DIEP Flap or go flat?

LindaJan

(My apologies if this is in the wrong forum or there is a better place for this post. Do let me know if I should post elsewhere or can find this question discussed already elsewhere here.). I'm 59, short, overweight pear-shaped BMI 32.2 (i.e. fat but not morbidly so) and am scheduled for bilateral mastectomy and DIEP flap reconstruction in two weeks in NYC. I originally was dead set against reconstruction, but surgeons were unsupportive of that choice, so I reconsidered the options and found DIEP flap appealing since I can have smaller breasts, which I've wanted since mine are floppy hangies – and I was totally seduced by the bonus "tummy tuck" since I have a horrid belly pannus. But I'm terrified of the surgery with its seemingly high rate of complications, and quite frankly, don't feel that I need breasts, anymore. I've been swinging back and forth in my choice now for 3 weeks and going insane. I switched to a different hospital with a much more sympathetic breast surgeon and plastic surgeon who support either choice and have promised me a nice flat result if I choose no reconstruction, and seem excellent for the DIEP flap, too. How have you handled your choices? Fear of complications is paralyzing me.

Jacklin

Hi LindaJan,

Since you are concerned about the possibility of complications, could you have the doctors perform the bilateral mastectomy now and wait and possibly do the reconstruction at a later date? This would give you more time to consider your options and make a final decision rather than you feeling the stress of having to make a decision now. Wishing you all the best.

LindaJan

Hi Jacklin, Thank you for your thoughts! I am eager to make a final decision one way or the other, but that's good to keep in mind, as it would give me future options.

Janetanned

Four and a half years ago I found myself in the same situation. I needed a BMX and wasn't sure if I wanted reconstruction. I was over-weight and a very good candidate for DIEP reconstruction. I was in my late 50's and wasn't very attached to my breasts. I could have gone flat. However, I decided to at least try to reconstruct. If it didn't work out, I knew I had given it a shot. I also knew that I had to do the immediate reconstruction rather than wait. I knew that I would not go back for a second surgery if I postponed the reconstruction. While it was a long and grueling surgery and recovery, I never regretted my decision. I did not have any serious complications, so that made things easier. I missed six weeks of work and needed PT to regain range of motion etc. It was all worth it! I also had my nipples done followed by areola tattoos. I can almost forget that this ever happened since my breasts look and feel so natural. The tummy tuck also looks pretty good. In fact, I had motivation to diet and workout so that the rest of my body looks better too.

It was a hard surgery to recover from. There were times early in the healing process that I questioned my choice. But all in all, I am so glad I went through with it.

Good luck!

LindaJan

Hi Janetanned, Thanks for your reply! It does sound like you were in much the same position as I. I admit that I'm more seduced by the idea of a free tummy tuck than getting breasts back and that makes me really question my judgement if I choose the harder course. On the one hand, I am intrigued by the idea of metamorphosis into a "wingless fairy", as I like to think of the flat chest look. On the other hand, with my pear-shape and short stature, nothing less than major weight loss would enable me to look actually good. Plus, there'll always be a little self-consciousness with the flat chest. On the other hand, the DIEP flap surgery is so terrifying with so many possible complications, that I have to presume I'll likely have at least one. The ps did say that with my overweight, I'm at more at risk for wound breakdown in abdomen. Could have fat necrosis, drainage, infection in abdomen. If I actually lose 50 lbs after all my surgeries, will I end up with another belly flap (and floppy little breasts), anyway? I know I need to just focus on making things BETTER, not IDEAL. It's very hard.

farmerlucy

Linda - I went back and forth too. In the end due to pressure from family I did the recon (I was 51). I wanted the DIEP but at that time one had to travel out of state to get it. I went with implants. They are fine. I don't like the pec feeling, but they look great. The best thing about it is going bra less most of the time. If they need to be redone I will seriously consider deconstructing. Best of luck!

LindaJan

Thank you, Lucy! I spoke to an old friend today whose reaction was that I had decided but that I was afraid. That may be true. I certainly am terrified! I have joined a DIEP flap support group on Facebook and am freaking out at the seemingly endless list of really serious and long-term complications most of the women seem to have. When I turn off those thoughts, though, I feel that this will give me the most reasonable physical results. But the fear is terrible!

Janetanned

Keep in mind LindaJan that support groups offer support for women who are experiencing difficulties. I would imagine that women who sail through the surgery and recovery don't typically join support groups or stay active in online groups. They no longer need the support and tend to move on with their lives. Many of the women who were active on the threads I followed here at BCO, when first diagnosed, rarely check in any more. Once in a while someone stops in to say hello, but for the most part they are moving on with life. So, you are probably hearing a lot of the war stories rather than the success stories.

LindaJan

Good point, Jane. Thank you!

GraceB1

I was 63 when I had a delayed DIEP because I needed radiation. They put expanders in when I had the MX but when it came to surgery time the PS said the skin was too thin and just used the flap skin instead. I hated the expander under the peck muscle. I also had some pain most of the time and couldn't sleep with any pressure on it. Yes, I had some complications with the surgery but nothing that couldn't be handled. Recovery was long but not that painful. If this is your first surgery it may seem worse to you but I had previous surgeries and kinda knew what to expect. I couldn't image my body shape without breasts on top to even out my big booty. I'm happy I did it and very glad it's over now.

LindaJan

Thank you, Grace!

Kali44

Hello, I have been lurking on this message board for a couple mths now. Sorry if I go on and on . I was diagnosed in Jan 2016 with stage 3 bc. Devastation, shock, why me....all the things that pass through our minds when we are diagnosed whatever the stage. Anyway, I am always searching on these boards to learn more about this journey we all wish we didn't have to go on.

Chemo is completed, as of April 27th and I had a mastectomy on my left breast, delayed recon, on June 16th and in recovery. A decision was made by my ps and myself and my husband due to me needing radiation for 5 weeks. My ps feels there would be a better outcome if I had surgery, rads and then recon thereafter. I have to say that I didn't want implants, no offense to anyone I just felt it would be strange for me, and liked the idea of having my own tissue etc to make my new breast. Which btw prior to my diagnosis thought I would like to get one day.... go figure. However, I didn't like the idea of having two surgeries and two challenging recoveries because let's face it, it sucks.

My ps said he wanted to make sure that my health came first and going this route was, in his opinion best for me. I had to trust in him, he said to me, I have 4 children and you have 3 and I want you to be healthy and there for your children and so I trust him. Not an easy thing to do, but here I am trying to focus on my recovery so, I can have radiation done and then onto my biggest fear, recon surgery, due the length of time and from what I hear very challenging but doable recovery.

I am scared and only hope that everything will be fine. Linda, I understand completely because I myself am worried too as, I think, we all are and so we can be here for each other as we go along our journeys together. And very thankful to all those whose posts are uplifting, positive, even with challenges, to help the rest us to get through this time in our lives. That one day we can all look back and smile and say ... I did it and I will be fine

Thank you everyone!

LindaJan

Thanks, Kaili, for sharing your experience and encouragement! I'm now 10 days post-op (DIEP flap) and recovering so far so good. All the best to you!

Kali44

Yay!!!! Linda I am so glad to hear you are doing so well I hope to have to have a great recovery too. Oh my these exercises are not easy but 5 times a day everyday I will get them done....how long does it take, after doing exercises is "normal" to get full movement back in the affected arm? I ask only because I had an appointment with radiation oncologist and she immediately said I needed PT.... I thought I was doing pretty well lol