DIEP Flap Reconstruction for thinner people in SF Bay Are

Ilomita

Hi all,

This is one of my first posts, and I hope this is the right place to put it.

I was wondering if anyone might know of anyone in the San Francisco Bay Area (or sort of nearby) who does DIEP flap reconstruction on thinner people? I have heard of people my size (or thinner) doing this in other locations (New Orleans or Florida), but not around here.

I've been told already by two plastic surgeons that I can't do implants because I will need radiation, and that I don't have enough fat to do a flap. (I've already had a lumpectomy and didn't get clean margins, and my surgeon isn't confident that we will get clean margins with a re-excision). I would much rather have a flap then implants anyway...

I can pinch and inch or so of fat at my waist, so I am not superduper thin. But I am petite and in pretty good shape, and so far both plastic surgeons just laughed when I asked about a flap. On the other hand, I'm only a B cup, so we're not trying to re-create a DD!

Thank you in advance!

WC3

I don't know of any surgeons in the bay area but I lost a lot of my reconstruction fat during chemo and while I have a little fat they can take from my thighs, I really just need to gain some fat back. I am trying to figure out how to do that with the least benefit to the cancer.

Ilomita

That sounds frustrating WC3!

I've been pondering that myself... how to gain fat in a healthy way.

I have been warned that if I should lose some fat after having flap reconstruction I could end up deflating boob...

Lula73

the reality is you may just have to travel to do the DIEP. And the reality is the vast majority of us travel for it even if we have more tissue to work with. It’s really not that big a deal to travel for it. The hardest part was making the travel arrangements. This is not like getting your appendix or tonsils removed where any old surgeon will do. This requires highly skilled microsurgeons. With that being said, just because a PS is qualified to do the surgery doesn’t mean he’s good at it. Before & after photos tell quite the story. Believe what you see in those photos. NOLA has plenty of photos of ladies on the thinner side for DIEP and SGAP. It’s 100% worth the travel.

Ilomita

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Lula73, the NOLA place does sound great, and I wouldn't be opposed to traveling there!

The only thing is I don't think my insurance would cover it. I just looked at the list of what they accept and I don't see mine on there... So that might not be an option.

Lula73

llomita- the list is just the list of insurances they contract with. That doesn't mean you can't go there. Most of us have “out of network" status and we have to pay a little more copay but that's it. You won't know how much your portion would be til you call and talk with Vicki in insurance. She will get your insurance information, contact them, get the reimbursement numbers then tell you what you would owe. Once she gives you the number, that's all you'll be responsible for regardless of what your insurance pays compared to what they bill. If you can have stage 1 done early enough in the year, you likely won't owe another copay for stage 2. Give them a call on Monday to get the ball rolling to see what it would run. Good luck!Keep me posted.

Ilomita

Oh, okay. I will get in touch!

Casun19

have you been to the women’s cancer center at Stanford? They have lots of surgeons that specialize in this microsurgery. I was offered many different choices of flaps the diep, lat-flap, there is a thigh and gluteal flap. All tailored to your situation. Might be worth a consult.

PM if you want more in

Ilomita

Oh, thank you Casun19! Really great to know that is there!

Unfortunately Stanford is not in my insurance Network. I also called NOLA and it was a negative on my insurance. I have an HMO so no out-of-network benefits. Stupid HMO!

I guess I will have to just go with implants and hope for the best. Either that or wait until January when I can change my insurance... which is tempting, but a bit sketchy because there is still cancer in me right now...

JoniB

After my lumpectomy I visited a plastic surgery because I think down the road I may have a prophylactic mastectomy. I always thought I was too thin for a flap but the PS said  I had enough fat for one foob. For reference, I am 5'4 and at the time 120 pounds (now 125) - I am a 32DD.   

Ilomita

JoniB that's great! Yes, I know it is possible. Just a matter of finding the right plastic surgeon!

Lula73

llomita- is there a PS that does DIEP or SGAP that is in network for you? If not, you should be able to request an exception and have an out of network covered as in network.

Ilomita

Lula73, there are a couple of plastic surgeons in my network who do DIEP, but they are saying that I don't have enough fat.... Which I'm pretty sure isn't true.

It IS true that I don't have that much on my belly, so I might need an SGAP flap or a stacked flap or something... And it seems that they don't do those. I think the stacked flap is very specialized and there are very few people who are trained to do it.

I will try going out of network and see what happens... Wish me luck!

JoniB

Llomita - soon it will be open enrollment time and maybe you have the option of choosing a new carrier? My employer offers BCBS and Aetna and I switched to Aetna since I knew they were in network for Nola (among other reasons).

Ilomita

JoniB, yes, I am thinking of doing just that. Though my doctors are advising me not to wait until January as I still have cancer in me (I had a lumpectomy but didn't get clean margins). So I would have to do the mastectomy first and then just be a uniboober or until January... But I might do that.

rdeesides

Llomita,

You can have the mastectomy with a tissue expander and that will give you more time to make a decision/find someone and you won't be a uniboober. That's what I did.

R