Right DIEP Flap survived / left DIEP Flap failed. NEXT STEPS....

Options
naiviv
naiviv Member Posts: 535
edited October 2014 in Breast Reconstruction

Hi,

On 5/21 I had my DIEP Flap recon, surgery. My right side survived and my left one died due to blood supply issues on my chest. It was hard to wake up with just 1 breast and a concaved twin. It has taken a toll emotionally on me.  I am trying to get back pro actively and planning next step. It is probably still 2 months away at least.

I now face, what to do next and I need some help with your experiences please. My PS is saying  he'll take skin and fat from back and use an implant. to create left breast.  Not sure how I feel about 1 implant. How will it look compared to the flap breast? If I lay down will they both react the same? I may be sounding petty and vain, but I would like as close  a match set in looks and movement as I can get.

I would love to hear from persons who have different flaps and from those who have one implant. Also if you had implant and went to flap or vice versa. Please share your experiences with me.

Thanks,

Vivian

· Share on FacebookShare on Twitter

Comments

  • gale1525
    gale1525 Member Posts: 232
    edited June 2014

    Hi Vivan, I have an implant and a DIEP flap. The flap is nicer than the implant it looks and feels more natural than the implant.  My surgeon did a great job with size the implant is almost the same  level as the DIEP. My primary doctor had to ask which was which. When I lay down there is not much difference. Mine are a small c-cup they are not really big. I had had two implant's but had implant failure due to rads. I didn't have enough stomach for two flaps (or they would have been really small). I could have gone back and got another flap but with my job it is kind of tough. If could could have done it I would rather have two flaps. Have you considered having a flap from some where else on your body? Maybe you could consult with the NOLA doctors you can send them pictures and they can tell you if they think they can do another flap.(no charge at least there wasn't for me). If you would like you can p.m. me and I can send you pictures of mine.

    Good luck with what ever you decide. Lynda

    · Share on FacebookShare on Twitter
  • naiviv
    naiviv Member Posts: 535
    edited June 2014

    Lynda 

    Thanks for the response.

    My problem is the left chest blood flow, I had enough fat for two , but my veins were no good due to multiple infections and chemo. Most flaps need a blood supply to survive. 

    I don't know if my ps brings lat flap to the front and it brings it's blood supply could they stack another flap and use the flaps blood flow and not my chests.

    Yes I will pm you and thank you 

    Vivian

    · Share on FacebookShare on Twitter
  • jbdayton
    jbdayton Member Posts: 700
    edited June 2014

    A lat flap does bring the blood supply with it.  Is it a possibility to do a lat flap and fill with fat grafting instead of implant?  I really don't know that answer.  

    I had only one successful flap with my DIEP and PS wanted to do lat flap and implant as well saying he could make it look really good.  I am like you and did not want an implant.  The difference is my bad veins were in the stomach fat not behind the rib bones.  I wish they could find you an artery and vein in the chest area but if there are none then ask for other options than an implant.  

    I would try checking with NOLA or PRMA as a consult for ideas if your PS has none.  

    Best of  luck getting information.  I know the disappointment you are facing.  

    · Share on FacebookShare on Twitter
  • naiviv
    naiviv Member Posts: 535
    edited June 2014

    jb

    thank you.

    Ill ask about the grafting. I will meet with ps in July and I will go with all questions. I have not had the energy to question him up to now.

    I had 38dd before and my flap once it is shaped (still kinda wide and squarish) looks to be big enough for c/d. I had wanted my larger breast again to fit my body size. I am 5'10  and size 16/18 working towards 14 but I still have the broader back and chest with hips to match. I am willing to go smaller if I can avoid implant. But I need some projection to balance my body type.

    Once I get info and answers from my ps, I will check out the NOLA anf PRMA sites , I had thought  that maybe if lat flap had it's own supply of blood, could they stack another flap to that blood supply.  Or possibly wait to see if  veins can heal or regenerate or if vein grafting is possible???

    It was very hard to wake up and see my chest, I had such hopes of breasts again, it still is, but I gotta shake the blues so I can get assertive with these doctors and ask away until I get answers.

    I am also blessed to be here and have the immense knowledge,ideas  and experience base of all of you.

    Vivian

    · Share on FacebookShare on Twitter
  • besa
    besa Member Posts: 1,088
    edited June 2014


    Just my thoughts on this-- I, as Jdayton suggested, would strongly consider going for a 2nd opinion to NOLA (or possibly PRIMA).  Get their very experienced take on the status and availability available of blood supply and their suggestions on how things should be handled. Then decide what you are going to do.  (The extra experienced opinions could possibly turn out to be a game changer.)

    · Share on FacebookShare on Twitter
  • jbdayton
    jbdayton Member Posts: 700
    edited June 2014

    I ran across an article talking about flaps being done using some veins from under the arm.  It was in reference to saving the internal mammary artery for heart bypasses.  I wonder if there is a set of artery and veins in your underarm that could be used.  Just a thought, no promises.  I hope this web link will work. 

    http://www.ncbi.nlm.nih.gov/pubmed/21921733 let me know if this doesn't work and I will get the article title.  

    · Share on FacebookShare on Twitter
  • jbdayton
    jbdayton Member Posts: 700
    edited June 2014

    here is a link to this topic being discussed in this discussion board.

    https://community.breastcancer.org/forum/44/topic/...   Hope this helps as well.

    · Share on FacebookShare on Twitter
  • BlueFox
    BlueFox Member Posts: 99
    edited June 2014

    There seems to be several different (related) strands on this thread.  My understanding is as follows:

    For free flaps (eg flaps from distant parts of the body) you need a blood supply to plumb the free flap into.  Normally there are 2 choices:  Intramammary  blood vessels (near the middle) and the blood vessels under the armpit (I forget what they are called). There are pros and cons of the different choices, but If one isn't good enough they can normally use the other.

    For my DIEP flap my PS was going to use the ones under the armpit, but they weren't good enough (due to damage from radiotherapy) so he used the IM ones.   So if Vivian's issue is the IM blood vessels, could the armpit ones be used?

    There are other flaps that don't need to be plumbed in (called pedicled flaps) eg LD flap and some other smaller ones (eg TDAP flaps).  These stay attached to their original blood supply.  

    So if neither the armpit or the IM blood vessels are good, the alternatives are normally pedicled flaps or fat injections or implants (or some combination).

    I lost a big chunk of my DIEP flap due to inflection, and I am looking at one of the above to fix it.  I don't want a LD flap as I don't wish to lose a big muscle in my back, but either a TDAP flap or fat injections might be ok. I believe the problem with the fat injections is that sometimes lots of the fat just get absorbed so they are not so good for big defects (which I have).

    I would be very interested in the views of others who are looking at further surgery to fix big defects in flaps.  

    · Share on FacebookShare on Twitter
  • naiviv
    naiviv Member Posts: 535
    edited July 2014

    mside,

    Thank you, I have been considering all the things that you mentioned.

    V

    · Share on FacebookShare on Twitter
  • naiviv
    naiviv Member Posts: 535
    edited October 2014

    Hi, I thought to come back and update  here as I was so devestated when I lost my flap. It has been several months and I opted  for a lat flap. I had it done in August. I just had some fat grafting and tightening done to match my diep.  I am extremely happy and content with results.

    I have been posting in the DIEP 2014 and Latissmus Dorsi threads so you can follow my journey there, but if you find yourself with a loss of flap and come here I have this thread saved and I'll do my best to help you.

    I really hope none of you ever have to find this thread.

    Vivian

    · Share on FacebookShare on Twitter

Categories