Diep 2012

My PS told me I do not have enough fat for a Diep and will need to have expander/implant instead. I wondered if this could be true because I am not a skinny woman (5' 7" and 155 lbs). It seems to me I have plenty of belly fat, etc. I wondered if there are ulterior motives as to why a PS would recomment/prefer a certain procedure. I do not really want to have implants and had assumed that I would be able to get a Diep. I am not sure if I should proceed. I also have a pretty crummy HMO.

 Any thoughts/advice would be great. Surgery is scheduled for February 7.

@vangoghpro - I am 5'3" and weigh 125 lbs. I got two nice DIEP breasts although I didn't have much extra fat. I did not want implants either. Some PSs will recommend only what they know how to do. I would look around for a PS who specializes in microsurgery and DIEP reconstruction. From the ladies on this board, I've read there are a number of good ones in Southern California. Keep looking and Good luck to you! PS - I have an HMO and it covered it all but my out-of-pocket deductible.

Vangoghpro - I am 5' 7" and 155 pounds (sound familiar) and I was told by the PS here in CO that I would most likely not have enough belly fat to make two c cup breasts as I had. I would have to go smaller. I ended up going to the Center for Restorative Breast Surgery in New Orleans. In NOLA I was told I had plenty of belly fat (that is what I thought!) and that if it turned out I didn't they would do a stacked DIEP and Gap which also takes tissue from your butt/hips. I was able to get by with just a DIEP and about the exact same size (maybe slightly larger) than I was pre surgery.  I think NOLA is the only practice that does stacked DIEP but I'm not positive on that. This at least gives you some options. It does sound like maybe you should keep looking for that PS that can give you what you want!

VANGO...I also had a local PS tell me I didn't have enough fat.(he didn't do DIEPs).. so I also went to New Orleans and I didn't have enough ab fat, but I did have enough butt fat.. so I got two c+ breast made out of butt fat,, I did have to have one re-done and then they used my abs to rebuild the one side... So 2 full C+ breasts AND a butt lift... all good.

Vangoghpro - I would get a second opinion for sure. I'm 5'6", 130 and my PS managed to get 2 C cups!

Run don't walk to see a PS who specializes in this procedure. Many, many of us had to travel to get it done and man it is worth it.

Readingmama- did u get any fat bulging over slightly over incision. I'm two weeks out, and I wear my binder which helps. Is this just normal swelling and does it go away in time?

just laura-oh kool, thanks for the advice, what did u have done in stage 2?

With revisions did u have to take time off for work

Hi everyone--I had posted before in the Jan-2012 Surgery topic and wanted to provide an update here.  I went into the OR on 1/19 expecting that I would have muscle-sparing free TRAM flap immediately following the left MX.  I was in the OR for 9 hours and the first thing I remember my husband telling me is that Dr. was able to spare your entire muscle!  In fact he was able to do an SIEA flap. The PS was so attentive--nurses in the ICU said he called many times throughout the night to see how the flap was doing with the hourly Doppler checks.  Then he showed up at 6:30 am the next morning to check on me.  Did anyone else have a warming blanket contraption(they called it a bear-hugger, and I think it is usually used for patients with hypothermia)? Nurses said this PS wants the flap to be kept warm at all times.  Here is the weird part that I haven't seen anyone else mention before: Because he was concerned about the SIEA flap 'taking' and wanted a back-up plan, he buried the other half of my belly tissue and my belly button inside my abdomen just in case.  He would have been able to go in and do a DIEP with that tissue if necessary. Therefore, as the dr. described to me, my belly currently looks 'half pregnant'.  That tissue will be removed on 1/31 in a 2 hour same-day procedure in the Hospital. I feel pretty strange without a belly button right now but it will be back.  I have had a lot of bruising and the new 'breast' seems a bit swollen but PS is pleased with the progress.  Still taking Lovenox blood thinner and aspirin and he wanted me to avoid chocolate/caffeine. Pain has truly been minimal and I feel so blessed--he said that there is less pain because no muscle was touched. Still waiting to hear from the Breast surgeon about the final pathology and whether any tumor was found--previously Paget's cells were confirmed in the nipple, but  MRI etc, did not identify any other specific tumor.

Hi ladies, I am scheduled for BMX with DIEP on Feb 1 in new Orleans at ochsner medical center. My PS is an LSU surgeon named Matthew Whitten Wise who works with Dr. Corsetti from Ochsner, who will perform the BMX. Dr. Wise has extensive experience with DIEP so i am hoping for a good outcome. Wish me luck and I will send an update on my progress after surgery.

LOUIENJ.. I am also from South Brunswick... Where do you live?? And who did your surgery?

Hi Judy!  About the bear-hugger blanket, I did the same as you--kept it off my legs.  He wanted the temp kept high in my ICU room too, and I was way too hot--I am a 'compliant' patient so I was kind of wearing the warmer side-ways to be sure the flap stayed covered.  My sister is a Nurse Practitioner who works with surgery and wounds and she kept telling me they use it to "Keep the baby warm".  Hi bdavis--I sent u a PM, too. My BS is Rachel Dultz/PS is Matthew Lynch.

Hi ship.  Thanks so much for replying.  My BS is Dr. Ahrendt and I really like her.  I wanted to ask Dr. Gimbel though what his personal failure rate was on the flaps.  She has seen only one in all her years, but I'd like to find out about him.  But, I was very happy to get Dr. Gimbel.  I'm a little freaked out about the ng tube (I didn't know about that) and the drains of course.  Other than that, I think I'm at peace with the surgery.  I had several abdominal surgeries before so I'm prepared for the pain of that and frankly, he's going to reduce me from a huge D to a perky C and I'm kinda liking the sound of that. 

Tamyln - I'm so sorry.  After you've recovered from this, what will be your next step?  

Diagnosis: 12/22/2011, DCIS, 6cm+, Stage 0, Grade 2