DIEP 2011

Kathylyon:  I had a skin sparing uni-mx December 2010 with tissue expander immediately implanted.  I didn't have either rads or chemo.  My DIEP was in August.  The surgery was 10.5 hours, I was in ICU for 3 days and a total hospital stay (including the day of surgery) of 6 days.  I cam home with 3 drains.  One (the flap) came out in about 1.5 weeks.  The belly ones didn't come out for 5 (and I still collected a very large seroma after their removal.)  I was still over-producing liquid, but the PS felt the possible downside of infection was greater at that point than the upside of removing the fluid.

I'm scheduled for stage II in November as out-patient surgery.  I have a fair amount of fat necrosis, so am anxious to see what my PS will do about that.  I'm hoping for no drains - does anyone have any info about that?

gardengumby: We all heal differently. I was surprised to see how fast some people were up and about, hiking and doing all sorts of things two weeks out.My stage 2 is next week and I am looking so forward to getting it done and over with as the day gets closer. I prepared quite a bit of food and put it in the freezer when I had stage 1. I am only going to prepare a small amount this time.

gardengumby: I came home with two drains after stage 2 but they never pulled much fluid; surgery on a Wednesday and the drains pulled the following Tuesday. I think my PS was being extra cautious by using the drains. They didn't bother me and rarely needed changing.

Just_V . . .  I washed with Dial for about 3 days before my surgery.  My doctor recommended that, or Hibiclens.  Dial is cheap, so why not?  And my own personal thing is to stay away from my usual shower "puff", you know, the scrubby kind, and just use clean washcloths just before surgery, and then after surgery until everything is healed over.  

When I went in for my pre-op, the hospital gave me special soap to wash with the night before and the morning of surgery.

I'm home from my Stage 2 (lift of the non-affected breast) this morning.  Feel fine - but my instructions are to do nothing other that sit around for 3 days.  I'll try to be good.

I had the same doctor as Kaitsmom... so also was told Dial or Hibclens... I used Hibclens prior and after I used Neutrogena... which is what they had at the hospital...

Even after all my complications and weeks with drains and compression, I have no fear for Stage 2... I llok forward to the next step and getting closer to being done... No reservations at all... When I am at my doctor's office, I have a sense of security... and when I was in the hospital for my cumulative month this past summer, I told them it made me feel safe being under their care, like they were my cocoon... so Nov 14 is around the corner and I am ready!!

Ladies - I have a question.  I had my DIEP consultation on Wednesday and was told that the surgeon would not perform DIEP until six months after radiation, which would mean June 2012 at best.  I had my BMX with TEs last April.  That PS told me I didn't have enough fat for DIEP, which turned out to be not true as I am 12 pounds lighter after surgery and chemo. 

Other than Kay1963, did anyone have DIEP after chemo but before rads?  Does anyone know if one of the major DIEP centers (such as NOLA) would proceed immediately?  I am not happy about stretching out this process until the end of 2012.  I have been on this journey since June 2010 and I really don't want to think about giving up another summer to surgery and recovery, not to mention the impact on my family.  I may rethink my desire for DIEP, to be honest.  Given my Stage 3b diagnosis and its accompanying prognosis, perhaps worrying about outliving the average lifespan of an implant is unrealistic. 

Michelle

Treesprite - That's good to hear - I hate drains.  My body seems to be a liquid producing engine, as after the mastectomy I had drains in for 5 weeks, and after stage I - 5 weeks, they pulled 'em even though I was still producing over 70 ml per drain per day - so I ended up with a sloshy hot water bottle stomach for awhile.  Compression took care of that for the most part, though.  (at least I'm not sloshing anymore).  Do you work?  If so, how long were you off after Stage II?

My stage II is scheduled for November 4.  I'm hoping for morning surgery, but expecting afternoon.  Outpatient and we live about 30 miles south of the city, so getting home from UW Med ctr will not be joyful on a Friday afternoon/evening.  My poor hubby has spent more time on the freeway getting me back and forth to hospitals and doctors than he ever wanted - that's for sure.

LuvRVing - I know my PS would not do reconstruction until some time after radiation (I didn't have rads, but we discussed all options anyway.)  If I would have required radiation, the one thing he was insistent about was that tissue expansion be completed prior to starting radiation.

LuvRVing--PRMA states on their site they don't balance bill, so they'll take whatever your insurance pays as full coverage.

If anything is out of network, I have no coverage for this year.  If it's in network, I am 100% covered as I have more than met my out of pocket maximum for this year.  I could select a different plan for 2012 that would have out of network coverage, which is usually about 70% with my DH's plans.

Jeskachi - I doubt their billing policy would apply in my case, with zero coverage out of network.

Thanks, everyone, for your tips. 

Betsy - I have contacted NOLA and will probably get an answer or two on Monday.  If this surgery could have happened this year and NOLA was in network, I would not have to pay anything.  That's just how our insurance works.  I already had skin-sparing BMX in April.

Everything I have read seems to indicate that DIEP before or after rads is more of a surgeon preference.  I can't find any clinical evidence that supports a reason to do things in a certain order, although it seems it would be easier to work on non-radiated skin and vascular system, then clean up any cosmetic damage in Stage 2. 

Let's see...if I change my mind and accept implants, I will be finished long before June of next year.  If I could find a surgeon willing to do DIEP in the next few weeks, I'd be finished by June 2012.   If I have DIEP after rads, I will be finished by December 2012, maybe, if everything goes well. 

My resolve is wavering.  It's a lot to ask of my family, considering I've been in treatment since June 2010. And I'm tired, really tired, of the whole damn thing.

Michelle.. I should add that the doctors in NOLA are in a contract with Three Rivers (a third party that processes claims for Aetna under my plan) but my portion is deducted out of my OUT of network coinsurance... So.. the doctor charges a fee, the insurance has a negotiated rate, and I am responsible for 25%... but it draws from my out of network coinsurance... so not really in network, but the negotiated rates and no balance biling saved me a lot of money.

LuvRVing, valid points.  Definately.  I guess I am not worrying so much about 20 years from now, as much as I am today. I really hated the concave chest and I hate this constricted, hard noob.  If I had it to do over again, I would try the DIEP.  Most of the time the results are fabulous and the recovery wasn't horrible.

 You wonder how long your DH's employer will remain patient, well I wonder about my own.  They have been wonderful so far.  My DH has typically missed one day for each surgery and one day for my first chemo.  I get most of my support from my parents, sister, and daughter. I went to rads alone after working a half day.   I guess that is why I am strongly considering the implant now.  I was told it would be one week recovery.  It's possible I could have a hip or thigh flap but the PS isn't positive without a scan that the blood supply in my chest isn't damaged too much.  I really don't think I can deal with more stitched up areas....I feel like raggedy ann.