DIEP Flap Reconstruction vs Implants

BKN1970

I had a bilateral mastectomy with right axilla dissection and tissue expanders placed on September 29, 2017. Then I had 6 weeks of radiation on right side and axilla area. I am trying to determine which reconstruction will be best for me, DIEP Flap or Implants. I’m appx size 16-18. I would like to hear from ladies that have had the DIEP flap and what their experience has been.

Lula73

hi BKN1970- I had DIEP flap after BMX down at NOLA. I was a size 12–14 in pants when I started. I’m a loose 10 now but a tight 8 so I stick with the 10. If nothing else, carrying the extra weight in my lower half allowed for beautiful breasts today. I am thrilled with the results-my breasts, tummy, hips and thighs look better now than before the first surgery and I thought I looked pretty good when we started. One thing I will point out is to make sure whoever does your DIEP does hip and thigh contouring at stage 2 (to get your proportions back in line) and gets it covered by insurance as part of the recon process. There are many that don’t or want you to pay out of pocket for it. It’s important because the heavier we are when we start, the more the tummy tuck part can look odd without that contouring. And you shouldn’t have to pay out of pocket for it when bc was the root cause.Feel free to ask any questions!

Rrobin0200

I am a size 4-6, so I was not a candidate for DIEP. I received direct implants immediately after my BMX, and they look incredible. Very natural, smooth, etc.

however, another friend of mine had DIEP. She is a few sizes larger than me, and she is also quite pleased with her results.

We both had it done in NOLA, our hometown.

BKN1970

thank you for taking the time to reply

BKN1970

thank you for taking the time to reply and being willing to answer questions. Did you have radiation? I appreciate the extra info. I am having a consult with my plastic surgeon soon to discuss options so I will definitely mention to him about the contouring. Thanks for that tip.

Lula73

I did not have rads for the BC, however I had the lifetime maximum amount of rads to my entire chest and abdomen about 30 years ago. Skin did just fine.

SoniaL

Has anyone had an implant on one side and DIEP flap on the other? My BMX was 10/20/17 with tissue expanders placed...the ultimate end plan being placement of silicone implants. But, the tightness of the left expander plus radiation to the left side ended up cutting my blood supply and causing a good bit of my skin on the left side to die. Earlier this week I had the left implant and dead skin removed and was stitched up flat on that side. I had the silicone implant placed on the right side and it looks pretty good. I don't think an implant is an option for the left side anymore due to the trauma the skin has endured so I think I will have to have a DIEP flap later this year. Will I be comfortable with one of each? Should I have the right implant removed and DIEP flap done on both sides?

Lula73

So sorry the implant failed :-( If it was me and I had enough tissue for 2 breasts from DIEP I’d do both. That way they’ll feel the same, look the same, move the same and age the same. Also, you can only do DIEP once, so if you just do 1 and decide to you want the implant one to match you won’t be able to do DIEP again. You could do SGAP though. The recovery is not any different one vs two. I opted for both and love the results.

SoniaL

Thanks Lula!

Lula73

are you looking to have it done in CLT? I had mine in NOLA and travelled for it. Would do it again in a heartbeat.

SoniaL

Lula, I did think I would have it done in Charlotte. I think I've read that Robinson is the doctor here that does it. Just realized you are from NC too...did you look into having it done here before deciding to travel to NOLA? I've been seeing that a lot of people do go to NOLA for this procedure. Did you drive? I assume by the time they release you from the hospital, you can tolerate the long car ride? I know flying would be an option too but not sure if I would want to be in an airport that shortly after major surgery.

Lula73

We flew for the surgery. I worried about that too, but in the end it was fine. We went to NOLA because they are the best at what they do. They are the ones who cleanup other doctors' botched jobs (not many PSs will touch a patient to fix a colleague's bad work). Women travel from all over the world to have them do their recon. They also had a lot of experience with this type of recon in women who have had full mantle radiation as I had. And they are the ones pioneering the flap surgeries at this point. Their before & after photos are hands down the best and I'm proof positive that they are the real deal. I went into this with the mindset that whatever recon I chose needed to leave me happy with the results (not just happy with the results considering I had BC). After everything we go through that was the least I could ask for. I did look at UNC but the PS there that does it only had 1 before & after and i sure would not have posted that photo as something to be proud of. I figured if a doc is going to post a photo it's going to be their best work and if that was the best i needed to stay away. No docs were listed as doing DIEP in Charlotte at the time. Even still i would compare their before and after photo results with NOLA's before i made my decision. I hope this answers your questions. Let me know if you have more.

SoniaL

Thanks Lula, I appreciate it - that is good information! Did you have any trouble getting insurance approval for traveling out of network for the surgery?

Lula73

if the docs and hospital in NOLAare in network for you it’s no problem. If they’re out of network and the cash pay portion the center gives you is not doable, you can request your insurance company to cover them as in network. You have to give them a compelling reason though such as there aren’t any In network Surgeons who do this type of recon I your area. “In your area” varies depending on insurance company and plan. For some, in your area is a 30 mile radius from your house, for others it’s more like 50-100. There are other reasons that are compelling as well. I’ll see if I can find that thread and post a link for you,