DIEP 2011

Kathe, my belly incision opened up about 3-1/2 to 4 weeks after my surgery. My PS was very perplexed that it happened so long after surgery -- if they open, it is usually shortly after surgery, he said. Mine kept opening and kept opening and getting deeper and deeper ... It ended up about 1/2 inch deep and 6 inches long in one place, and a second place (about an inch from the end of the first open part) about 2 inches long and 1/4 inch deep. I am 10 weeks out now and they are almost re-closed. We had to use wet-to-dry dressings and pack them 3x/day. They didn't hurt, but they were quite distressing. They did not get infected and I upped my protein intake to help the healing. My PS still can't figure out how it happened .... I couldn't wear the binder over the incision because of the drains (and it hurt!) so it kept slipping up around my waist. He thinks that might have been the culprit (cutting off some blood supply). I think it was my yoga pants that kept riding up and rubbing on it, since I couldn't pull them up over the drains (hurt like hell to do that and it hurt the incision, too).



I'm happy to answer any questions you might have about it,



L

Kathe, my DH thought it was just because the glue failed on the outside. It opened first right at the point of most strain -- just where it dipped into a very slight V below my belly button. It never did hurt when it opened, either. We stopped dressing it just this week whenwe couldn't make the gauze stay inside it anymore. At first the big one took a whole 4x4 and the little one a whole 2x2. At the end, the big one was taking a half 2x2 lengthwise and the little one was taking a half 2x2 folded in half shortwise. Now we just put neosporin on it in the morning after my shower and put a telfa pad over it held by tape. I let it just air out to dry at night.



I was on antibiotics for a month and then he took me off since I had no signs of infection.



Good luck with yours!



L

Deb -- I had a reaction to tape and glue almost immediately after surgery. I was told I could use hydrocortisone cream around the incisions, but not to get it in the incisions. It does help relieve itching. When did you have surgery? Angry+red could mean infection or reaction; best to check with your PS about this.

I have not heard of the type of DIEP surgery you describe, but I think it is smart of your PS to save the other side as a back up. On the other hand, how do you achieve symmetry if the other flap is not harvested? 

Sometimes a spit stitch can create a little hole that just gets bigger, like a zipper opening up. Spit stitches are where your body pushes out dissolvable stitches that haven't dissolved. Usually happens for me around the 5 week mark.  Right on cue, I had 3 come out around my belly button incision all at once, and 1-2 on the ab incision.

I had a wet to dry bandage.. they had me soak a gauze pad in prescription saline solution and stuff it inside of me.. It is supposed to dry up the inside... Didn't work for me, but should for most.

Mgm, GREAT news on your path report! I know just how you feel. My recurrence was 1.5 cm of DCIS but that was all there was. No nasty surprises, and nothing in the prophy boob. It IS a huge weight off your shoulders, isn't it?



I absolutely agree with the nurse about not being a martyr! If they had been able to find a narcotic that didn't give me hallucinations, I might've stayed on one longer ... But lying in bed watching everything move around me like a Salvador Dali painting was the greater of two evils ;-) ... And it was only the belly incision that really hurt hurt. I'm glad you can take narcotics without major SEs!



Kathe, what Betsy described is the wet-to-dry dressing I had to put in. I soaked the gauze (OK, full disclosure -- husband did the dressings!) in normal saline (prescription) and put it in the wound. The big one swallowed a whole 4x4. Ick. The small one swallowed a whole 2x2. We changed them 3x a day (more or less). As the gauze dries, it pulls out the proteins that the wound is making. It really worked for me, although it took a while. It was the antibiotic ointment on guaze that didn't work for me when it started to open -- it seemed to accelerate the opening. But everyone is different and everyone's skin is different. I hope your incision decides to stop unzipping and just zips right back up fast!



L

Hey ladies!  I haven't checked in for a while.  I miss all of you and hope you are all well.

I had stage 2 on November 3.  I can't believe it's been almost two weeks already.  I wasn't mentally prepared for my tummy incision to be completely redone.  Cut from hip to hip again!  Dr. Kline wasn't happy with the lumpiness of my scar so he redid it.  The pain wasn't nearly as bad as the first time.  He also completely redid the scar on my right breast.  This was the cancer side and I had a complete mastectomy almost a year before my DIEP surgery.  This side was larger, saggier and shaped differently than the prophy side.  They are a pretty nice match now and I am very happy with my results.  

My only little bump in the road was that I developed a fever the day after surgery.  I ended up with a partially collapsed lung and something that looked weird on the Xray.  I had a follow up Xray when I got home and got confirmation today that whatever it was was related to surgery and everything is normal and clear again.  Hooray!

I have to tell ya'll that I am finally seeing the results!  My tummy is flat as a board and now that the swelling from stage 2 is going down I am seeing a shape I haven't had in years.  I am so happy I went the DIEP route.  No regrets at all for me!

Susan

Betsy -- How are you feeling? I guess I never got your whole story. So, essentially the right hip flap did not heal properly (did the blood supply fail?), and you had to do the reconstruction over with DIEP. How long did you try the different bandaging measures before they figured out they needed to bring you back for DIEP surgery? And you had a fever and collapsed lung?

Are you are disappointed with your new size? Did you have fat grafting this round? I know you said you wouldn't mind having lipo in several places (ouch). I am also much smaller after DIEP. PS told me it would be so, and I have accepted it. The upside: small noobs are back up high so I will not have to wear a bra again for decades--if ever!

Susan -- Congratulations on getting through stage 2! It sounds like you have excellent results, but it also sounds like it was traumatic. Fever + collapsed lung? How long were you in the hospital? I am glad the abdominal and breast scar revisions went well. My abdominal scar is very ugly (and now open). My PS said he would be taking the whole thing out in stage 2, but I wasn't sure I heard him correctly.

How did Dr. Kline close your new incisions? Are they healing quicker than the first ones? I hope so!

Wow - I've like three pages of posts to catch up on... I am home after stage 1 on the 9th -- I had my other breast removed and a double DIEP.  Surgery 9 hours, then moved to a specialty floor...Four drains.... The PS was pleased... the proph breast looks pretty damn good (he left a cresent of skin with an indention for the breast lift in phase 2 but it looks good), the nipple still has sensation which is a bonus. The prior MX side looks good too.... he needed to remove the nipple because the scarring had damaged it so much, so my talented PS took it off, straightened it out, and is now attempted a skin graft with it... it looks like a cheese clothe wrapped blob right now... might or might not make it, but my PS will make it right regardless.  My sister who is here to care for me and I go see the PS for the first post op checkup today, and fully expect all four drains to be removed (sooooo exciting).    I do not remember much about Wednesday night except that at some point I was in the room and Dean was with me.  All Wednesday and Thursday I literally was unable to move my torso... my butt and back never moved from where they were on the sheet - I simply could not make my body do it....so you can imagine my terror when the nurse wrote on the board that the goal for Friday was to sit in a chair.... But on Friday, I was able to hobble to the potty and also sit in a chair!  But the pain in my ab the first time I had to move from the bed -- Oh. My. Gosh.  (the PS had to take a postage stamp size section of the ab muscle in order to get enough artery). Started eating real food Thursday night, too.... The nurses took ultrasounds of each breast once an hour Wed-Thursday, then every two hours on Friday, and then moved to three hours on Saturday prior to my discharge at 11am.  My PS visited twice a day and my breast surgeon each day; my care, between the surgeons checking up on me and the nursing staff was incredible.   DH picked my sister up about 130 on Saturday and they have been so wonderful and mother henish -- I am totally spoiled.  Saturday I could do almost nothing by myself but each day got easier and easier.  We've had a few of moments of excitement when I move wrong, screamed, and scared the tar out of my sister and DH, but overall I improved consistently.  Cannot quite stand upright yet, but getting there.   So I should find out from the PS when the phase 2 surgery will be (likely February timeframe), but in the meantime, when I look in the mirror I am at the same time amazed and disgusted (I vacilate between thinking of my torso as Mrs. Potato Head and Frankenstein)... What these doctors can do boggles the mind.   Now I need to catch up on all that you all have been posting!!

db53 and justV- can you stand up straight yet?I'm not as hunched as before, but still not straight.

What does your reconned breast look and feel like at this point? Mine is dome shaped, very firm overall and has a harder ridge on the side nearest the center of my chest. BS said this was normal and that things should soften up after a while. My friend, who had a tram, said after a year hers had softened quite a bit. Here's hoping...

DIEP grads- could I ask how much your belly boob changed over time? 

Seeing my PS tomorrow, hoping to get some drains removed....haven't showered since a week ago Monday!

all best

mgm

mgm -- I am 4 weeks out from surgery and still can't stand up straight! I am getting there slowly. As to belly boob size changes, my right noob was initially swollen but is no longer and currently has that hamburger bun shape --and size. Left noob is twice as big as the right (2 buns?), and looks like it came out of surgery yesterday. So it is still swollen quite a bit. PS tells me lefty could be like this for months because of radiation damage to the skin.

I started taking showers --with 6 drains-- after day 3. Your PS said no showers for you??

Completed stage 2 yesterday. Feel a little beat up and look pretty bruised up but no narcotics for me thanks. Working 800 Ibprophen staggard with 400 Tylenol. No drains yay! No nipple guards apparently. Doc says don't need em. We'll see what happens. Taking my Arnica and will do topical in 3 days when I can take off all the bandages. This was supposed to be outpatient surgery but we did a little more work than he was planning. Always good to do a face to face discussion of expectations. I spent the night in the hospital. Getting ready to go home now. 7 hr drive since I have to stop every 45 minutes and walk around to prevent blood clots.

Good luck to all you gals coming up.

kay1963 & carol57- how lovely that you've softened up! The harder it is, the more bionic it seems to me. when did your drains come out?

 kathew- my belly boob, radiated like yours,  is larger than my lifted boob. A little discolored (tan) under the armpit

snobird- looking forward to reading about your fabulous stage 2 results

seeing my PS this a.m., first post op visit,fingers crossed that all is well...

xo to all

mgm

I am just under 2 months out and my noobs are both soft and jiggly.  They softened up immediately after the big swelling went down (and the dang drains came out).  They look just like the old ones except for the scars, but I don't feel anything inside them. I had lots and lots of tummy to transfer.  I do have a firm place on the outer right lower quadrant of my right noob (not the radiated one) that the PS told me to massage.  He doesn't think it is fat necrosis, though (he says I don't have any at all), just a little residual swelling.  My radiated noob (the left one) is still discolored underneath -- has been since my first stereotactic bx in 2007.  I believe that is permanent.  It is smaller than the prophy noob, even though he gave it the larger flap.   When I have Stage II, he will reduce the prophy one.  

L

Wow, Kay!  Mine had to be under 20cc/day for three days!  I had 6, got the last one out 3 weeks after surgery.