anyone have DIEP-lose weight=how did it affect your foobs

Hi Karen,

 I needed to lose weight when I had my DIEP surgery, so I asked my surgeon to make the flaps as large as possible, so that my new breasts wouldn't shrink down to nothing if I ever get thin again.   They are belly fat, and will supposedly increase or decrease in size as weight fluctuates.   I have really been trying to lose weight, and it's coming off very slowly.  I've lost about 12 pounds since February, but I cannot see any difference in the breasts yet.  I want to lose another 40 pounds, so I'll have to check back in with you when I've done it.  It's best to have DIEP done once you've lost the weight and are stable, but I had a cancer diagnosis and wanted immediate reconstruction, so I didn't have time.

I'm not happy with my abdomen either--my original surgeon did not pull me tight at all, and so now it is up to me to lose weight and hopefully obtain the very flat abdomen that most DIEP patients enjoy.  Unfortunately, that means the skin will never be taut like I hoped.

 I'm not on any particular diet, not yet.  I am just trying to make better choices, avoid french fries like the plague, and get as much exercise as possible.  I am working really hard in the pool most evenings, but I did skip tonight.  I am not sure that I have been losing fat, as I've had four surgeries in the last year.  I have been dealing with a lot of abdominal swelling, plus healing from having lipo four times.   I wouldn't doubt if 12 pounds of fat has been sucked out and I've accomplished nothing by my own methods!

 I swear I think that my upper abdomen is fatter than it was a few months ago.  I'm on Tamoxifen, and think that it is causing a redistribution of the fat to my tummy.    Dr. DellaCroce has done lipo just about everywhere and I think things were better before.   I am going to be really upset if this doesn't go away as I lose weight.  My rectus muscles are very tight from the repair, but I don't look as tight as I feel and it's really starting to bug me in a big way.  

 I had my husband pick up some Lean Cuisine meals for me, and just need to remember to take them to work so I won't need to decide what to eat when I'm really hungry. 

 Your stage II will fix the size difference, so at least you know that will be fixed!

I wish I were posting here about my fantastic weight loss, but I'm here to tell you that gaining weight definitely affected the size of my breasts.  I joke that I am ruining the amazing body my plastic surgeon gave me.

Ten pounds didn't do a thing, but 25 pounds and BAM-- I'm up a whole cup size.  So As I start to take the weight off I'll keep you posted, but I expect them to get smaller as I do.

Sandy- I definitely felt like I was pulled tight enough in the abdomen the first time around, however, gaining so much weight definitely changed the contour.  It wasn't terrible-- so if any other girls out here are thinking, oh crap I can never gain weight... trust me, there are still no rolls when I sit, but the skin did get a little bit loose. 

I did have this revised with my surgeon, and I wonder if I can get it tighter through exercise... please keep me posted on your success. 

hello karen,

yes,every lady that want to do DIEP ll surely face it,when i did mine DIEP surgery i did foob excise,and a cream was recommered for breast excise before i went for the surgery and it for it not to be thin if i finish my DIEP surgery but i can refer you to a songeon that can help you with a cream for your DIEP surgery.

Helen,

                             GOD IS WITH YOU,DON'T BE AFRED

Oh well, after losing two pounds last week, we are now in Las Vegas for four days, and I know that I have wiped out the progress I'd made.  I'm with my husband and two teenage sons, and it's so hard to make good choices when I'm eating with them!   Beth, I'll let you know how I do...feeling somewhat discouraged now, but somehow I will find a way to be thin once more.  It's just so much harder now.  I was very thin at 40, but had a disastrous lasik experience, and went through a major depression during which I gained this weight.   I just didn't ever feel strong enough again after that to tackle the weight loss, but I've received a head start due to the lipo and tummy tuck, so I really, really want to take advantage of that and succeed now.

Sandy sounds like fun in Vegas and it is too hard not to eat a lot when there. We go every couple of years and plan on next spring.

As far as weight loss in the tummy area depends on your body too.  Some of the gain or pouch look comes from visceral fat which is the fat that is around the organs in the abdominal area and can only be removed by diet and exercises not surgery.  I have this issue in that I gain my weight in my stomach looking pregnant even after my tummy tuck which had my muscles tighten.  When I gain weight (which is were I am now) it stretches my tummy out.  Exercise helps tone my abdominal area. 

Also remember that the body loves to swell after traumatic surgery including lipo.  When I had my work done I wore a lot of compression garments during the time to help in the swelling.  You might want to look into that and try wearing them at night or around the house to see if it helps along with drinking lots of water.

I did so well after my tummy tuck and lipo the last couple of years but once I was diagnosed with cancer and all the different surgeries along with tamoxifin the gym seems a million miles away.  I need to hire a personal trainer again.  My neighbor challenged me to a 5K fun run in December so I am determined to not make a fool of myself.  I do better with a goal I would rather have a tropical vacation instead of a fun run but hey I will take what I can.  The hardest thing for me is to get past the mental portion for motivation.

Have fun Sandy - win big! It's hard for me to remember that entertainment does NOT have to include fattening foods..........try for extra walking and maybe you'll even lose weight!

Hannabanana - you're so right about the visceral fat. I have no fat left under my tummy skin after my Stage 1 surgery, but still my stomach bulges outward and I know it's from all the excess in and around the organs. I'm thinking about Jenny Craig - I always do - but I always end up back with Weight Watchers because ultimately they teach you how to use portion control and read your labels. I'm still in the "recovered from surgery-summer vacation" mental mode - but when I get back to work, it'll be back to WW.

There really is no free lunch, huh?  I had to have a hysterectomy four years ago and was excited to have a "mini" tummy tuck to go with it.  It was and is great, but that nasty fat found its way to other places.  I now am the proud owner of "back far" and the bra bulge that I didn't have before.

I just had my lumpectomy with a reduction on both sides.  Now I'm worried that the fat they took out will be found in other places.  Time to hit the gym after I recover!.  And, of course, things look even more dismal if I have to have chemo.  Oh, well, one step at a time.

Hi Girls,

I am going for a DIEP consult this Fri (currently have implants).  I would like to lose about 10 lbs (have already lost 20 lbs with Weightwatchers) and don't know if I should try to do it before or after having DIEP surgery.  Is it better to be my ideal weight beforehand?  I'll still have plenty of fat for my new bilateral tummy boobs because that is where all my fat seems to settle since chemo put me into menopause 12 years ago ( I was only 110 lbs before chemo and gained 50, but then lost 20, since).  Any input appreciated as I don't want to have hanging skin or weird lumps and bumps in my abdomen.  Maybe implants aren't so bad???

Thanks!

Debbie

Debbie, the DIEP surgeon will be able to answer that for you.  You don't want to diet away the tissue that would be needed for the flaps, and if you only need to lose 10 more pounds, that will not affect your outcome if you lose it later on.  I know of a lot of ladies choosing to have implants removed and having a flap surgery.  There's about a 50% complication rate with implants, and you'd need to replace them at some interval of time.  I really love my DIEP breasts---they look very genuine, they're soft, and will last me forever.

Sandy,

Would you also know that when they do the DIEP flat on you to rebuild the breast, will the do this just from the belly button down?  Will they do some lipo above the belly to make it somewhat flat as well?  Is the scar from the surgery down around the bikini line?  I'm meeting with my PS on Tuesday and have really have to make some decisions soon of what type of reconstruction I want to have at the time of removing my breast. I really appreciate all the information I can get from anyone out there.

Diane

Hi all,

I had my consult with the DIEP PS on Friday.  He said that it didn't matter if I lost the weight before or after from an aesthetic point of view.  Though they will barely have enough for a bilateral DIEP with what I have now, so they really don't want me losing much weight now.  My biggest concern with DIEP is the risk of losing one of both of the flaps.  In the presentation that they had me watch beforehand, it said that there is a 3% (or 6% for me since I'm bilateral?) chance of losing a partial flap and 5% chance of losing a whole flap (or 10% for me?).  That would be 16% chance of losing a a partial or total flap.  This presentation also said 13% (x2?) chance of fat necrosis (areas of dead tissue that have to be removed later).  However, when I asked them these questions, they said that 10% of people have to return to surgery and that they lose the flap in about 1/2 these cases or approx. 5% of the time.  They weren't clear if it would be x2 for a bilateral (they didn't know if their stats were per person or per breast).  They take a picture of your butt too in case this happens because their next course would be to do an SGAP if a DIEP flap fails.  I would HATE to have all of these scars on my breasts (already have them), then add a huge scar to be abdomen, then have a flap fail and have to end up with yet more scars on my butt!  I saw the pics of the scars with SGAP and I didn't like what I saw.  Or, even worse, or just as bad is to end up with one DIEP breast and one implant.  It seems like the woman who have DIEP either have a great experience or terrible.  A pedicle TRAM is at least a guarantee (pretty much) that you won't lose the flap (though you do lose the 2 muscles - does it really have any affect on you)?  Why are pedicle TRAM's so frowned upon when the potential risks are so much less re: total flap failure?  This is what I'm struggling with.  Too bad you don't know which side of the odds you are going to end up on with DIEP??  I'm just venting now but any input or insight appreciated!   Diane, what did you decide??

Debbie

Debbie,

 With a highly experienced DIEP surgeon, the risk of flap failure is less than 1%.   You need to seek out the best of the best, no matter which method of reconstruction you choose. 

Here are some sites with excellent information:

http://www.breastcenter.com/introduction/procedures.php

http://www.breastcenter.com/resources/faqs.php

http://www.drfrankisik.com/diep_flap_breast_reconstruction.html

http://www.diepflap.com/faqs.html#07

"The DIEP flap procedure is today's gold standard in breast reconstruction. Advances in breast reconstruction have made it possible to use excess skin and fat from the abdomen (rather like the tissue removed during a tummy tuck) to construct a new breast without the need for implants or the sacrifice of abdominal muscle. This procedure, known as the Deep Inferior Epigastric Perforator (DIEP) flap, is a sophisticated modification of an existing procedure known as the TRAM (Transverse Rectus Abdominus Myocutaneous) flap. TRAM flap surgery is a common breast reconstruction technique that requires the rectus abdominus (sit-up) muscle to be sacrificed and relocated to the upper abdomen. Unfortunately, this technique can be associated with significant post-operative pain, prolonged recovery, loss of abdominal muscle strength (up to 20%), abdominal bulging (or "pooching"), and even abdominal hernia." (http://www.associatedcontent.com/article/360841/the_hype_around_diep_flap_breast_reconstruction.html?cat=70)

Hi Sassie and Sandy K,

I met with the "best" and most experienced DIEP PS in the Boston area.  The overall stats that I saw in a Powerpoint presentation by several PS's (including Robert Allen who invented this method) was that there was a 5% chance of total flap failure, 3% partial flap failure and 15% chance of fat necrosis.  It said that 8-10% of patients have to go back in to surgery within 24 hours for some complication.  I then asked the PS himself what his stats were (as the others were overall industry stats).  I insisted on absolute numbers.  So, here they are:  He and his partner have done 407 flaps (306 patients).  32 patients had to go back into surgery within the first 24-48 hours (7 hemotoma, 20 venous, 3 arterial, 2 other).  That is 7.9% going back into surgery.  Their incidences of total flap loss have been 2.7% per breast, or a total of 11.  60 patients, or 14.7% of patients had fat necrosis.  Anyway, that leaves me with an approx. 6% risk of losing one of the two flaps (mine would be bilateral).  I already have had implants for 13 years and havent' had any complications (other than now the right one has capsular contraction and looks bad).  Sandy K, do you know who, other than perhaps Bob Allen (inventor of procedure) and the folks at NOLA that have less than 1% total or partial flap loss?  Who did you go to?  I'm not sure that I want to travel alone to another city to have this done (I'm single and have no parents, sibs, etc).  Also, I understand that you aren't totally out of the woods in terms of potential flap complications until 14 days out so what do you do if you are 2,000 miles away from your surgeon and you have a problem.  I know that if you have a flap issue (blood flow), time is of the essence.

I don't really see a lot of risks w/TRAM.  The people I know that have lost a muscle have seemingly no ill effects (supposedly studies show that too?).  And risk of flap loss is practically 0. 

I'd love any comments on the above!!!

Thank you!

Debbie