Diep 2012

Marcie,



I have been thinking about you so much. My heart is with you..... I wish you peace and acceptance.



Be strong my friend. Although we have never met we are sisters.



Be well,



Ruby

marcie...I just had bilat diep on Nov 1 and on Nov 6 leftie failed and was removed the next day...so disappointing to say the least.  I am so tired of those around me telling me I should be thankful to be alive.  I am but i want my boobs back!  Others cannot appreciate that we MUST mourn our loss of them.  They were a big part of us til BC took them away.  For a while I would cry that i was not a woman as I lost my boobs to surgery my hair and period to chemo so what is left that makes me womanly.  I have gotten over that for the most part. I now just jokingly refer to myself as a uniboober.  I am scheduled March 5th for a gap to replace leftie.  If that one fails I may just have them take em both off and live for the rest of my days boobless.   I wish I could jump in and give you a big hug.  Take care of yourself. 

Maggie

Good for you Shari.

Just wanted to make clear that we did not know going into surgery if I would have radiation or not.

Despite all the tests, MRIs, and scans, we did not know positive nodes until my snb which was done while I was having my masectomy and then subsequent node excision. My choice to do snb as part of the mx.



Until the surgery was complete and the full pathology report was back, we did not know if I would have rads or not. That is why my PS prepared for that as part of the DIEP.



Hugs!

How did he prepare just so I know....u may have mentioned but maybe I didn't get that part... I don't want to wait 6 months for the reconstruction after either.. But I am going thru chemo now also.. Thanks for feedback.. Please write again..

Shari.. It is my understanding that if you have DIEP and then radiation, the PS will overstuff that side allowing for shrinkage. Then after radiation, wait a few months and then have revisions. Someone on the ASK THE DOCTOR site recently asked this question, and Dr D said to either do the DIEP or use just implants (no TE) to hold the space until after radiation. TE expand the muscle which could cause pain and need repairing afterward. If it were me, I would have the DIEP and then the rads and then the revisions. In the care of the right doctors who have done this before, you should get excellent results.

I say this above because he stated this on his website (plastic surgeon) and ,ade a valid point to waiting.. He said it can be done either way but this is why he recommends waiting... I am including blurb below:



While radiation therapy can complicate breast reconstruction surgery, with proper preparation, most women can achieve a satisfactory reconstruction even if radiation therapy is part of their treatment plan.



Ideally, to achieve the best cosmetic results with the lowest rate of complications, we like to wait approximately six months before performing a perforator flap reconstruction when a woman has had radiation to her breast or chest; this time period may vary depending on a woman’s particular circumstances. Some of the radiation-damaged skin can be replaced with soft and supple skin that allows for the shaping of a much more natural appearing breast. Furthermore, if reconstruction is delayed until after radiation is completed, the tissue used for the reconstruction is not exposed to any radiation that could potentially affect it.



The need for radiation therapy cannot always be determined prior to surgery. This is because evaluation of a mastectomy specimen by a pathologist may uncover certain findings that lead to the determination that radiation is needed to optimally treat a woman’s cancer. Consequently, on occasion, a woman may have already begun the reconstructive process when she learns that she will undergo radiation treatment. Since treatment of the cancer takes precedence, radiation will be administered and if necessary appropriate measures will be taken to optimize the final reconstruction and manage any complications that arise.

Shari... Here is an explanation from Dr D about delaying DIEP:

PATIENT:

Thank you Dr. D

Do you think that it would be better when one has to have radiation treatment that they wait to have reconstruction breast surgery until radiation therapy is finished. The reason I elected to have immediate reconstruction is one surgery. I am a high functioning person with MS and also have had a carcinoid tumour of my bowel resected 6 years ago. I don't want to have to go under with anasthesia more than I have to.
With Tram Flap surgery, can it still be done if I have 2 ceserian surgeries, but not to have babies, one for hysterrectomy and the other for the resection of my terminal ileum.

DOCTOR REPLY:

In situations such as yours, where the amount of abdominal fat is marginal and there is a high liklihood of radiation post-op, I occasionally offer an alloderm-sling implant reconstruction without excising any skin, to allow for the breast skin and breast shape to be preserved during radiation without subjecting the flap to the volume loss and firming up that will occur as a side effect of the radiation treatments. Once radiation is done, the implant will no longer be a good option as capsular contracture will inevitably set in and likely become severe. So, 4-6 months after radiation is over, we go back in, take the implant out and replace it with the flap transfer.

If you radiate a "smallish" flap, the volume loss may be substantial and trying to make up the deficit with an implant can be troublesome. By contrast if you cut the whole breast away, skin and all, then a "smallish" flap may likely not be enough to match the other breast.

Breast reconstruction is complex and each case unique, be sure you are in the most experienced hands possible to avoid a regrettable situation.

Hi, I am hoping someone can reply to my post who might have some insight on the issue I am having.  I am 5 months post DIEP reconstruction for DMX.  I had right side TE failure and either DIEP, TRAM or Lat were my options.  I found a great surgeon in SF and decided to go with the DIEP.  Cruising right along, had a decent recovery and was feeling very good and back in action.  Around 8 weeks post recovery I was cleared for exercise, which I started off with walking then a few weeks later my normal exercise routine - which is a bit more intense.  About 3-4 weeks ago, I felt like I pulled the right side of my abdominal muscle during my routine.  I rested it for a few days, but it was still pretty sore.  I am now having what feels like muscle spasm in the same area (the only thing I can compare it too is when I was pregant, and my baby kicking inside my tummy)....at least a few times an hour.  I had my PS check it out this past week, she did not find any bulge and prescribed ibuprofen --- that perhaps I did pull something and its just irritated.  Its very uncomfortable and I was just wondering if anyone else had this type of issue and have any recommendations.  Thanks! 

Thanks bdavis,,,,, will keep u updated after consultation... Appreciate all ur help

I don't understand the need for radiation if mx is planned.  I would think that if you're going through chemo, which is tough enough on the body, and possibly looking at radiation, why not wait for diep until your body is strong again?  Granted, TE aren't my idea of a good time, but they do what they need to do until the time is right for diep.  I vote for delaying Shari

SheChirple...see you later   We'll be thinking of you & hoping you can put bc out of your mind for a while!!! 

FaithorFear...I did the same thing @ about 3-4 months post diep (my exercise was throwing my 32 lb grandson around). Had the muscle spasm/ache thing, also on the right, and was really worried.  My ps said it was a muscle pull, that there wasn't anything to worry about as far as the stomach was concerned as the dissection was in the lower abdomen. It subsided a few weeks later.  I know how you're feeling, I'm always thinking that it's important not to mess this up! Wonder when that concern will go away

Hi Marcie,



Just checking into say hello



I hope each day is easier and that you are resting and healing well. Tonight when I was feeling poorly my Hubby brought me a bowl of lemon ice and I have to say it made things a lot brighter. Sometimes it is the little things that help the most.....



I am guessing you are a reader. What was the last book you read? I need a recommendation.



All the best,



Ruby

faithorfear, something like that is also happening to me!  About 3 weeks after my reconstruction, I remember reaching up high for something from a kitchen cabinet, when all of a sudden I felt the most intense pain in my rib ,right below  the center of my left breast. I litterally doubled over from the pain.  For a few nights I could not even sleep on my left side, then the pain just went away.  This past week, out of the blue,   every so often I feel it again.  I try to see if if feels like a pulled muscle, but I can't really tell, but  if I hit the right spot I gasp from the  pain.

I have no idea why it would start again and   I don't think I have pulled anything again.....

Mena, thanks for the bra rec awhile back. I agree the Bali comfort revolution is the best find! Stretchy with a little padding and no sides seams. What a relief as the under armor sports bra I had turned into a torture device after a few hours.



Marcie, glad you're doing better and hope you found someone to help. Did your breast center have recs for a psychologist? I wish more places offered support. We are always here though!



I vow to rest this week. I wore myself out with work/activities this past week and was having ab pain. The compression garment from ps is back on and helped. I have had just quick sharp spasms so not taking meds. Mostly when I've been twisting in car etc. Btw, a friend got me a super soft body pillow which has been perfect for getting comfy on my side at night. Wish I had gotten one weeks ago.



I hope all of you are doing well this week. Even though we're at different stages, it's wonderful to support each other along the way. Have a great week!

@RonnieKay, sometimes radiation treatment is indicated even after MX, if the tumor has invaded the muscle fascia or skin. I had MX largely because of my strong desire not to have rads, but due to the location of my tumor, my surgeon told me she couldn't guarantee I would avoid it, even with MX. In my case neither skin nor fascia was involved so I didn't have to have RT.

Ruby -- 2 weeks out I was (like you) beginning to feel really good -- then I would just completely run out of steam. Allow yourself plenty of rest and do what feels good for you -- spoil yourself a little. I found that propping my arms up on pillows (sitting on the couch) with a good movie provided a great distraction, with occasional naps inbetween. I was careful to eat only things that tasted good -- that were good for me. (Must help the body heal itself by offering it really good nutrition).

I had both BMX and immediate DIEP -- so not sure if our circumstances are paralell... my surgery was Nov 6 -- so I am now about 3.5 weeks out. 

Anyway -- I also had a terrible rash from too tight/irritating bra/binder -- necessitating lots of pain-pills to help keep me from scratching. By the end of week 2 I finally was getting that under control, and able to switch to just Tylenol, which really helped me be less fuzzy-thinking.

Since then, I have felt steadily better day after day... I think the recovery is amazingly smooth and quick -- as long as you take it easy the first two weeks, especially. I was more adventurous with my walks -- outdoors in a field close to the house -- but by end of week 3 I am back out hiking through the woods (carefully, and certainly more slowly than in the past). 

Now you can begin some of those arm-stretching exercises -- a little goes a long way, and they get easier and easier, although I still have complications in my node-removed arm... and that arm is considerably limited in range of motion, as compared to my right arm, which feels completely back to normal. (If one has to be lesser -- I am blessed that it is the left -- and also blessed that at least until now it is only pain/limited range -- without the swelling of LE. My hope is this is muscle/tendon/nerve -- and not the start of LE or Cording (AWS). 

Yesterday Les took me WAY out on the  ranch (very bumpy dirt roads, so I held a pillow to my chest for support) for over 3 hours -- and today I am just fine! We collected pine cones (I want to make Christmas ornaments like a little kid! and we cut down our own tree (well -- I selected and Les cut it down, with a big smile). Then we drove an hour (each way) into town for a real splurge -- pizza and my first beer in almost 7 weeks. What a wonderful day -- and today I still feel great!

My best to you all! (going to go play with my pine cones now!)

Linda