Should I attempt diep reconstruction

Anonymous

I am currently 5 treatments through neo adjuvant chemo and will have a unilateral mastectomy in mid April. I would like reconstruction, but do not want implants, and the ps says I am a good candidate for diep reconstruction. I am also able to do a skin and nipple sparing mastectomy. If I just think about the end result I want, this seems like an obvious choice. My hangup is that I have a very busy home with young kids and I don't know how I would handle the recovery of diep surgery. I do have quite a team of friends coming in to help us with meals and childcare needs right now, but it already feels long and hard and I don't know if I feel strong enough for what a diep would require (both me and my support network). My only other option would be to have a simple mastectomy and avoid reconstruction until another season of life. I'm afraid there will never be a convenient time to do it though. Thanks for your help in making this decision.

mustlovepoodles

You're right. There is never a good season to do inconvenient things. But I'd like to offer you some support, either way. I had my BMX last year, Feb 2016. At the time I did not want reconstruction, but I have since changed my mind. In a lot of ways I'm glad it worked out that way. It gave me plenty of time to heal and do my research.  Now I know without a shadow of a doubt that I want DIEP recon. At the moment, my mother is seriously ill--she is in end-stage kidney failure and will not recover. In the meantime, she needs help--I have 3 sisters and we take turns, but obviously this is not my season to do elective surgery, especially one which would limit my movements and activities. So, I wait. 

I can't tell you what to do. Only you know that. But I wish you the best.

debiann

If DIEP is what you want then you might as well go for it right away. First, doing immediate recon will get you a better cosmetic result. Second, you'll have down time with either surgery. Recovery will be a bit longer with DIEP, but if you have people to help you it won't be bad. I am a teacher. I went back to work half days at five weeks, full days at six weeks. I was tired, but able to function.

You may need additional revision surgeries with DIEP, but the recovery for those is not bad. You don't need to do those right away either, you can wait for a convenient time.

MicheTheVanquisher

I had a DEIP 4 years ago and I'm very happy. While it wasn't a walk in the park I was hiking (slowly) the day after I got out of the hospital and taking care of my horses (not riding and not lifting heavy things) a few days later. I didn't have anyone to take care of the animals so I did it and I think my recovery was fairly quick because I was active--moved slowly but I stayed active. I was lucky though because I had very little drainage or swelling. That said I couldn't stand up straight and my shoulder bothered me for quite a while. I did the Mx and DEIP on the same day. Then 6 months later I went back for tidying up. The best thing is my breasts feel and look the same.

Good luck.

Scwilly

Are you going to have radiation? If so that would affect the timimg of your Diep surgery. My PS said she would normally like 12 months between rads and Diep, mine was a little earlier because I had some DCIS in my right breast (had left UMX) and my BS wanted to not wait until the end of the summer as I had planned. I don't think that rads after a Diep is done but I may be wrong.

I wish you well. I have no regrets in my reconstruction choice

Anonymous

Thanks to all of you. It definitely helps to read your encouraging words. I told my husband last night that the end result of diep is really what I want, and I am willing to face the recovery myself, but am hesitant to put my family through it. He was supportive and said he would take time off where needed if that's what I want. I am not fully there, but I think I will get there.

Swilly, I don't *expect* to need radiation as my lymph nodes have looked normal, but SNB won't happen until the mastectomy. If I choose to do reconstruction, the PS will place the TE at the time of the MX, and if I have to do radiation, it will be there throughout. If radiation isn't needed, then reconstruction surgery will be in May.

debiann

Joy, are you not able to get the DIEP at the same time as the mx? That's how mine was done, eliminated the need for TE's.

Falconer

Joy- I have a similar situation. I also had to wait for pathology before I knew if I needed rads. I did so the TE is in until I get a recon date. I'm seeing the PS this afternoon so I hope to find out today. I will be having DIEP even though, like you, I have young (well one young) child. Good luck to you as you decide. Your husband sounds like a good support to you

pupmom

I thought if one had a mastectomy, rads are not usually recommended, regardless of node status. But I may have this wrong. I had a lumpectomy with rads, but not because of the 2 positive nodes.

Anonymous

debiann, I guess it is not usual protocol to do it at the same time anymore, at least not if rads may be needed. They don't want the new tissue to be radiated, so they postpone reconstruction until they know that's out of the picture/done.

The nice thing about having diep is that the TE isn't placed under the muscle, only under the skin, and I think I've heard that's the most uncomfortable part (stretching the muscle).

Falconer, I'm sorry you had to add rads to your treatment, but thankfully they know the best steps to take to truly kick this bc! It gives me courage to hear you're also doing this with a young child. I have 5, but all are in school but my 2 yo. If friends are needed to care for me, I also need someone to care for her.

Pupmom, if lumpectomy is done, they always follow with rads, no matter what the LN status is. If mastectomy is done, they only do rads if there is LN involvement. I remember my first "meeting of the minds" with my team of docs right after DX and all the studies they were using to back up these protocols. It was mind-blowing. I'm glad they know what is best for a long-term disease-free life.

pupmom

Thanks Joy. I did not know that rads were recommended after mastectomy, if nodes were positive. Live and learn!

WGraf

I am 6 weeks post BMX & DIEP tomorrow. My PS located an enlarged lymph node under my sternum during surgery. Removed it and it came back with gross metastasis. I was supposed to have surgery and then done since all US and MRI's were negative for nodes. Now I will get my port on Friday and start chemo next Thursday. Chemo startis dependent on the wound healing on my abdominal incision. My wound vac was placed today by home health hopefully it does the trick so chemo won't be delayed. I will have to do 27 rounds of rads after 8 rounds of chemo which means I will likely not be able to have revision surgery until June 2018. My PS said I have to wait nine months after radiation before they will consider finishing. If I had known I would've had to of done radiation I would've done my reconstruction differently.

Falconer

wgraf- sorry to hear about the prolonged treatment plan, but glad to know you got the wound vac in place to help you heal. Holding you in the light as you go through the healing process.

WGraf

Falconer - thanks for the prayers. I was in the same thought that the other person was in thinking no rads if you did a BMX. I was really confused when I got that news. My PS was disappointed bc I'm sure she would have had me wait on reconstruction. But this isn't the hand I wasn't dealt. As DH says I was dealt a full house so let's beat the house with a royal flush (cancer being the house - Lol). They always have a way of looking at things

Anonymous

WGraf, I am so sorry to hear of the enormous change in treatment, but like your husband's perspective. Thank God that lymph node was found during surgery so it wasn't left there growing. I will pray for you to heal so you can get started with the chemo as planned. I'm 5 treatments in with Taxotere and Carboplatin right now. It's an exhausting journey, but it is reassuring to know it is being attacked hard.

Anonymous

I just wanted to follow up to this thread to say I made my decision - one to wait on reconstruction. I realized I wasn't ready for the seriousness of the surgery at this point in my life. There is no easy time for reconstruction surgery, but I think there will be easier times in the next couple of years. As well, I want to try out living without reconstruction and see if I can live happily that way. If so, then I will have no regrets. If not, then I can still choose diep reconstruction later. This is my blog post which talks more about my decision: https://psalm7326journey.wordpress.com/2017/03/06/realitys-chill/