DIEP Reconstruction Timing

I am four months post rads with TE. There are docs that say four month minimum is fine.

Look for ps that can do nipple sparing mastectomy. NSM.

My ps at john hopkins told me he now likes his rad patients to wait a year. Said thats what some study at md anderson said. I think he is crazy.

I could have had my diep scheduled for sept. Now i am starting over with newdoc. And wont find out if he does nsm until i see him in three weeks.

I am considering this surgery as well.  I am two years out from my diagnosis.  I also had radiation.  My fears are a bit, I don't know what to call them, a bit unfounded?  What I am now worried about is "waking" up sleeping cancer cells by having the delayed surgery. I think of planting a garden, disturbing the soil and how this causes weeds to grow, etc....I feel a bit crazy feeling this way but I do worry about it. I have tried to find studies that prove this to not be true or vice versa but I haven't been able to find anything.  I am also worried about causing a major flare up of my lymphedema with the surgery.  I am worrying about a lot of issues with this but would like to feel more normal. I really don't like having only one breast.  I will check back with interest to see if anyone has anything to say regarding the radiated tissue that I also have and hopefully some insight into the other fears I mentioned as well. I hope it is ok I added them to your questions in a way, I don't want to hijack the thread! 

Hello All

Im just wondering if any of you were offered immediate reconstruction at the time you had mastectomy? I guess thats the best thing about having chemo first, more time to research doctors and procedures. After my lumpectomy with node disection i did mri showed another tumor so i decided to do chemo first before having double mastectomy. I saw 2 PS that were really kinda lazy only wanted to do TE with implants because the flaps were long surgeries and risk of flap failure. I didnt want to have more surgery down the line to replace TE with implants and replace in years once they expire. I was very clear with my surgeon that i only wanted NSM and to keep my own nipples and my PS only does TRAM and im ok with that. He knew a PS who would do DIEP but i said it ok the TRAM will be fine. I had a breast reduction in 2004 and thought that would be an issue but it wasnt. He said it was good since the blood supply is already directed towards the area that the new breast will be. The only thing is im having it for 2 breast instead of one which means they will be about half the size they are now. could have implants to make them bigger but as i said not into implants.

It seems every doctor has a different time frame after radiation treatments when it comes to reconstruction. My surgery will be about 2 weeks after im done with my chemo on october 2. Im lucky my wbc's never dropped low enough to need a booster or transfusions during my AC. My onc was amazed i made it through all 4 bi weekly said that rarly happens, couldnt remember last time a patient did that. Now im on taxol weekly and no SE. I understand about wanting to feel normal again thats why i wanted to go into surgery with 2 breast and come out with 2 wanted it to be my last surgery. You ladies are very brave and i think you should continue to research different PS because i think its a perferrence of the doctor and not the standard when it comes to waiting.

I am 3 years post BMX/DIEP. At the time of sx I was 13 years post rads on one side, 8 years post rads on the other. I'm very fair skinned and it took over 2 years for the last little spot on the left side to heal fully after the DIEP.



Don't be in a big rush to have recon after rads, give yourself ample time to heal.



Mgdsmc, it's certainly up to you to choose between TRAM and DIEP. I also had the choice and went with DIEP because The TRAM utilizes muscles. I didn't want to lose muscle if I didn't have to. May I gently suggest you investigate further before making a final decision?

I have a question about diep. Why are there more than 1 step? I'm confused thought it was complete at the time of surgery. Also why are so many women going to NOLA for surgery and what does it cost?

Than you for the information. I will do more research before making my decision. I have 5 more taxol treatments so lots of research time.

I wasn't aware that insurance would pay for out of state procedures. I'm aware of battling to get insurance to pay for in state procedures sometimes. It would be great to have the same size breast once this is done.

I was set on having the TRAM because I'm just tired and want it over. Now I'm not so sure that TRAM would be my best choice after thinking and reading the experiences of women who had DIEP. I'm still going back and forth with it.

The requirement for my BC/BS policy to pay in network rates to an out of network surgeon was...that there couldn't be a surgeon within 30 miles that performed that surgery. No one in my region performed DIEP, so I was able to go to Dr. Massey.

I would say, find the surgeon you would most like to use first, then see if your insurance will cover them.

I had a unilateral mx then did 8 months of treatment, then had to wait 6 months after rads to have my DIEP. That gave me a lot of time to research and I actually did all the insurance research and exceptions myself. Blue Cross sent me all the necessary forms and told me exactly what to do. It was a lot of work on my part, but so worth it. I know many ladies just let the PS office deal with the insurance. But I'm kind of OCD in details like that and didn't have any problem. I was very fortunate to have a cancer policy that covered my airfare and helped with lodging all 3 trips to Charleston. I had met my out of pocket the first 2 surgeries so I paid nothing for the surgeries. The 3rd one was a different year, and I paid around $2000 to the hospital.

There is a "Charleston Bound" thread and "NOLA in September " tread and "DIEP 2012" where you can find tons of info.

I did the same treatment as you...AC and Taxol x12 weeks. Hang in there, it is almost over!! Chemo has been the hardest part of my experience so far. The DIEP reconstruction, while overwhelming to plan...and I thought could never happen, was almost healing emotionally, as I felt I was finally doing something to restore me rather than damage me! Best to you as you find what is right for you. Don't hesitate to PM me if you want to.