DIEP 2011

Betsy -- Hurray for being done with stage II! Did you have a lot of lipo done? Where does it hurt most?

Betsy, I'm a few weeks behind you for stage 2, with lots of lipo in the plan.  I hope things improve fast! Please keep us posted on your feel-better progress. I'll have a 3-hour drive after discharge, so I'm very interested in your opinion about feeling up to travel. 

Carol

mgm1953

I can stand pretty straight - I definitely feel pulling but not too bad.  My noob looks like the hamburger bun that I've read others on this site say they had.  I have some skin bruising issue that my ps is going to fix today.  She's going to remove that piece of skin, she doesn't think it's going to make it.  She is doing this in her office later this morning, I'm a little worried about pain but she doesn't think I'll feel it - Yikes!  She's going to drain some fluid too.  My drain came out last week because it was only putting out 7cc's a day but after it came out I've gotten quite full and firm.

db, I had some skin die, and removal was painless--no nerves there.

It took quite a few weeks for the area to heal, and some experimentation. At first PS had me putting silvadene on it, which is a messy affair (multi layers of gauze to keep the silvadene from oozing through to my clothing). But after a few weeks of silvadene, PS concluded that wound healing wasn't making much progress. He said that sometimes, silvadene (which is an anti-bac, anti-fungal used mostly for burn victims) hinders healing, and the do not know why.  So, he switched me to covering this very raw area with A&D ointment and wow....healing went into turbo mode, and every day I could literally see the wound getting smaller. 

Now I have scar tissue, which is thicker and a different color from my skin.  I have been covering it with silicone strips made for flattening and fading scarring, which apparently takes 6 to 8 weeks of faithful application.  I am about 3 weeks into using the strips (do not do this without your PS green light/ you want to be sure the area is completely healed first!).

I can say that the scar is already much flatter, although I still see a pretty big color difference between this area and the surrounding skin. 

By the way, did anyone explain why the skin didn't make it?  My BS told me that scraping skin in a skin-sparing mastectomy is a manual process, and that it's very difficult to be aggressive enough to remove the breast cells, without inadvertently scraping too thin in spots.  My PS told me that I had been particularly at risk because my breast skin was quite thin, being stretched through weight gain over the years when I became quite large (D cups).  I am still very, very happy with the outcome of my surgery, and at my age (57) some scarring is the least of my worries!

You might ask your PS to give you a thorough description of what to expect to see as your wound heals, and how to help nudge it along.  Maybe your skin bruising is less severe than mine was and you'll hear faster and with less scarring.  Hope so!!

Carol

Carol... I had blisters and very raw skin after MX, and it was explained to me that the scraping from the MX caused the rawness/blisters... that te BS just got too thin... Ultimately, the skin scabbed and was black... I had other problems, like my incision opening etc and they had to do a wound surgery... so at that time, they removed the skin and replaced it with ab skin (redoing the right side with a DIEP flap after hip flaps originally)... at stage II, the PS removed the ab skin and now I only have one vertical scar... It is amazing what he did and the final outcome.

Hey all - 10 days out of surgery (this was proph UMX and double DIEP)... discharged after three nights, drains out on eighth day, almost completely upright yesterday on day nine... all in all, much easier than first UMX with TE placement.  Slept on side last night and almost all pains are gone- just bloated feeling from the tight tummy... my toobs (tummy boobs) are pretty cool although will definitely need phase two... looks like the skin graphed nipple on the original cancer side will make it too... all in all I think my PS is incredible.... Think that since no lymph node work was done this time, this surgery was much easier...

Hi Just_V,

Just a thought, but did your PS give green light to sleep on your side so soon?  Mine insisted I wait a few weeks; cannot recall exactly how many--maybe three?  Fear was pinching the newly connected blood vessels.  PS's instructions seem to differ widely, so maybe yours has a different opinion on this, but if nothing was said, it might be worth a call to double check.

But sleeping on the side was indeed heavenly once I got there!

Carol

Amy, yes.. it is amazing. In August when he patched me with ab skin, it was about a 2.5 width of skin, and I assumed I would always have the breast skin and ab skin, with all the scars that comes with that, but at stage II, he somehow pulled the skin (during a lift?) to have the breast skin meet breast skin, eliminating the ab skin altogether... Magical!!

Just V... I agree... I was told not to side sleep for 4 weeks, not only due to blood supply but for possible distortion of the flap... but was yours the TRAM? Maybe when the blood supply comes from the muscle and not local vessels may be different.

Carol... yes, it is amazing. I had the debridement in August... what a mess beforehand... I wasn't sure that black scab would ever heal... and so the re-do was a good thing for me... and necessary since it wasn't just nasty skin, but leaking flap. I had come to accept the two tone skin, and here I am and its all gone.

My PS is obviously way more lenient on everything. No rules about no side sleeping, no compression, only rule was no lifting anything heavier than a half gallon of milk and no exercising (other than walking) for six weeks.



She is so young and so cute and hip. My daughter reminds me of her. I think that is what she is going to be like at 30.

Congrats to those of you that are post-surgery and hope your recoveries continue to go well.  I'm 9 days away from my DIEP and getting a bit nervous. I was invited by my Aunt and Cousin to go on an all expense paid cruise at the end of Dec (they forgot that I was having surgery this month) so I'm a little bummed about missing that but my new body will be well worth it. I actually entertained the idea for a few minutes but then came back to reality My PS said I will be wearing a binder for a couple weeks but I'm wondering what the benefits of wearing a compression garment longer are. Did you have any restrictions on showering? Any problems bending to get on/off the toilet?

SeaShelly.. I would go... I had my DIEP on August 23 and showered the next day.. no submersions until all drains are out and healed, which means you may not be able to swim, but still... One month after surgery I travelled by myself to my 30th high school reunion 3.5 hours away, for the weekend... Glad I went and felt fine.. I never had issues getting on and off the toilet.. as for wearing compression beyond the 2 weeks, that depends on your comfort level... Some women prefer the "being held in" feeling... and if you still have drains, you should definitely wear it longer.

After DIEP, I wore a girdle that went to mid-stomach (for compression for butt due to hip flap surgery in July).. had I not had the girdle for the hip flaps,I would have worn a binder for a couple of weeks... blood flow is up by breasts, not in the belly.. with the abdominal compression, I healed quickly and symmetrically, and it helped reduce swelling... I don't recall ever swelling in my abs. It also helps prevent fluid pocketing and forming a seroma.

mgm...Its true, all doctors have a difference of opinion and we follow what we are individually told, but its good to know what others hear, so they can ask their own doctors questions if they have concerns.

All 3 PSs I spoke with told me ANY muscle makes it a TRAM and can compromise abdominal strength.. My local PS, who I did not use, said he would not perform the free TRAM as it would make my abdominal muscle strength less than 100%, and he doesn't do DIEP, so I continued on with my search... So I think the difference between DIEP and TRAM comes down to MUSCLE use.. the dfference between pediculed TRAM and free TRAM is one shimmies it up under the skin and the other comes out and needs to be reconnected, with microsurgery, but with the muscle as the blood source.

I should add that i did have a complication after my MX and hip flap surgery in July... My BS scraped my skin too thin and I had raw skin and blistering and ultimately needed to get a wound surgery and DIEP to fix it... but we knew right away that I had an issue... the DIEP surgery took place one month after my hip flap surgery.... SO.. my suggestion is to make a committment to your Mexican trip AFTER you have surgery to make sure you are ok.. or get trip insurance.. but if you don't have any problems, I don't see why you couldn't go.. and MOST women do not have complications.

Meegan...  I was told  that even a small amount of muscle can compromise the entire abdominal muscle, and any muscle, large or small is a TRAM flap... And I was also told  that the muscle is taken BECAUSE it has a blood supply.. why else take it? And it would be blood supply for the flap... When they perform a DIEP, they remove the fat and then have to find a vessel up in the chest to connect to, to give the flap blood... when muscle is taken, it brings the blood supply with it. For a DIEP they take a small amount of the rib out to create a pathway to re-route the blood vessel from within the chest up to the flap (called a rib resection). I would assume that a TRAM flap with muscle does not need the resection, but that I do not know.

Maybe someone can do a  google search on it.

DIEP flap does NOT use any part of the muscle. A definition can be found at Wikipedia or just google DIEP flap. Do not let any PS tell you otherwise. Any use of any size of the abdominal muscle may compromise the future use of that muscle. This is not to say that some women may not be a candidate for a DIEP flap but would be for a Free Tram Flap which could be used instead. The fat and skin are the same it is the connector that is different. If your ab muscles are important to you and your lifestyle then you do not want a PS who says they may need to switch to a Free Tram or use a tiny bit of muscle to make the surgery work while they are doing the surgery and you wake up with compromised muscles. Know before you go under the knife what you are having done and that your surgeon understands and respects your expectations.