Increased risk for recurrence/metastasis after DIEP flap?

smlowry7

Hello all,

I'm wanting to find out if anyone has experienced recurrence after delayed reconstructive surgery, specifically the DIEP flap.

I had 6 rounds of chemo ending in a June 2016, R mastectomy in July 2016, ovaries removed Sept. 2016, radiation Nov 2016-Jan 2017, 6 more rounds of chemo to treat what was specifically left in my lymph nodes post mastectomy. There was vascular invasion, couldn't get clean margins during mastectomy, so I was told that told radiation would take care of it.

I'm a preop nurse and have had two patients in the last two weeks come in and talk about a loved one who had breast cancer, did chemo/radiation, and was in remission for 6mo-year and went back to do the diep flap and within a few months after the cancer had spread to brain, spine, etc. and they passed away not long after. This isn't exactly what I need or want to hear within 2 months of my DIEP surgery and I'm starting to worry that cutting back through the scar and tissue where there was not clear margins before radiation could spread lingering cells to wherever else they touch while in there. The anxiety is not knowing if anything is left behind from surgery, chemo, and radiation.

Has anyone been told there is an increased risk or experienced recurrence after delayed reconstruction? Do you take the risk to have reconstruction or should i wait or not do it at all? So confused now

Thanks in advance!

Shannon

Meow13

I don't think you would increase your risk with DIEP. My tumors were close to the skin but luckily the skin not involved. But I had tissue and skin from abdomen area which was not likely to have any cancer. 6 years so far so good. My delay was 4 months, i don't think it matters.

Lula73

it's entirely possible their cancer had metastasized prior to the surgery but wasn't big enough to detect on CT or MRI yet. And perhaps they hadn't even had their follow up scans. I had immediate DIEP done and try to stay on top of recurrence studies but other than some observational retrospective studies that after you get past their eye catching headlines and this plethora of "evidence" end up stating that there is no significant difference between groups of women who have immediate recon/no recon and delayed recon. They do note that they think the absolute difference (which is not clinically significant and no causation determined) is interesting and should be further evaluated but that you can't really do controlled studies on the subject.

Bottom line- there are no controlled clinical studies on the topic and the observational retrospective studies (regardless of their headline) that do exist show no clinically significant difference between immediate recon/no recon and delayed recon.

Why is it that people want to share the worst case outcome stories with us anyway? Your experience rates a post on the SteamRoom thread.

Falconer

Shannon,
I would avoid anecdotal evidence and look at published research. Considering that 1 in 8 women are dealt this dreaded diagnosis, and you heard about two of them, you still have tens of thousands to learn about before you make any final decisions.