DIEP 2011
Comments
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I watched that video - it was fascinating, and I'm glad I won't be awake to watch them do that surgery on me! I hope my docs take as much care as they seem to in the video. It also helped me to understand how it can possibley take as long as they say it will.
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Thank you to all of you on this board who informed me along the way. Thank you Dr. Joshua Levine for the fine work work you do. Thanks to Sandra and Kim, Dr. Levine's great staff and All the fine people at New York Eye and Ear Hospital for bringing my life back to me. Happy Thanksgiving to All!!!!!
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Meegan -- For me, DIEP reconstruction was not as painful or debilitating as ALND. After DIEP, I could use both arms right away; sitting/getting up was not a problem either. I thought the ab incision soreness would be like C-section, but it was less painful than c-section. BTW, they pump you full of fluid during the surgery and once they take the Foley catheter out, you will be getting up a lot to go to the bathroom!
THat said, my left axilla (ALND site) was utterly re-aggravated by DIEP surgery. My left noob is still 2X as big as right because of swelling. PS blames aggravation and swelling on rads. Is your rads side your dominant side? If so, you might have more issues with getting back to normal activities.
Libby -- How is your incision?? I started doing the wet-to-dry dressing; not sure I am doing it right. I watched a few utube videos--everything including 2nd set of gloves are sterile. I doubt I am keeping everything sterile. Did your husband use 2 sets of gloves for the dressing??
MGM -- Both my arm pits, but especially lefty (the rads side), got more sore 2 weeks after surgery. I believe that is because newly forming scar tissue tends to make things tight and sore. You are doing the right thing by stretching it out! I have been doing wall crawl, arm swings+circles. PT has been doing soft tissue massage. What valley/town do you live in?
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Dr. Chang is the head of the Breast Center and Dr. Prati is her right hand - personally trained by her. Dr. F and Dr. Prati work really well together. I think they are used to each others' surgery style and pace and it benefits us. I have nothing but good things to say about UCLA.
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Kathe,
My incision is finally healed -- it started pulling apart at about 3 weeks after surgery, it took a couple of weeks to pull all the way apart (URGH!) and now it is all back together -- so about 8-10 weeks from start to finish. Mine was quite a large and deep wound ... the big part was about 1/2 inch deep and about 4-6 inches long. The small part was about 1/4 inches deep and 2 inches long. They were separated by about an inch of skin that didn't open.
DH did not use 2 sets of gloves -- nor did we use sterile gloves. We just bought a box of gloves at the medical supply store and used those (sterile ones are wrapped individually). We did use sterile everything else -- sterile gauze to pack the wound, sterile normal saline solution to wet the gauze, sterile gauze to cover the wound, and a sterile ABD pad to cover the gauze over the wound and keep clothing from rubbing. I used paper tape because that was the least irritating to my skin (although it still irritated it like crazy, but it didn't leave blisters like the other kinds of tape). He washed his hands twice before donning the gloves. When he had to use scissors to cut gauze, he cleaned them off each time with alcohol pads.
Once the wound stopped opening, there was a period of about 10 days when we didn't see any movement at all, which was very frustrating. Then all of a sudden it started getting better. It seemed to get better by leaps and bounds every day once it started getting better. It grows together from the inside out, so it just gets shallower and shallower until you start to have trouble keeping the dressing inside. At the end, my dressings kept falling out and that's when we just started taping gauze over it instead of packing it. A couple weeks ago, the skin started to grow over it like a little skim of ice on cold water. Now it is all grown over and I don't use anything anymore, although I am still wearing big granny underpants so that I don't put any elastic or irritation on the scar.
Does that help?
L
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Hope everyone had a nice Thanksgiving, all things considered. I'm thankful for this forum, that's for sure
No one understands our lot like you all do!It's a good thing I allowed plenty of time to get dressed for the holiday yesterday. I only found one pair of decent pants that fit- some stretchy "jegging" type jeans. I wore the surgical bra for the first time too. I could hardly wait to get home and strip my clothes off!
16+ days post surg, my belly looks flat, but its tight and swollen. And numb, in an area about the size of a standard paperback book, centrally above the abdominal incision going upwards to the chest (including the funky looking navel). PS said it might take months for the numbness to subside-- DIEP pros- what were your experiences? And how long before you fit in your jeans?
KatheW- you said it. After 2 weeks the underarm hurt, not before. (and I live in West Hills, near Woodland Hills in the SF Valley). OW those stretches hurt.
HappyLibby- so glad you're intact again.
Regarding sterility and drains: one nurse told me just wash my hands. Another gave me a new box of sterile blue hospital gloves to use- and emphasized not touching the stem of the plug when inserting it back in drain bulb. (that nurse, bless her heart, gave me a whole goodie bag to take home from the hospital- with tape, gauze bandages, and even neosporin!).
Every day is a smidgen better. Down to 1 pain pill every 4 - 6 hrs (2 at bedtime). Shuffling around the neighborhood for 20 minutes.
xoxo to all
mgm
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Kathe & MGM - I live about half way betwen you two. I'm in Encino.
I had my SNB Sept. 27 and I think the numbness in my armpit is finally almost completely gone.
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Thanks for all the replies! Hope everyone had a happy Tday.
So, two studies I found interesting. One noted that in 2009 there were 192,370 cases of bc and 1/3 will have mx. This study, 86,424 had breast recon, of that 66,075 had impants. I wonder if that will change in 10 years as autologous tissue impants become more commen or if it will stay very specialized and not availably on a widespread basis? This also says "main adv. of both free tram and diep over pedicled tram are less disturbance of the ab muscle, more aesthetic inset of transferred tissue and more robust blood supply. Disadvantages are more technically demanding surgery and higher risk of total flap failure. Significant functional diff btw diep and muscle-sparing tram have not been clearly demonstrated. however, sparing more muscle and fasia minimizes risk of hernia, etc.
have to post 2nd study later..
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Libby -- Hurray for your incision closing!! Ten weeks is a long time to dress a wound; your husband deserves a medal! And thanks for explaining the WHOLE thing to me. When my incision opened, I didn't realize that it would keep opening up! It has stayed at about 2 inches for the past week, but it is deep-- at least 1/2 inch! And there is at least one other small opening that is oozing; but too small to pack. I have been packing the bigger one with 2 wet 2X2s rolled together and keeping that in with another gauze pad taped down. Luckily, I got a roll of Medipore tape when I left the hospital. Like you, I am allergic to adhesive, but the Medipore has been okay.
I think I see signs of healing in part of the opening, but there is another part that is just gross. You have given me hope that it will heal-- thanks! I look forward to seeing it start closing. We have a family vacation in Hawaii planned for January 1, so I am praying that it heals by then.
MGM -- Yes, the stretches do hurt! Numbness above the ab incision is normal. I am regaining some sensation there now. I have good friends in West Hills; they live near the reservoir. Are you in that area?
Cookie -- Good to hear you are regaining sensation in your arm pit! I actually live in La Crescenta, but have had all my treatment at Huntington or UCLA in Pasadena. My husband works at the Galleria, so I do come out your way once in a while.
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KatheW - almost exactly 2 years ago we moved from Glendale to Encino (I was working in Burbank but then moved to Brentwood work wise and the commute was MISERABLE!). DS was born at Verdugo Hills Hospital and most of the moms I met through the new moms group live in La Crescenta. I'm very familiar with the area. I hope that your husband survives the next month at the mall, I avoid them at all costs from now through the end of the year, pretty much.
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Cookie -- Both my kids were born at Verdugo Hills Hospital! That was a while ago; my son is at Rosemont M.S. and my daughter is at C.V.H.S. now. What moms groups were you in? My husband actually works in an office in the Galleria. Sadly, most of the mall was converted to offices long ago. Still, I can't help but help but think of Frank Zappa and smile a little smile whenever I go there ;-).
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I know a number of the teachers at CV, mostly science, as I'm also a science teacher and worked with an outreach program as well.
The group was just a group of us who met in the new mothers group at VH Hospital and we formed friendships and have stuck together some, although a few have moved away, we try to stay in contact. But now with us in Encino it's tougher. I think they all mostly know about my BC and some check in on me here and there.
I always mix up the Galleria and Fashion Square, I bet the Galleria isn't really that bad as it's mostly restaurants and the movie theater with just a couple of shops. It, of course, looks NOTHING like the old Galleria.
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MGM - I washed my hands with Hibiclens each time, and used Hibiclens in my shower for 2 days before and now ever since the surgery - had my four drains removed at 8 days.
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OK, the second study was done at Beth Isreal in NYC, there was 802 recons, of which 165 were implants and 469 were autologous and 168 were auto+implant. On general satisfaction, 52% implants were satisfied and 72% autologous were satisfied. On aesthetic satisfaction, implants were 48% satisfied and 73% autologous were satisfied. But the study is small, retrospective and nonrandamized.
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I am getting very nervous now!!! Not sure if I am ready. My PS didn't mention only using certain soap ahead of time, does everyone else do this? Did everyone start stool softner ahead of time? I took 1 today and I guess I'l take 1 Mon/Tues. I realize I don't have an eye mask, which was on my list, but never got bought.
Went to church today and everyone around me was coughing and I think the train will be like that tomorrow too, I've been drinking Emergen- C to help try not to get sick.
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My ps was fine with either hibiclens or an antibacterial soap, i.e. Dial seemed to be the only choice around here. Some recommendations are to start using a week ahead, but I just used it the night before and morning of. Any shaving/waxing/plucking should be done at least 3-5 days before surgery -- you don't want any extra opening in your body; I do my own pedicures (with help) to make sure there aren't any opportunities for germ entry. I gradually eliminated foods that don't digest easily and used Metamucil to make sure everything was moving along. The few days ahead of surgery, I ate very light . . .veggies and broth. So much better to prevent constipation than to try to deal with it after.
good site for what you can do to prevent infections:
http://www.hospitalinfection.org/protectyourself.shtml
I did the things that felt comfortable and reasonable for me, especially reminding people to sanitize, keeping as warm as possible (like not waiting for the nurse to turn on the warming blanket after getting into my hospital gown . .I crank that baby UP!).
I also make sure I come home to freshly washed EVERYTHING and keep hand sanitizer nearby just in case!
I wasn't scared or worried, just did the things that I could control to help prevent infection.
Hooray for emergenc-C! My DH just went to go buy more, I'm 6 days post op stage 2B and taking two packets of 1000 mg a day. Be sure to use the breathing thing while you are in the hospital you get home . . helps clear your lungs of post op fluid.
Great statistics! Really helps to know how women feel about things on down the line!
Best wishes to everyone approaching surgery and wishing everyone post op a speedy recovery, although don't push yourself . . .your body has been through a lot and needs some time and attention to get strong again; and it is mental and emotional a strain on you and all of those around you! Kind of like have really needy house guests WAY overstaying their welcome . .we all need a break from time to time . . .good time to have friends fill in for you main caregiver and give everyone a break. No matter how much our support people love us, it is draining.
Best wishes to all . . 2011 winding down!! I so appreciate all the kindness, support, and good information everyone participating has brought to this thread! You all helped me feel confident and supported going into this journey -- no substitute for someone who has been there ahead! Thank you!!
Kathy . . . just had stage 2B . . should leave just the tattooing! hooray!Getting the nipple constructed in Stage 2B (along with contouring, lipo, fat grafting, etc) feels like I'm way closer to normal than ever . . . I'm super happy to have that part done! Damn - it looks like the real deal! I look so much more natural when I see myself in the mirror!
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Meegan.. I used Hibclens once and DIAL the other times... You just need to use it the day before and morning of... As for stool softener, I waited til surgery was over... It is really for the anesthesia and antibiotics... I didin't or wouldn't want diarhea beforehand... just something to keep in mind.
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My PS had me use Hibicleanse for 2 days prior to surgery. I stopped shaving 2 weeks prior to surgery and start back for a month post surgery. I used Hibicleanse post surgery as well for a few days and then went to natural oatmeal based soap which is the only soap I use normally. I'm allergic to Dial but the Hibicleanse didnt bother my skin like Dial does. I only took colace after surgery but I did eat lightly before and early so that I had plenty of time to drink fluids after. I took a sleep aid so that I would be well rested prior to surgery. Slept like a baby. Don't take too many clothes to the hospital as you will be in a Johnny the whole time until you leave. All you need is fresh undies, sweats or yoga pants and a loose button down top and shoes and socks of course.
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i did wear my own nightie after day 2....
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I managed to get the preadmission nurse to give me a couple of hexachorophene sponges for my last two showers. I ordinarily use Tersaseptic antibacterial soap anyway, but I like the extra insurance. I appreciated the tips about the shaving. They did not give me any direction on that but it sounds like good advice. At the preadmission they swabbed me all over for MRSA and VRE so presumably if I light up any of those, I will be getting special treatment when I get there.
My hospital said to bring robe and slippers but they provide the "nightie".
They also gave me advice about eating light and non-greasy non-spicy food in the last day. The previous hospital (Dec 2010 mastectomy) did not do that and boy I could have used that advice. After my lumpectomy, I went straight home day of surgery, felt great, ate a huge plate of spaghetti and was in misery until I gave in and took the Colace and it started to work. I was smarter for my mastectomy in terms of promptly starting Colace and eating light afterwards but the pre-op diet thing was never mentioned until I read it here and my new hospital mentioned it as well.
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I should add... my hospital supplied a robe and "nightie" but after a couple of days in the hospital gown, I opted to wear my own... I did not have my slippers the first go around and the second time brought them... I loved having my slippers... and I also brought a light weight robe which I preferrred over the heavy "hotel quality" robe the hospital had. I also brought larger undies as I did not like going commando and with the compression garment needed larger ones to fit over the garment.
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Thanks for the advice! If anyone has their pictures over at TimTams site, please let me know. I finally am looking over there today, but feel like I am not searching very productively and am unsure the best way to see DIEP and Free Tram pictures, although also looking at GAPs.
Although looking at my list, I did find 14 threads so far...
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The pictures on Timtam whether they are DIEP, TRAM or GAP will look the same... the differennces are either where the fat came from or where the blood supply came from, but the finished product will be similar.
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My surgery is in the morning. I think I'm pretty much prepared - thanks in great part to the vast info. on this thread and you wonderful women! I wish I had thought about the shaving thing before as I just did that this morning... I will be extra vigilant about germs now.
I've been so busy with getting things ready for Christmas, organized and cleaned at home, taking care of business stuff, etc. for the past month and actually told a friend today that I'm surprised at how calm I am about this surgery. Well... about 20 minutes later, my husband and were hugging and I totally lost it! I had a major 'freakout' and cried my eyes out. I guess the anticipation, anxiety and stress had built up and it was time to be released. I feel SO much better now!! My bag is packed and all I have left to do is have something else to eat, get some sleep if I can, shower and head to the hospital. Whew. I will be ready for the upcoming R&R I will be getting
Please wish me luck and send good vibes. Thanks! -
Good luck SeaShelly! The same thing happened to me. I was extremely calm about the surgery and wondering why, then the night before I had a melt down of epic proportions. Crying, slamming doors, said I wasn't getting the surgery. But I got it out of my system, and was very calm the day of surgery. Best wishes and looking forward to hearing from you on the other side.
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Ditto Kay.lol.....
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SeaShelly: no worries, all is good and it sounds like you are super ready! You are a Seattle sister! Who is your surgeon?
We do such a good job keeping our game face on, so when the opportunity comes to let it all out, it is healthy and good; we are always balancing emotion with reason; we've done our research and DIEP is the best option for us personally but still, none of us exactly choose this journey.
I'll be sending you good juju vibes all day today!
definitely take advantage of the time to rest, rest, rest, rest!!
Kathy / Everett
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SeaShelly - god luck!!!
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I really appreciate the information in your post. I committed to my PS (having met with two) and one concern I've had is that he mentioned that sometimes he needs to convert to taking a small amount of muscle. It's been on my mind and here I visit the thread again and find this discussion. I initially didnt' think I'd want to go with a flap because I didn't want to do anything to compromise my core. I practice martial arts. I spin and do yoga. Being active is extremely important to me. I have some issues with my feet and hamstring (tae kwon do injury) so core strength is really vital for me. The abstract you posted addresses a lot of my concerns/questions. I have a lot of confidence in the surgeon I chose. He was more upfront about possible risks (one of which involved possibly taking a tiny portion of muscle) than the other surgeon I met with. And so I move forwards. I am 2 1/2 weeks from surgery at this point.
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Regenschim, Have you done some baseline measures for trunk flexion, extension, and time you can hold planks, etc? I had my trainer record a bunch of measures, including some photos so I could see how far I could reach, stretch, and number of reps on crunch variations. I want to measure progress in my return to fitness by measuring against my presurgery benchmarks. Plus, I found the presurgery baseline measures to be very affirming, helping me to know that mentally and physically I was as ready as possible. I view the small muscle loss as just one more small bump in the road, and knowing exactly where I was before surgery helps motivate me to work on getting it all back.
Good luck! Sounds like you did your homework and you are ready to take things in stride.
Carol
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