Implant VS Flap reconstructions experiences

beebee22

Hi, i am newly diagnosed with high grade DCIS. I am going into surgery end of May. My plastic surgeon has given me 2 options: direct-to-implant VS flap (from abdomen). I never give birth and it will be a unilateral masectectomy. She has explain to me the pros and cons. Anyone was in my situation before? I understand decision is personal, but I would like to ask if you can share with me how you make your decision at first and how was your recovery experiences either direct-to-implant or flap? Thank you!

dewo1965

Hi! We sound be in the same situation. I met with the reconstructive surgeon yesterday and he wasn't biased between the implant vs. tummy tuck/flap option but I felt him leaning a little towards the flap. I wondered if anyone could share their experience with this procedure and how their recovery went? I can't be off of work much more than 4-6 weeks, and I do not have a physically demanding job at all. He told me that the operating time would be a couple hours longer than with doing the implants, and there would be a couple days spent in the hospital vs. an outpatient surgery. My surgery date is June 7th so I have a little time to make my decision. Anyone have any input?

beebee22

hi Dewo, my plastic surgeon told me if I do flap, I will go into ICU post-op for a few days as it involves connection of blood vessels and they need to make sure the blood supplies are all good before transferring me to in-patient ward. Hopefully we can get more input from members who went through flap and give us more info about. Thanks!

abigailj

Hi Dewo and Beebee - I had a skin and nipple sparing BMX with immediate DIEP flap recon and am very pleased with how it turned out. Yes, it was a long recovery plus I was 62 at the time, now 64 and not very physically active and am a former smoker so naturally healing took a while, and I had a few complications but my breasts look close to the way they looked before (actually more like they did when I was younger) and they feel like real breasts to the touch and I have a flat belly (yes with big long scar but it's at the bikini line and faded pretty well. Recovery time is a good deal longer than I’ve heard from others that had implants. I’ve heard 4 to 6 weeks for most that have DIEP flap recon although I took 2 months leave from work due to the wound healing issues I had I spent 5 days in hospital when I had the surgery but none were in ICU although the monitored my frequently for tissue health and I had a warming blanket for a few days

In addition to the cosmetic aspect they also grafted nerves into the reconstructed breasts and I did regain a decent amount of sensation. I don't think it is as common to regain much if any sensation with implants. So from my perspective if you are a good candidate for DIEP flap and have access to micro surgeons who specialize in it where you're being treated and can manage the longer recovery time it really it worth considering.

serendipity09

There's a thread that I follow, although there hasn't been much traffic on it as of late; Seeking DIEP recovery stories.

Abigailj - I agree about making sure you have a microsurgeon that specializes in DIEP. Mine is highly recommend and only does DIEP surgeries. He comes highly recommended by my plastic and breast surgeon.

The technique you refer to regarding reattaching the nerves in the breasts is called Resensation, my microsurgeon discussed it with me and will perform it on me. It will be nice to have at least a little feeling. I had the option of having my surgery on 6/9, but asked to do it towards the end of summer. I wanted more time for my sin to heal after rads and since I'm going to be in compression garments I thought its be best to wait until it's a bit cooler out. I had my exchange last summer and was so uncomfortable due to the compression garments, the summer heat and hot flashes. I wanted to enjoy this summer as the last two were a total bust.

I hope other's chime in with their experiences. If not, check out the thread I mention above.

beebee22

Thanks for sharing Abigailj, i found your other post in "DIEP recovery stories", I shall ask more question there. Thank you so much.

beebee22

Thank you so much. I found "DIEP recovery stories". Very helpful! Will continue my questions there.

kaaadams

I had a skin sparing right MX with DIEP. I have not been pleased with the result. My DIEP does not project out like a natural breast, but is flattened. It's been 2.5 years and I'm now considering getting implants on both sides. It's hard enough to lose your nipple, but I wish I had chosen an implant from the get go. I was 60 when I chose the DIEP, so I should've chosen the easiest surgery. Couldn't stand up straight for a few weeks because of the tummy tuck and had 4 drains for several weeks which was pretty awful. The abdominal scar is huge. Looking back, I wish I'd chosen the implant for better results and easier surgery. DIEP surgery is Very extensive.

NNS121317

I had skin-sparing (but not nipple-sparing due to location of my tumor) BMX with direct to implant reconstruction last October. At the time, it was my only option to keep my skin - the hospital didn't have space to accommodate a DIEP due to COVID. I don't love my implants, and am strongly considering taking them out and having the DIEP done. My implants look amazing and have healed really well, but they're cold and uncomfortable and heavy, despite being smaller than my natural breasts were. I'm currently doing radiation, and then I'll take a few months to think about it before I see my reconstructive surgeon again, but I'm hoping for a better outcome long-term. DIEP seems a little intense, but I love and trust my surgeon, and would love to get these implants out!

K-Gobby

I only had my left so far, and I had a skin saving with the expander put in. I was supposed to have radiation so I did not get the implant right away. I did not need radiation after all.

I had no idea they did skin saving. I only read about the flap and all those choices. My tumor was closer to my chest, so my skin could be saved. I also am not big busted, so it is perfect for now. I had my ovaries and fallopian tubes out the same day. My middle after surgery felt like I had done 1000 situps.
But I wanted to say that the nerve blocker at surgery worked so well I had no pain in my breast. My under arm area shoulder to wrist was in pain. From the 3 lymph nodes removed. That area for a few months.
Once my blood clot is better. I will have my other breast removed. I will have skin saving. He said I can keep the nipple on that side and he may be able to restore some sensation. At 61, I thought if he can good, if not ok. I have The Brca2 mutation.

beebee22

Thanks nns121317 and k-gobby for sharing. I now not sure if I will go for DIEP flap or implant. My surgery set on 26th May but investigation still on, yet to confirm if bilateral or unilateral. I don't have enough fats at abdomen for Bilateral diep flap. If Bilateral, I have to do implant. Can I ask how long after surgery you can start cooking? Also, is that true that with implants, your breast will look high up right after surgery? It will settle down and drop a bit may be after a mth or so?

Hi k-gobby, is there specific reason you choose surgery for both breast on a separate occasion?