Diep Flap Surgery

audra526

Looking for feedback. After 20 weeks of chemo, double mastectomy and lymph node removal, tissue expanders, followed b 33 days of radiation, which I completed in September. My surgeon advised I wait until 6 months after radiation so I scheduled diep flap for March 26th. In January my surgeon's office rescheduled me for March 12th because her son was having surgery. I was fine with that. Then the office called me to move me back further to April 2nd because of another patient that needed "emergency" surgery. I said no because I felt I had already switched my date and was already mentally prepared. Now 1 week before my surgery they called to cancel/reschedule me for June. I'm depressed and I'm angry. I already scheduled time off at work, in June my twin girls are graduating high school and I will be busy with getting them ready for college. I think my surgeon is unprofessional for not having a backup. Now I'm thinking about looking for a new surgeon. Thoughts?

dawnann

audra526

Is there an issue with the surgeons willingness to do the procedure? I was clearly steered away from the DIEP procedure. It seems to me you were too, or you wouldn't be sporting tissue expanders now, as I am. If there is only 1 microsurgeon, that can be the issue. I am scheduled for Diep in NOLA for May. Seems crazy that I needed to travel from Chicago for a medical procedure, but it is what it is.

Kahnartist

I am so sorry this is happening. I also have had some scheduling issues and I agree, when you are ready, they need to be ready. The mental prep is so important and for you to have to switch gears is so frusterating. I hope it gets better!

Runrcrb

so sorry to read you’re getting the run around. What’s interesting to me is that DIEP flap surgery is complex, long and typically calls for two surgeons. In my case, getting on the schedule was tough and once on, it was locked in the surgeons’ calendars.

I can’t comment on new surgeon or not but I would call and speak to the surgeon to get more information straight from him or her.

My DIEP was 9.5 months after my last radiation treatment. Longer is better from a healing perspective.

Moderators

Yes, we agree with the others. The mental prep is so important.

Perhaps with all this back and forth a second opinion could be helpful to you. We are really sorry that you are going through this with your doctor!

Lula73

It’s not unheard of to bump patients who have already had their mx to accommodate a patient who needs the MX and is doing immediate DIEP. The fact that the cancer is present and mx is needed trumps the recon only surgery. Now, if the surgeon is moving things around to accommodate personal non-urgent events that have come up in their personal life that’s another matter altogether. Backup surgeons for microsurgery are non-existent, so she’s not being irresponsible in that regard. Perhaps this is a sign you should seek out another surgeon. (I highly recommend NOLA.)Or perhaps it’s just a sign that it would be better to wait a little longer (especially with radiated skin healing issues.) I know i felt depressed, upset, disappointed and frustrated when my stage 2 had to be rescheduled from June to November one week before surgery. My leave at work had to be cancelled, plane tickets and hotel reservations changed, etc. But in the end it turned out better to wait as my breasts were still changing in that 5 month window. So I ended up with a better outcome by waiting.

audra526

Thank you for all your feedback.  I guess I was just feeling overwhelmed and depressed.  I was looking at it like it was a regular surgery and wasn't really thinking it through that it is a microsurgery and I chose this doctor because of her reputation. The thought of having these expanders in for over a year is just upsetting.  I also have purposely been putting on weight to have enough stomach for this surgery so I've been feeling down.  I'm rescheduled for October and will just deal with it and keep my eye on the prize I guess.  I was also feeling a little skeptical that it was cancelled after I wouldn't switch my date a second time.  The office told me that the doctor has a stiff neck and will cancel all diep flaps for the next 2 months and will only be doing live cancer patient expanders.  

Hopefully I will have a better outcome by waiting.

Kahnartist

audra526,

Your feelings are valid and you have every right to feel the way you do. I think part of this fun journey is also learning to let go of things you can't control. I suffer with that one all the time!

Thinking about you!

mitzi458

Audra526- I’m so sorry you have to go through this. I’m curious...have you considered a second opinion? So many doctors go about this in so many different ways. I saw three PS (and sent photos to two others) and all five said something different. But I’m glad I got so many opinions-I became more knowledgeable because of it. If I were you, I would contact NOLA (if your insurance will cover part of it), or PMRA in Texas, or any of the top notch places in other states if there are no other PS in your area who do this surgery. Just see what they say about the timing, etc.Good luck in whatever you choose to do! I’m sure you will make the right decision!

TWills

This would be so very frustrating to say the least, when I had my consult with my surgeon he straight up told me that I could be moved around in the schedule to accommodate more pressing cases and when I decided to have the surgery I had to sign a paper stating that I understood, they really made a big deal about it so I was worried right up until the day of my surgery. I understood the reasoning but it would have been so frustrating if I would have been rescheduled. Sorry you had to go through that!

marymorris

I, too, am from Chicago Metro area.. I am searching for an outstanding DIEP surgeon in this area. Why do we have to consider traveling all the way to NOLA for DIEP?

I had a horrible experience with a PS consult here. After doing some research and having a conversation with Lula73, I am more and more certain that DIEP is the right reconstructive procedure for me. I really like my general surgeon and would be perfectly happy having him perform my BXM, however, I am wondering if it's feasible to delay reconstruction and head south to NOLA or do they do it all there in one surgery? My head is spinning...trying to find a PS surgeon, locally, who has the required expertise for DIEP...immediate or delayed....or do I just want to go flat and be done with all of this.

I'd really like to move forward with treatment asap and put this behind me.

Thank you,

Mary

Dx 4/17/2018 IDC, Stage 1, Grade 2, ER+/PR+/HER2-

Lula73

hi again, Mary! NOLA can do MX with immediate DIEP recon or you can have mx and do DIEP later. It's ideal to do it all at once with a team of surgeons who routinely work together and are familiar with how each do their part of the procedure. If you can do skin/nipple sparing, and do immediate DIEP, you'll have fewer scars. Doing it all at once also means you have to undergo 1 less surgery

Why is it so hard to find a DIEP Surgeon? It's a very specialized field within the world of microsurgery. Most surgeons are just that - surgeons. Microsurgery is a whole other type of specialty. So the number of microsurgeons is small. And it gets even smaller when you take into account some of those microsurgeons are in other surgical specialties, and then smaller still when you weed out the ones who don't produce quality outcomes. When it comes to DIEP and other flap recons, you want someone who 1) does at least one flap surgery per week, 2) has consistent quality outcomes as evidenced by a significant number of before & after photos showing results that you would be happy to have for yourself; not happy to have considering you had mx for BC. I know you've seen NOLA's results. You'll need to see how the outcomes of other surgeons who are closer to home compare.