Cancer in DIEP Flap?

Andrea, I know reconstructed breasts are prone to cysts -- at least that's what showed up and was dx'd when I had an u/s locally for something that felt concerning.  As it turned out, my problem was an area of fat necrosis that my PS @ UCLA quickly took care of, but I know from the experience that my Diep breast had several cysts in it, too.

Is the doctor of facility that did your recon actually the ones doing the u/s?  I think that's important b'cuz, in my case, the local u/s rad (who is excellent, by the way) didn't fully understand about fat necrosis in a Diep and didn't fully dx my problem.    

Hopefully, your new lumps will be one of those two things, but yes, I think a new bc lesion could grow behind the Diep recon or directly under the skin where you still have some original breast tissue.    Deanna

My PS and my onc told me that you can't get cancer in the flap; its made up of fat and I guess you can't get cancer in fat tissue.  They don't even do a mammogram on that side . . .

Agree with Tammy, AND you can also get a cancer just under the skin in what little breast tissue might be left over (not the flap skin, but your original breast skin - whatever is left of it). BUT, your chances are much, much less since you have had a mastectomy!

Andrea - just so you know, I just went through a similar situation last week - lumps in my hip flap reconstruction... went for US and they were all (and there were more than just the 1or 2 that I was feeling) oil filled cysts - that used to be fat necrosis. My radiologist did not recommend biopsy but said to keep an eye on them and possibly re-US in a year.

Would I worry? Well, I would tell you not to, but that would be hypocritical of me. I think that it is much the same as the initial breast cancers... only 1 out of 8 are positive... but when you are that one it is a big deal. I also think most of these lumps in reconstructed breasts are benign... but when someone turns out to be that one person that isn't, it is a huge deal. So, here is what I say, TRY not to worry because it doesn't help change anything, prepare yourself just in case, but hope for the best! And we will all be here cheering you on!

Does anyone but me get mammo every year (or ever) on your DIEPs? I just switched radiology centers and they called yesterday (mammo was today) and told me they don't "do" mammos on trams (read DIEP). I told them that because I am a cancer survivor the previous center would only do diagnostic mammos so we settled on that I would get a screening only and they got it approved by my prescribing doc. My PS who did that bilat DIEP also said yearly screening would do no harm but the radiology place said that I am subjecting myself to more radiation that is necessary hen you have belly fat!

Sorry for the long post, but does anyone else have mammos on their TRAM/DIEP foobs?

Happy Holidays! 

Nobody has recommended this to me... yet anyway. However, I went to a conference where the woman who spoke recommended yearly or every other year MRI's of the breasts/flaps.

"My PS and my onc told me that you can't get cancer in the flap; its made up of fat and I guess you can't get cancer in fat tissue"....

I fully dis-agree with the above statement. I personally know 2 women who had flap procedures and later developed BC. Rare, certainly yes, but happened to these women who both shockingly had prophylactic mastectomies to reduce their risks, one was 2 years out and the other was 8 years out from her surgery. You can learn more about their devastating journeys thru www.facingourrisk.org  Both women have fought back with amazing strength, determination & courage...true warriors to say the least.

Well, ladies - Earlier this year I had a lump in my tram flap needle biopsied after I was told for three years that it was fat necrosis. It was cancer. There was one good size lump and several small lumps. Had two surgeries to the reconstructed breast to get clean margins. I have had mamos on the tram for several years, they just kept telling me it was nothing to worry about. Finally my surgeon did the biopsy even tho he too thought it was nothing. 10 years after the original dx, almost exactly. Now I am on Aromasin and was told I am cured by my new oncologist..........

Karen- was your lump/cancer on the edges or deep inside the flap?  I was told to carefully examine the edges, since that is where any future lumps tend to be found.  

Hi Lisa,

I started with Dr. Prati at UCLA as my BS, but she had to take pregnancy leave before my mx and I switched to Nova Foster.  She is having me do yearly mammos and MRI, but staggered so that one or the other is being done every six months.  I'd actually like the u/s, as my original cancer was not seen with a mammo.

Deanna - I'm nervous about the mammo on the DIEP.  I really don't like the idea of squishing it, I've been treating it pretty nice since my surgery last May

I see that both Lisa and Deanna are HER2-, so maybe the different in my follow up is b/c I'm HER2+ ?

Sue

wow...i am starting to think this might be more common than i thought.....i just went through a scare also, had an area of concern,,,ps, and bs did a mammogram and an ultrasound, and confirmed it was fat necrosis, but, the bs told me, although it is rare .... it can happen. 

Andrea,,,,we both went to dr gray, and dr rebecca at mayo.....i dont know if you remember me, but you had just had your diep when i was dx.....and you were sooooo very helpful in calming my fears....thank you......i finally had my diep mar 8th...still going through some revisions...i hope all turns out okay, and if your interested, we have a great group of gals who meet monthly,,,we will be getting together jan 8th...if you want more info, send me a pm..... hugs to you!!

karen

Hello ladies,

I haven't posted in quite awhile.  Original dx was 2001, and reoccurance in same (rt) breast was 2009, which then prompted me to have bilat with diep. First was er/pr+ with just lumpectomy and rads, second time was er/pr- and her2+, so i had herceptin and chemo that time.  Fast forward to 2013.  I still have spots of fat necrosis, and lymphedema in right side, so just keep an eye on it.  However, I have noticed over the weekend, two "spots" that feel like bb's-small, round, hard.  Both my previous dx's were done by mammo, so i have no idea what it actually "feels" like.  I have emailed the Center that did my reconstruction, though they are in a different state.  I am not sure who, or if I need to see someone on this at this point?  Suggestions anyone?

talked to my onc and saw him today.  Having ultrasound Friday.  He says he does not think it is anything, but even if the ultrasound does not indicate any action now, we will keep an eye on it. Feel some better after seeing him.  I do have a lot of faith in him.

well, had the ultrasound.  radiologist thinks it is scar tissue, but will have to see what my onc thinks.  may redo ultrasound in 3 months. at least feeling like i can breath again.

the girl doing the u/s said i had both cyst and areas that were not cysts (not clearly fluid filled)...I am waiting to see what my onc says.  those are the ones that the radiologist said he thought was scar tissue, but i don't know how scar tissue develop after 4 years?