Diep 2012

Sharon789  I had read on BCO about people with flaps being "hard" so I asked about the firm spots I had and they said the "hard" meant hard like wood, and extensive areas. I have firm spots along the cleavage curve for example. I just got the operative report via my GP today and from the descriptions in that, I am thinking the firm spots are related to where they stitched the shape of the flaps into place in the underneath layers, and scars form around them. By all means ask your PS office if you are concerned, but there's a lot of stuff that has to settle into place. I am 8 weeks and still have those but either they are less or I'm getting used to it. (The swelling that just started a couple weeks ago, I'm a little more curious about, but the word so far is as long as it's not red or hot, watch and see. I'm going to consult a LE therapist.)

Thanks goldlining, I do have some Xanax. I don't take them much anymore, but the anesthesiologist did tell me I could take one the morning of surgery and I'm sure I will. Just to calm my nerves and keep my BP low. And of course, once you get there and they get the drugs flowing I get pretty calm, pretty quick! Right now, it's coming in waves. I will be fine for hours and then suddenly I feel like I can't breathe. I'd be worried if I wasn't scared.

It seemed so far away and now it's almost here. And my husband just asked me what I wanted for my "last meal". Kind of wish he had phrased that differently. lol

Thanks Diana. I have heard of him.

I don't know the answer, melster, but that is one reason why I'm having the surgery now in winter. We have a pool also and we spend every available minute we can in it during the summer. I didn't want surgery to interfere with that. I might have to delay Stage 2 until later. I'll have to see how it goes and how long I'd be out of the pool after that one, but three months from now is May and getting into swim season for us. I do remember after something I had that they weren't as concerned about it because it was our private pool. Public pools- more of a problem.

c8ndygr1, with the Xanax and the drugs flowing in the IV in the pre-op area, I know the most stressful part will be the drive up to the hospital! Once I get there, I will calm down. I need to pay more attention in the OR when they take me in this time. When I had my MX, it was later in the morning and I had been getting the Versed for a long time. I was very relaxed and pretty out of it. I do remember my friend taking pictures of the gurney as they wheeled me off and saying, "She's a scrapbooker. She's going to want pictures of this." The nurses were all laughing. The only thing I remember about being in the OR was them asking me to scoot over onto the operating table and I remember thinking it was such a tiny little table. Narrow. Someone asked me something about scrapbooking and the next thing I knew, I woke up in recovery.

So it all comes back to the saying that got me through six months of chemo- You don't have to be brave. You just have to show up.

Thanks BDavis...I am not planning on swimming anywhere close to that soon! I was thinking more along the lines of do I have to wait like 3 months! I figure surgery in April..can I swim in June.

Hi--I'm new here. I was dxed with papillary carcinoma four months ago at age 45. My surgeon excised the lesion and took 5 lymph nodes (all clear but I'm paranoid about lymphedema!). I was planning for the traditional route of radiation and tamoxifen but my genetic tests came back with a BRCA2 variant of unknown significance. After consulting with my surgeon and two plastic surgeons, I've opted to do a double Mx with DIEP reconstruction.

 After a slow start to this process, I'm now crashing the boards. The scheduling just fell into place three days ago. I have my mastectomies on Monday and will return for DIEP flap 16 days later. I've been running around getting pre-surg exams,ultrasound, and CT scans... all while arranging to take extended leave from work. It's been so hectic that I haven't had time to really consider what's coming down. 

 I'm single and live alone so have some anxiety around caring for myself. My friends are wonderful and have all offered whatever help I need but I want to use that generosity sparingly. I figure I'll get through the DMx and see how bad it is. If I have trouble at home, I'll hire someone for the DIEP aftercare.

 After all that back story, a question: has anyone had DMx with no expanders? What sort of pain level/recovery should I expect? 

 Thanks for this great forum!

I had a left breast mastectomy and DIEP all at once also similar to Bdavis. Wondering also about the different days for surgery for you. I do know some women actually have mastectomies followed by TEs and then have chemo and radiation before the DIEP but usually that is overly the if not a year's time between mastectomy to DIEP. I am curious too.

Thanks for the welcome. Both PSs recommended down time between the two surgeries, saying it provides for better symmetry and healing. Two weeks is not their recommendation though---they'd rather it be a month but I pushed on that and got the gap closed somewhat.

Hi Dressager. Welcome to the DIEP world. And with minimal waiting and dread from the time you get your date to the time of the surgery. The suspense is very nearly the worst part. (Drains are the worst!)

I had one immediate and one delayed in my bilateral DIEP. I don't know what purpose expanders would serve. Those stretch the skin to allow room for an implant to go under. In the delayed DIEP, the abdominal skin was used for the lower half of the breast mound and there isn't a need to stretch the skin. They opened the previous mx scar and put the flap between that scar and the inframammary fold, and stuffed some of it under the chest skin above. 

Mine would have been more symmetrical to use the same pattern on both sides, but there are a lot of people who do bilateral mx with immediate DIEP with fine symmetry. Part of me wonders whether the motivation could also be that separate surgeries reduces the OR time on each occasion, either for your benefit or theirs.

I do have more swelling on the delayed side, and I don't know yet if it's like bdavis says, the tissue having healed to itself and now being disturbed. I have a mild regret that I was deprived of the chance to have the bmx/immediate DIEP because I started out at the wrong mammography centre and the marble just rolled down the hill from there. I'm healthy and it looks fine, but it was an inefficient way to go.

Bdavis. I was wondering the same because my BS and PS said that with a NS SS mastectomy there would be something to 'hold the spot'. My PS specifically discussed the tissue and skin that would be left would heal to itself. Of course that was when they were explaining holding off on the DIEP until after chemo and radiation (if I really wanted to wait) was the way some did and still do this, but they heavy leaned toward immediate reconstruction for women and I went with their recommendation.



We know that each woman's story is hers. The length of the surgery is a concern for some surgeons. My PS said that is why he operates with a partner and a PA to minimize time on the table.



DressAger. Are you having any biopsies done during the operation? Like a sentinel node biopsy? Or nipple tissue biopsy? Frozen section sampling biopsies were done online while I was on the table. That led to further axillady excision (more lymph nodes removed) but a GO for saving my Nipple. Just wondering. Everyone has different stories. I think we are all intrigued with each other's journeys.

Definitely sounds like time would be an issue then for you. The estimated time of my surgery was about 6-8 hours and it ended being almost 9 hours.



Just to clarify: for the DIEP portion I had 2 Plastic surgeons working together at one time and a physicians assistant from my PS practice as well. For the mastectomy, sentinel node biopsy, and axillary excision I had my Breast surgeon. All of those surgeons were there and started at he same time on my surgery date. While my BS was doing the sentinel node biopsy and beginning the mastectomy, my PS team were beginning the DIEP in my abdominal area. This was to it down on the time that I would be under. If it had been a double mastectomy my time would have probably stretched to 13-14 hours.



Glad they are being cautious with you over the time. Sounds like a good plan for your situation.

Betsy---I'd love to check out your pics but the site is asking me for credentials...?

I expect I'm not a candidate for skin sparing surgery due to the location of my lesion, which was pretty close the surface and the nipple.

Betsy, your doctors did an amazing job of correcting the necrosis wound. How did you get such full volume? Your scars are nearly invisible. Thanks for posting your pics on the photo forum.

Betsy, I just saw your photos. I had no idea you went through so much! You are looking awesome!! I took some photos yesterday and plan to share them there after my surgery. I do wish that I had thought to take pictures way back before the first MX. You girls who haven't had any surgery yet- take pictures! You will want them someday!!

dressager- I think you have to have a certain number of posts or been around for awhile before you will be granted access to the photo site. You can certainly understand why. They are intensely personal photos. Security is pretty tight. Keep posting away!

I'm getting down to the wire here with surgery on Tuesday. In a very odd twist of fate, it's snowing here in Texas today! That doesn't happen very often. How very cool!!

I bought a zip up nightgown yesterday. I was in town so I ran in Dillards to see if they had anything and I found one on sale for $12. Couldn't resist it. I have bought so many new nightgowns and all for around $12. Lots of clearance sales right now and I figure I will live in them for the next few weeks. I had figured I wouldn't even take a gown. Just wear the hospital gown, but they are so uncomfortable. The two I am taking with me- one zips and one buttons. I think I will be more comfortable in that. I'm not taking much with me. I live about 15 minutes from the hospital and DH and my sister and my mom will be in and out and can always bring me something if I need it.

Just relaxing today and going to order chinese delivery for dinner. Perhaps a beer.