide and you will know which one is right for you.

pab

I too am trying to figure out which route to take. I was just told by my PS that she would prefer to do the lat back flap on my right, which is my 'bad' side-rad, nodes- and an implant on my left. I had nipple/aereola sparing and left worked but right is a little sad so to speak. I was not anticipating this route. I was thinking implants and done. I just hit 3 months post rad so I'm getting antsy to be done with this. My PS said that women with implants complain about discomfort and pulling feeling on side that has been rad. Any thoughts anyone??

Moderators

Hi pab,

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