Conversion from Implants to DIEP

AliceKo

Has anyone done the conversion from implants to DIEP. If so, why? Are you happier with the results?

I had unilateral mastectomy with TE and implants. I have had my implant for 4 months, I am in discomfort, its this tightness in my chest, shoulder, upper back on the affected side. And I wonder if I did DIEP could that help my discomfort. It's not terrible, because I can sleep, I can live without pain medication, but every little movement reminds me that I have it and there is this feeling like I am sick, when I am not. I know most women do the DIEP for the looks, and I would be the one considering doing it for the feeling like I am not sick.Not fan of the length of the surgery, recovery and extent of the scars.

And my implant results are considered "good". It looks in the bra, that's where it ends right now. they are open to doing more surgery either on the other breast to work on symmetry (i really don't want to touch it) or do a DIEP.

Scheduled CTA to see if I am a true candidate

Lula73

Hi Alice- I did immediate DIEP however I’m in a FB group for women who went to/are looking at going to NOLA for recon. Several of them had implants with similar tightness as what you describe. From their posts, they have experienced relief from the pain. I will say with DIEP it’s not all about the looks, but also the feel. And truly the scars aren’t that bad if you have a good microsurgeons who is dedicated to quality outcomes. I had DIEP done in Feb 2017 with revisions in November and you can hardly see them. What you can see is faint and easily hidden in even a small bikini. Insist on seeing before and after photos of the surgeon’s patients before moving forward with them. And if you wouldn’t be happy with the results you see in the photos, keep shopping for a microsurgeons who can give you results you’d want.

Mom-mom

I’ve had a uni but I’m still in a TE. Pre pec. Planning on implant but have considered DIEP. Before you opt for DIEP would you consider a good course of PT? I waited 6 months post MX to start PT and wish I’d stated way sooner. PT really helped chest, shoulder, arm, and hand and aches. It’s made my right side feel good again and my PT says the implant will improve it even more.

Just a thought.

My plan is to save the DIEP in case my implant fails— I’ve had rads to that Breast previously.

Best to you

NancyHB

I had UMX with immediate DIEP for the very thing you’re now experiencing. I have sensory issues and know I would never have been able to tolerate an implant. My left breast feels and looks incredibly natural inside and out. The surgery is long, as is the recovery, and while I had minimal incision issues I did wind up with a superbug infection that landed me in the hospital twice. It’s a tough surgery but for me, it was the absolute right decision.

AliceKo

Lula, wait you had the DIEP, so what are you doing now for reconstruction? Thank you for telling me about women experiencing relief from DIEP after implants. I asked my PS and another PS and they all are like, no you will not have any relief. All your pain is from mastectomy, we do not cause any pain with our surgeries. And I just can't believe that, like my body is telling me the opposite, that some pain is caused by the implant. The pictures I saw at my surgeons office looked AMAZING. I do not look amazing. I asked if something went wrong, they said I have a good result, the breast is synthetic and what do I want and they can do a DIEP for me. They never had a DIEP that they could not save to this day, they have been doing it for at least 10 years

AliceKo

Thank you mom-mom. I did do PT and she specialized in reconstruction and I did get all my range of motion back (!). I also still do craniosacral therapy and I actually have some sensations under arm. I recently started accupuncture. I am still waiting a few months before I decide.

And you will feel better with the implant and if you are small enough, it might actually be ok.

AliceKo

Nancy, thank you for your reply. It just confirms my suspicion that it might actually help me with feeling better. I just feel sick with it.

But it did allow me to take s short leave of absence from work and I was able to take care of the kids soon after my surgeries. I was lucky, no infections. And I am concerned about long surgery and long recovery. Even though, I think the doctors that I have found are really good. How long was your surgery and how quickly were you able to go to work or do things?

I am so sorry you ended up with the superbug, that's so scary. Where did you do the DIEP? and who did it?

Lula73

AliceKO- I think your answer as to whether to let those PSs have another crack at your recon is right there in your reply to post:

The pictures I saw at my surgeons office looked AMAZING. I do not look amazing. I asked if something went wrong, they said I have a good result, the breast is synthetic and what do I want and they can do a DIEP for me. They never had a DIEP that they could not save to this day, they have been doing it for at least 10 years.

So how did the ladies in those pictures get that amazing result and you didn’t? Doesn’t sound like you had complications and they admit nothing went wrong. So why don’t you look amazing with your implants too? Answer is likely the surgeon’s fault. Or he was showing pics of breast augmentation vs recon or he touched the photos up before printing for patients to see. If you are considering letting them have another go and do DIEP with them, you need to know who trained them, how many DIEPs have they done in that 10 years? How many have they done in the last year? How many do they do each week? How do they address the lower part of the body needing sculpting in stage 2? Do they get insurance to cover that sculpting or do they require you to pay for it if you want it done? What flap procedures have they pioneered in their 10 years?

NOLA docs started their clinic in 2003. They’ve pioneered the APEX flap, SGAP flap, and body lift flaps. They have performed over 10,000 flap recons between them. They each do a minimum of 2flap recons a week. There was a thread on BCO once asking if the members who championed NOLA were really patients or just employees of NOLA posting on the boards. Many can’t believe NOLA is that good. The reality is, NOLA is THAT GOOD. I’ve had too many surgeries to count for various issues, been to lots of docs. No doc or hospital experience has even come close to the experience at NOLA. The NOLA experience is how allmedical care should be.

AliceKo

Yes, I went on the website and I watched the video and it does sound good. My PS does 1 DIEP a week every week. the amazing pictures had a donut lift that it is not recommended for me, so absolutely no scars

AliceKo

Lula, after the DIEP how's your tummy feeling? Is there any sensation? Do they cut any nerves ?

Lower body sculpting, that never came up. I will be sure to ask that. Thank you

Lula73

tummy feels fine. There is a little reduced sensation on either side of the incision line but even that has been getting better. On any given day I don’t notice it at all. When I first had it done, however, I was hunched over at the waist for about 3-4 weeks. Then later just if i’d done too much walking/activity. That lasted another 8 weeks or so (like at the end of a really long work day. Note that my job is pretty physical). Definitely ask about the lower body sculpting. Your waist will be a little shorter with surgery and your hips will likely have what they call dog ears. That lower body sculpting helps even the waist back out, recreates the natural curve from waist to hips to thighs and takes care of the dog ears. Any fat pulled from those areas can then be used to fat graft where needed in the breast area.

AliceKo

Thank you so much for answering my questions! I will definitely ask when I go back. So, did you have to come back to NOLA for post op follow up? For that lower body sculpting?

Lula73

Yes you do go back to NOLA for the lower body sculpting. It is a much shorter & easier surgery and a much shorter and easier recovery (typically 2 weeks). If you need an oophorectomy/hysterectomy, they can arrange to have that done during the same surgery session as stage 2. The recon is typically done in 2-3 stages:

stage 1 is mx (if not already done), harvest the donor tissue and transplant it in the shape of breast mounds on your chest. Post-op visit is typically 6-7 days after your surgery date.

Stage 2 is often called the make them pretty stage as this is when they will lift, reduce (if desired), sculpt, work on symmetry, scar revision, fat grafting, lower body sculpting. Post-op visit is typically 4 days after surgery date.

Stage 3 is nipples and/or tattooing (if you don’t want nipples/tattoos or had nipple sparing mx then this stage is skipped). I had nipple sparing mx so I don’t know for sure the post-op timing but if I had to guess I’d say 2-4 days after surgery.

Hope this helps!

AliceKo

Lula, thank you so much for taking your time. NOLA sounds very good for DIEP. I am glad I saw their website and now I have all the questions to ask our DIEP PS.

I am still scared of the surgery. And I just don't see how I can travel there now, at this time in my life. Maybe when my kids are older. I will figure it out

Lula73

hi AliceKO - I just responded to one of your questions on another thread as well:

https://community.breastcancer.org/forum/44/topics/863233?page=1#idx_18