DIEP 2011

Sherry... So does the skin just hang there till recon?



Kay and Rachel... One reason i chose nola over dr allen in nyc, for example, is because dr allen did not offer much at stage II... He was like, i will if u want me to... The docs in nola want a finished product and will sculpt you, for no extra charge...



After my complications and dealing with all of this for 9 weeks now, and stage II in november, which will be my one year diagnosis anniversary, i would not want to drag it out and be in surgical recovery for a super long time... I would prefer one surgery, one anesthesia, one recovery...my 2 cents.



Rachel... If you can have your mastectomy, and the incisions are from the nipple down only with no recon, and no loss of skin and a month later have your diep, then i guess its something to consider... But all incisions i have seen from mx first are not consistant with the diep incision, so it would not be my first choice.

I had a BMX with immediate TEs back in April in Kansas City.  Didn't have time for a 2nd opinion (cancer growing like wildfire).  I have extra skin on the left cancer side, which I suspect will be used when I have DIEP.  Mine is sort of "rolled and tucked" so it doesn't just hang there.  My PS at Brigham & Women's looked at everything and was very pleased with the state of affairs.  It will be in  teresting to get the DIEP surgeon's impression of what she has to work with.  I will see her on 10/5.  First consultation with local RO tomorrow. 

Michelle

No - the incision is horizontal but below where the nipples would be.  I'm sure I'll have extra scars as DIEP was not the intended outcome by my original PS.  The MX scars have faded substantially, so I don't think it will be too bad.  Not as good as if DIEP had been done originally, but no worse than anyone else who ends up changing reconstruction methods "mid-stream."   I'm not nearly as concerned about scarring as I am about being in my mid to late 70's and being told I need to have an implant removed/replaced.  This is all about not having an implant, and not being totally flat.  And getitng that tummy tuck.  If all goes well, I'll have a better shape than I did in my late 20's...not bad for an old chick.

Some PS's prefer delayed with no TEs; especially with a BMX you would be symmetrical. You never want to feel rushed with these decisions. Tell yourself that no matter what path you choose, you will be okay. I delayed my mx in order to have my PS at my mx to put in a tissue expander; I knew there was some risk involved but I decided it was right for me and no matter what the result, I would be fine. I was lucky as my lymph nodes were clear but I had also told myself that even it the eventual outcome was stage IV, that I would be okay and that I would handle whatever hand I was dealt, one step at a time.  That is easy to say since my outcome was good but it helped me feel much calmer throughout my decision process. I'm not suggesting that anyone delay their mx, but it was the right choice for me in my given set of circumstances, although it did make a few members of my family crazy.

Betsy, congrats on getting all your drains out.  It's amazing how much better you feel when you get those things OUT!

LuvRVing, you go girl. The first couple days after surgery are the hardest.  After that is gets better & not near as hard or as painful as I thought it would be.

Stage 1 or 2, my PS said the main objective of Stage 1 is to get the flap to survive. She can fix the other things in Stage 2 or however many is necessary to fix things. Or you can quit whenever you want.  

RachelVK, I have not followed your whole story, so forgive me, but I just had to jump in... There is a dramatic cosmetic difference in immediate free flap reconstruction. Your incisions will be mainly hidden in the inframammary fold ( the crease under your breast), with a small vertical incision from nipple down to IMF. As long you've got the fat somewhere (the NOLA docs can find it on anyone!) your breasts will look very similar pre and post surgery. The breast tissue is kind of scooped out and the skin envelope left behind, then re-stuffed.( Re-shaped if you need a lift, etc). Women have truly beautiful results! You can not leave the skin envelope empty, as in a skin sparing MX, and wait, as the skin and tissue will scar down. If you have MXS with tissue expanders placed they usually remove a lot of the skin envelope even tho it may be called skin sparing. Then you have to go through the expansion process ( not fun) or have skin from your donor site added along with the fat. This involves additional scars and an ellipse of skin that doesn't match your breast, as it's tummy skin, butt or hip skin. And the breast envelope is not your original so shape and size will be brand new, not like your originals! If you read over on the NOLA in SEPT. thread you will come across many women, ME INCLUDED, who wish they'd known about free flaps ( and NOLA) from the get-go. Also, the TEs, implants etc can lead to scar tissue formation which may be a problem you will never get away from. Removing scar tissue often leads to more scar tissue formation. Delayed reconstruction is a wonderful gift when there is no alternative, and certainly beats suffering with a chest appearance that brings you misery. HOWEVER, if you've got the choice, very seriously pursue your options now for immediate reconstruction.

Woohoo, Kay!  Three sizes is very sweet!  I've gone from an 8 to a 4 with surgery and chemo...I guess I might end up a 2 after DIEP!  My 4-baby belly will be gone and I'll look better than I did in my 20's...from my shoulders down!

Michelle

Thanks Sherry and Michelle!  I am a 2 now!  Hard to believe. I really hope I can stay here.   I know what you mean aobut from the shoulders down Michele.  I would say from below the boobs down, LOL.  I will have to look into those laser procedures.  Have no idea of the cost though.

Sherry, the weight loss really was from better nutrition and exercise which was inspired by BC.  I wasn't nauseaus on chemo.

Sherry... I know I have said this before... but please get a second opinion about the weight gain... I have MET women who are very thin and get the procedure... maybe from the hips, or a combination of hips and abs, but before you gain too much weight, please at least inquire with a second surgeon.

So Jerusha, is the reverse true?  If I should gain a few pounds then the "tummy" breasts might grow a bit?  Not that I would plan that to happen, but I'd be working hard to not lose any more weight.

Just curious.

Michelle

I think fat is fat... if you gain weight, your boobs will grow and if you lose weight they will shrink... That is true wth breast tissue as boobs have fat in the skin too... Without the breast tissue and its all fat, it may be more pronounced though... I think the point Jerusha is making is that to gain weight in order to et a DIEP and then lose it, you willl lose from the boobs as well.. so its not a great plan... I had my breasts made from butt (hip) fat I lready had and then also had a re-built breast from the abdomen... if then next year I lose 30 pounds, I will lose it everywhere, including my breasts.

My PS told me that stable weight is best - no more than 3 to 4 lbs fluctuation. He said that the noob would gain weight like tummy fat.  Breast also gain and lose weight, but maybe not at the same rate. I have lost 65 lbs over the last year and a half, and would like to lose another 10; however, I am mostly going to try and stay stable.  I'm no size 2; but thanks to DIEP my tummy is flatter than it has been in years.  My Stage 2A is scheduled for Oct 5th, and with 2B I would love to lose a little in the waist.  Right now I am a size smaller in the hips than the waist.

I concur with all the responses about shrinking and growing breasts. I think it's true that some women with natural breasts experience more change in their breasts with weight fluctuation than others do, some women have more or less changes in their tummies with weight changes -- and similarly there is also variation in changes in a DIEP reconstructed breast ( and probably other free flaps like hip and butt) from woman to woman. I think it is hard to predict ahead of time just exactly how your reconstructed breasts will fare!

Perhaps you could get a lumpectomy in the meantime to remove the DCIS... then you have the time to wait and not worry.

I would go for immediate DIEP... why would you not?