DIEP 2011

dee7493 - how many drains will you have left after today?

vmarie - i know what you mean by yeah the last drains came out, can't wait.

@dee Re: your question on how much tissue to harvest.... Do you mean could a PS take too much and therefore not leave enough on your abdomen? Or not take enough and say you were hoping for full B cups and only ended up with smallish almost-B's ? Now this is my opinion only, so here goes: I am thinking that if you have excess fat in your abdomen (as I do), and I simply exercised it away, then it would be gone. (not likely for me, but do you know what I mean?). During a DIEP, the PS basically dissects what he feels is extra plentiful fat and whatnot, and moves it up to recon the breast mounds. This leaves a flatter abdomen, but it is not the exact type of "tummy tuck" (abdominoplasty) that is done if you were going in only for that - abdominoplasty usually includes some tightening of the abdominal muscle fascia.

Now if too little is haversted, and your results are not as big as you had hoped, then I suppose you could discuss fat grafts during your stage II surgery.

I think the trick here is to develop of good repore with your PS and make your expectations known.

Did you watch the video on OR live? It gives you a good idea of what goes on during a DIEP.

Question for anyone who was already consulted with a PS:  When you asked your PS how many DIEPS he/she has performed, how many years he/she has been performing them, and his/her failure rate, what were the answers? I wonder how the one I met with yesterday measures up. This was his answers: He has been performing DIEP's since 2005. He has done greater than 500. He has seen a flap-failure rate of 1 to 1.5 percent in his patients. 

He also said I was a "Type A" personality and he claimed he is one also. Not sure how I should take that. I asked my DH what he thought that meant as it refers to the PS and he said' " It probably means he is a bastard to work with in the OR."  Okay then. I have worked in many an OR with different surgeons and sure enough some are bastards. I'm hoping it means he is a perfectionist and prides himself in how his "work" comes out. BIDMC is a teaching hospital (of Harvard Medical School), but the PS did tell me he does not allow anyone other than him to operate on his patients, with another PS from his office (there are 3 and all do DIEPS) assisting, that is. I guess he meant no students, interns, residents...whatevers.  

Off to google what this "Type A" stuff is all about.

@Xmasdx Perhaps the notebook that I brought with me freaked him out a little. No person should ask another if there are "any questions" after they are finished with their spiel unless they welcome the questions and try their best to provide answers, IMO. This PS was very articulate when he explained the procedure and answered my questions without a blink of the eye. Not to mention that I could picture him sitting between Christian Troy and Sean McNamarra while they asked me, "So L, tell us what you don't like about yourself?" I was a little freaked out by the young man who accompanied the PS into the room, whom he introduced as "Doctor So-and-so". This young man looked like a kid. My DH said this young doctor kept making goofy faces while the PS and I were chatting. I asked if he (DH) thought the guy was making faces at me, and he said NO, it was more like a facial tick or something. That's good 'cause if I noticed it, I would have had to ask him to leave the room.

Regarding if you end up much smaller than you want or expected; my PS has already offered me a small implant behind the new tissue, but I'll know more after Stage2 consult. Not that I want to be bigger, but it's an option and always has been.

Xray - yep had to do the before and after photos also but where I go they use they lovely silky throw away tong underwear. I couldn't wait to get them off and throw them away, just not me.  Sounds like your ps has done more than mine. If possible try and find anyone (best change is on here, bc.org.) that has had this procedure done with the doctor you want to have it done with. I had 2 people who have already had it done with my doc and 1 who is going to in a few months who I could ask questions throughout this whole thing and they have been such a piece of mind helping me know all that I was in for and all that I still may be in for.

Hi girls,

@dee---they will take the entire ab flap as they can't just leave part behind.  It would be lopsided if you imagine.  If they don't (or can't because of the way the blood flows) use both sides they will discard the excess.  Don't worry about them taking too much.  And yes, it is a long incision, but it is definitely low enough that unless you plan on wearing a really skimpy bikini it shouldn't show.

I had some pics taken along the way too, can't really remember who though---pretty normal stuff for PS prep.

I'm curious about others DIEP going into Stage II.  Mine is a bit lumpy, uneven.  My doc didn't mention fixing that at my last visit, just lifting the other side to meet the new side.  Do you all think I should contact her with those concerns?  Also wondering about the tattooing.  Did any of you have your nipples done BEFORE stage II?

Thanks,

Sharon

Xray-i do not think the underwear they gave me was supposed to be thong but they ended up that way on me if ya know what I mean LOL. They only took front pictures.

I feel very lucky. I only had the primary PS, his nurse and my DH in the room for the marking. Also I did not have to shave anywhere, in fact it was recommended to me to stop shaving everywher prior to surgery to avoid infections from ingrown hairs when it started to grow back. I was also wearing my own underwear for the photos which the nurse took. My husband was taught how to take additional photos to send to the surgeon every 4 weeks during recovery since I lived 5 hours away. When the scars heal more I will go back for further stages.

Thanks so much for those funny stories, ladies! 

I had a breast reduction at 19, so it brought back memories of the photos -- not by the PS mind you, but by the Medical Photography unit! Some additional perfect stranger whose only relationship to me was "disrobe please". (No thongs involved though.) Also the purple marker. I was really comforted by that. He did it the night before, back in the days when people were actually admitted the night before surgery. I was glad to have the time to process in my head. I was a little freaked for my mastectomy that there was no purple marker and he was just going to "freestyle" it.

I'm waiting on DIEP consult and OR date and as I'm uni-mast (Dec '10) and prophy mast with immediate bilat DIEP to schedule, I'm getting various other things out of the way through Labour Day. (So watch for my turn at the "eeeek, tomorrow" posts in about 6 months.)

I looooved the funny stories about the thongs and all our bodily insecurities, but I'm now taking the position that I'm not flabby, I'm tissue farming. 

MARXI!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

You're back!  We were all getting worried, and now I see why!  You have been put through the wringer!

 I'm so glad to hear from you though.  I'm so sorry it has been such an ordeal.  But I'm glad to see you back posting!

Hi everyone,

It's nice to hear a lot of upbeat comments today (after all we go through!).  My original PS for my immediate reconstruction (implants, but left one failed) was in private practice and was the nicest woman.  I was in full cancer shock mode at the time and cried a lot.  She always sat down with me and asked me to tell her what was wrong.  I miss seeing her.  She always took pictures every visit. Because she did not do DIEP flap and I was changing insurance, I sought out another PS for my left breast reconstruction which had to wait till radiation healed, so I was without left breast for over a year.  I did go to Loyola Medical Center in Chicago for a consult with my current PS.  I had my list of questions which he answered and threw in a little joke type remark here and there, but not enough to be silly.  I immediately liked him, found him knowledgeable and comforting and patient.  His nurse was always in the room with me.  He does not take pictures till the end.  Well, I'm one for pictures, so I had been taking pictures of myself from the night before the dmx (kind of droopy uneven boobs), through just a few weeks ago (DIEP done on Dec. 7, 2010.)  I gave a copy of all my pictures to the PS and he really looked at them and had them scanned into my file.  He made a comment about my radiation pic which was very burnt.  He said, "and they say radiation does not damage skin?"  My PS had his Fellow (one who has done surgery but is now specializing in vascular surgery) assist him in surgery.  A young resident marked me (he could have almost been a grandson of mine).They said they took pictures during surgery, but I'm not sure.  I wanted a video, but they did not take me seriously and said it would be too long anyway.  I watched the one on or. something everyone has been watching, so I got the gist, believe me.   I always bring a paper with questions on it and even then I forget something.  PS always says, "ok, what else is on your list there?"  He and his nurse keep saying, "Be patient."  I know I have some stage II stuff to be done, he's just waiting for things to settle down, but the top of my new breast is raised up, swollen and hard (my own tissue).  I think this should be addressed sooner than later.  I see his this coming Fri.  Not one of us has had an exact duplicate of the other, but it is good to hear all the possibilities, good and not so good.   Comment, I did not have to shave, nor did they shave me.....

Marxi we've been thinking of you while you were going through it all, wondering how it was going. So sorry for your complications and much admiration for your strength in fighting back. For all of us on the pre-op side, it's probably all of our darkest fear, all the sideways things you can't control. Thank you for sharing and letting us know you're home. Hope to hear that you're fully out of the woods soon and end up with the best outcome in the history of outcomes for all you went through.

thanks for all the well wishes. your support means a lot.

WOW, Marxi, you have literally been through the wringer!   They had me very worried about my flap for the first 24 hours as their new SAT monitor kept showing the O2 levels dropping considerably which is a sign of flap failure.  They literally were in my room every hour for the first 24 hours checking it.  All ended up being fine.  I am SO sorry you had to go through all that additional pain----physically AND mentally!   It's like adding insult to injury.  It's bad enough to get the BC dx, then to have to endure what you did---whoa.  You must be one strong cookie!  God love you for it.

(((HUGS)))

Sharon

Hi Marxi,

You do have a good drain(s) in the left side, correct?  Is it ouputting a lot? It is not clogged, is it?  I can see where it would be swollen and huge, I had surgery 2/28 without the complications you had and it is still very swollen, so I'm sure it's normal.  I just wondered if it is draining well.  Because if it is not, that won't help matters!  Have the doctors suggested heat or anything to ease the discomfort and help healing?  I know normally it's ice for swelling, but our flaps love to be toasty, right?  

You get some good rest, you deserve it!