HERNIA OR BULGING AFTER DIEP SURGERY
Hi. Has anyone experienced either a hernia or bulging following DIEP surgery. I know hernia is relatively common after a TRAM flap but I haven't read that about DIEP. When I'm doing stretching exercises, I can feel something wanting to protrude from my abdomen. I have to sit down, put my hands over the area and kind of push back. No pain, just feels weird. I see my PS tomorrow and will ask him, but I was just wondering if anyone has experienced something like I'm describing. Thanks.
Comments
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I have not experienced this, but my PS said you can get hernia and bulges after DIEP. Even though they do not cut the muscles, they still have to move them around to get to the veins, and that causes them to be vulnerable for a while.
Good luck with the PS tomorrow.
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Thanks for your response. My PS wants me to have a CT scan. He couldn't really feel anything, so hopefully the scan will tell us more. My surgeon said he has never seen a hernia develop after a DIEP surgery. If it is a hernia, he's wondering if perhaps it existed even before the cancer diagnosis and subsequent surgeries. Take care.
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Mollydog -
I have a bulge on my side after my DIEP. It is painful when I lay down. It just appeared recently. Had my surgery around Thanksgiving. I will be seeing my PS next week.
Good Luck with your CT scan...
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Well, good news: no hernia. I feel a little silly now, but I guess I really did need to check it out. The CT scan isn't cheap, although my contribution is very little.
We'll watch it -- see if it's a pulled muscle.
Ang7, what did your surgeon say about the bulge?
Take care.
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That's good news, Mollydog -
My surgeon said mine is a hernia and that 5% of people get them after DIEP. What luck, huh?
I am going to have surgery on it May 10th. At least it won't be as long of recovery as DIEP was...
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Wow, Ang7!!! I guess it wasn't so silly of me to have it checked out after all. I am sorry you're facing another surgery, but it's good to have answers. Please be sure to check in once you've had your procedure and let me know how you're doing. Take care.
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I just read that your surgery has been postponed. So sorry to hear that. More waiting... Take care.
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Thanks Mollydog -
Very maddening. I am waiting to hear from my onc. if I can start Vitamins and Iron to try to up my counts. I used to be anemic so this is no surprise. I just hate to put off the surgery...it is painful at night and I do not want it to get worse.
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Hey Mollydog~
Hernia surgery is scheduled for next Wednesday, June 16th at 11:30.
Will let you know how it goes....
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Hi, I'm pre-surgical (doing chemo first) and have been reading about DIEP. I have maybe a dumb question. How do you say DIEP? Each letter separately, or phonetically? Dipe? Die Ep? Deep? Dee Ep?
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I have what my PS calls a "ventricle hernia" on the left. It occurred after having a horrible coughing spell following Stage II. She says my fascia is very thin on that side. She will gladly do a repair when and if I decide to do so. I also sometimes have that funny protruding feeling when I move a certain way but it goes away immediately. No concern....it only occurred after the surgery. My PS is familiar with the complaint occasionally.
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Riley702:
No, absolutely not a dumb question. There are no dumb questions in this scary world of cancer.
It is pronounced like "deep." In case you don't know, DIEP stands for Deep Inferior Epigastric Perforator. Below, I've cut and pasted a paragraph about the DIEP Flap procedure from a website that I thought might be helpful.
In the mid-1990's it was recognized that the TRAM flap could be harvested without the rectus abdominis muscle by dissecting the blood vessels (the perforating vessels to the skin and fat) through the muscle (see figure 2). This flap, called the deep inferior epigastric perforator or DIEP flap (see figure 3), uses the same skin and fat of the lower abdomen as the TRAM to reconstruct a breast. There are several published series in the medical literature that show that patients who undergo this procedure have less pain and a faster recovery than patients who undergo TRAM flap reconstruction. There is also less risk of abdominal wall weakness and herniation. Finally, since the flap is taken from the low abdomen like a TRAM flap, there is the added benefit of a "tummy-tuck", with the abdomen nicely re-contoured.
Good luck. Let us know how things are going for you. Take care.
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Thanks for writing, Nursecal. It is reassuring that I am not imagining what I was feeling and continue to feel. My PS said he hadn't experience hernias in his DIEP patients, but clearly, this doesn't mean it doesn't happen. I'm glad to hear of your experience, and that your PS is familiar with the issue. Take care.
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Hey Ang7! Thanks for letting me know. I am very interested in hearing about your experience. More than likely, I will be away next week because my 90-year old Dad is not doing well. I have to go home. Unfortunately, I don't have access to the Internet at my parents. But please write when you're able, and I'll get back to you when I'm back. Be well.
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Thanks!
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Ang7 and Molly...thanks for putting this up there. I was diagnosed with an "inactive" hernia...but I've been having increasing trouble with what feels more like a charlie horse than a bulge. It can be quite painful and incapacitating at times, the last time I moved wrong...I was in pain for 2 days -unable to sit comfortably. My family Dr. told me I needed to go back to the PS to get it looked at and maybe fixed...but the problem with that plan is, I don't trust him! He was told specifically that I choose DIEP because it could be done without taking any muscle, and he took muscle anyway. Fear of a hernia is exactly why I didn't want to do it if it meant taking any of my stomach muscles. So, who do you see about something like this if you don't want to go to the PS? Any ideas?
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Wow navygirl~
I don't know what advice to give. I trusted my PS and I ended up with a hernia...
He did say there was a 5% chance that I could end up with one.
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Navygirl, I'm curious how you found out the PS did, in fact, take muscle. Did the PS actually admit it? That is a real bummer, because, as you know, the DIEP was an improvement on the TRAM flap, because you had to sacrifice muscle with the TRAM. Have you thought about seeing a different PS? I don't see why you couldn't switch now. Have you considered consulting with a physical therapist? Good luck and take care.
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Navygirl - my PS promised me a Diep - yet he took a "small cuff of muscle" when he dissected the perforators, which means I really had a "muscle-sparing free tram".........so you are right not to trust your PS. Mollydog - I discovered the truth about my surgery by obtaining the operative reports from the hospital - anyone can request their reports, they belong to you. I ended up asking for the reports after being encouraged to do so by my insurance company follow-up nurse (who was the best support person I had during my long ordeal). She would call me every two weeks and gave me fantastic advice. I started doubting that I received a true Diep when I saw a bulge just above my abdominal incision - my PS was so dishonest - he kept suggesting that I gained weight (I lost weight) or that it was "post-surgical swelling". After I saw my operative reports, I went to my PCP and he ordered a Cat scan. Even then, the radiologist did not see a hernia - but he did report on a defective abdominal muscle. Thanks to BethNYC here at bc.org, I went to a hernia specialist with my CD - he took one look at it, then showed me the scan on his laptop and said that it WAS a hernia - but a radiologist wouldn't notice it because the scan was taken while I was laying down. This surgeon had me stand up and cough while he placed his hands on the bulge - this was proof that I had a hernia - the cat scan showed that I had no muscle remaining on the right side where the PS took the perforators. I needed open abdominal surgery (which took place a year after my so-called "diep") and the hernia surgeon worked with a plastic surgeon to place a biologic mesh material - they also tightened up my muscles and supported the mesh so I should never experience another hernia again. Repeat hernias are common after hernia repairs, especially with mesh that isn't biologic. The mesh they used on me was called Strattice - made by the same company that makes Alloderm. This summer will be my first summer without surgery in two years - and I'm so grateful for BC.ORG and the wonderful people here who have helped me.
I hope my info has helped you - there's a lot of info here at bc.org about hernias - just do a Search - there's an article buried here somewhere where it states that women who have had prior abdominal surgery run a 25% increase risk of hernia after a Diep.......the risk for hernia after a muscle-sparing free tram is even higher. Good luck and I hope anyone who experiences a hernia after breast reconstruction surgery can find an experienced hernia surgery as wonderful as mine (Dr. George DeNoto - North Shore University Hospital in Manhasset NY on Long Island - he works with Dr. Ron Israeli a wonderful plastic surgeon who's practice is devoted to breast reconstruction. You can see his web site at www.breastreconstruction.org
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So interesting. Sounds a lot like my situation but no lying by my PS, no muscle removal. I had a repair but had a terrible coughing spell after that and the bulge returned. She says she can do the surgery again, but of course it requires abdominal again and much more time off from work than I want to do and feel comfortable doing. I have been told my fascia on the left side is just so very thin that there is not much connecting there, so the mesh is necessary. I believe Alloderm was what was used. Still would like to have repair again. I live in Texas. Maybe if I go back to Dr. Spiegel with your story and discuss further it might make more sense. Thanks for the input.
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One other thing. It seems that if they did remove some of the muscle wouldn't you have severe abdominal weakness and need to compromise your range of motion. That is exactly why I had the DIEP back when I did and not the TRAM or the pedicle. One doctor here in Houston tried to tell me that he would not know until he got in whether he would be able to do the DIEP and if not would do a TRAM. Of course, that is why I did not use him as my PS.
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Nursecal - I'm sorry you ended up with abdominal problems even after you did such great research (more research than I did prior to my so-called "DIep"). The following web site really explained things well to me, unfortunately not until it was too late - hope it's useful for any one else:
http://www.diepbreastreconstruction.org/
Also Nursecal - my abdominal problems were probably STARTED by the PS removing a cuff of muscle, but it became so much worse after I developed mrsa in my abdomen and lungs. I coughed so hard for about a week - and yet, even then, my PS refused to acknowledge that I had a hernia. My new surgeons did not use Alloderm, but rather Strattice because it has anti-mrsa properties and they didn't repair just a small area around the hernia but rather my entire lower abdominal region. They both wrote a paper describing their new technique - perhaps you can print it out and bring it to your Dr. Spiegal - tell him Dr. DeNoto travels the country giving talks about his new procedure. Hope this info helps you! We post-tram-flap hernia girls need to stick together!
Title of the article below is:
Extended mesh repair with external oblique muscle reinforcement for abdominal wall contour abnormalities following TRAM flap
click the link below for the article:
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I found out about the hernia after I had severe pain in my belly while recovering from ooph. I then requested the surgical report and plain as day it says the muscle was used. Now I have to constantly be aware of how I move or it acts up. I really can't fathom the thought of one more surgery, let alone an abdominal one. It just makes me want to cry at the thought of it. I finally just had my ankle replaced after 2 years of putting it off for all the BC stuff...I just want to get back to being me and be done with the surgeries. My PS did a double recon on me; one side is fine but the other has a huge divot where it looks like my breast is tacked to the chest wall by my armpit. I asked about this from day one and he told me it was fine, that it would "settle in" after a few months. That was two years ago and its just gotten worse. Between that and using the muscle when he never told me that was a possibility, I could be happy never seeing him again. For now ill just try to live with the stomach issues, maybe one day I won't feel so burned out and ill seek out a hernia specialist. Thanks for all the tips and advice. As usual, the ladies here provide more support and information than the doctors.
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I found out about the hernia after I had severe pain in my belly while recovering from ooph. I then requested the surgical report and plain as day it says the muscle was used. Now I have to constantly be aware of how I move or it acts up. I really can't fathom the thought of one more surgery, let alone an abdominal one. It just makes me want to cry at the thought of it. I finally just had my ankle replaced after 2 years of putting it off for all the BC stuff...I just want to get back to being me and be done with the surgeries. My PS did a double recon on me; one side is fine but the other has a huge divot where it looks like my breast is tacked to the chest wall by my armpit. I asked about this from day one and he told me it was fine, that it would "settle in" after a few months. That was two years ago and its just gotten worse. Between that and using the muscle when he never told me that was a possibility, I could be happy never seeing him again. For now ill just try to live with the stomach issues, maybe one day I won't feel so burned out and ill seek out a hernia specialist. Thanks for all the tips and advice. As usual, the ladies here provide more support and information than the doctors.
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Thanks for the information. Will discuss with PS.
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Navyirl, can you say a little more about your divot? It's only the 2nd time I've come across any mention of this issue on the Discussions Boards. I have developed a divot, too. My PS says he can correct it with a fat graft from another part of my body. I just don't want to go under general anesthesia again. I'm trying to figure out if it's a flaw I can live with. I asked my doctor why it happened. He said why, made sense when he said it. I just can't remember now his explanation. Thanks.
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Molly,
I really don't know how else to describe it? The left boob, the left side -about about 2 O'clock if you are facing me, just where the boob meets the area where my lymph nodes would be for under my arm, looks like it is literally sewed to the chest wall -which creates a large divot. It almost looks like you took an icecream scoop and scooped the area out. I imagine it's much what a larger sized lumpectomy would look like. It looks nothing like the right one. Which in turn makes it sit at a different height and slightly off center. It just looks aweful. I've been told it could be fixed the same way, but I have extensive nerve damage from that same blmx, so I have no real desire to go under the knife for anything that isn't necessary. It doesn't cause any problems, it just looks bad. I hope this helps...
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Hi all,
Back home from the hernia surgery and feeling pretty good. Am on Vicodin and I have 1 drain that hopefully will come out on Tuesday.
Last night at the hospital was not all that bad - with 4 kids a home, it was VERY quiet...
Sort of nice.
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Hi Ang - glad you're home and feeling OK!
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Ang, glad all went well! I don't know why it surprises me that you have a drain, for some reason I thought that was only for recon...I hope your recovery is going well and you can get the drain out on Tuesday - take good care of yourself until then!
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