Diep/bs and ps.

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Justmarried
Justmarried Member Posts: 3
edited August 2014 in Breast Reconstruction

does your BS have to prepare you any way depending on which kind of procedure you decide on.   I'm so confused.  I have to have radiation after my right breast is removed from invasive cancer and tumor.  I had to stop the first round of chemo after 4 treatments instead of 12 and started on 2nd half of treatment plan with red devil chemo and am going into surgery in 2 months.  My BS said we are going to use your stomach  to rebuild your breast. Said he does this all the time.  I like him a lot.  Dr Creely in Metairie. I was sent originally to stollie but although I heard he was the best he was out of network and I was not happy with his bedside manner.   He was just plain rude. My husband was with me and if we had a different Bs felt like we could have handle this situation a bit better at first.  Anyway my BS said we can rebuild using the stomach.  I figure this is diep?   Sorry I'm so new at this and doing all the research I can.  Some things are good and some or bad.  Mainly when your BS had to remove your breast does any preparation have to be done depending on the proceedure?   Also. I looking into PS now.  My BS will give me some names and numbers. Oh and even though I'm not having the other breast remove I though my BS said he can use my stomach also to tweek the other breast. Is this true or is he confused and is going to take the other breast off that I don't want removed.   Lol.  I better get my shit together.    

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  • dlb823
    dlb823 Member Posts: 9,430
    edited August 2014

    Justmarried, if they use only the tummy tissue, not any muscle, it's a Diep flap procedure.  If they also take muscle, which until a few years ago was the common way to do it, it's called a Tram flap.   Not all plastic surgeons are qualified to do Diep surgery, which is the preferable method now.  They must also be vascular surgeons because they actually reconnect blood vessels when they move the tummy tissue.  Be very careful about choosing a plastic surgeon.  Be sure they have extensive breast reconstruction experience and also extensive experience doing the specific type of surgery you will be having.   This is not a job for a general plastic surgeon whose breast experience is primarily breast enhancement.  

    I think (not 100% sure) using some tummy tissue to tweek the other breast would possibly be a fat transfer procedure, where they use a needle (sort of like liposuction) to remove fat from one area and add it to another area.   I haven't heard of doing a Diep plus a fat transfer to the 2nd breast in the same procedure, but perhaps others have and will comment.

    When I had my Diep, my BS and PS worked together and did both procedures (mastectomy + Diep) at the same time (7.5 hrs).  This is often the benefit of going to an NCI-designated or major cancer center, because the BSs & PSs work together or in tandum all the time.  If you plan to have your reconstruction after you've finished your radiation, be very sure that the PS you choose is comfortable working on radiated skin; many are not.  You will also have to wait several months after radiation.  And be sure your BS and PS communicate about what needs to be done during your mx if you will be having delayed reconstruction.  

    Hope this helps.  (((Hugs))) and good luck!    Deanna

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  • NatsFan
    NatsFan Member Posts: 3,745
    edited August 2014

    Justmarried - it's good you're doing your research now. 

    I was originally going to have an immediate DIEP, but I came up with a
    positive node, and there was a possibility of radiation. The PS
    preferred to wait on the DIEP until after radiation.

    Therefore, my surgery was changed to a skin sparing staged DIEP - that meant that I had a bilateral mastectomy, but the "skin sparing" part means that they basically made the incision below and to the side of the breasts, leaving the top skin intact, and sort of scooped out the breast tissue, leaving a lot of skin, which gives a better cosmetic effect in the end.  The "staged" part meant that they'd do the mastectomies first, then do the DIEP after active treatment.  

    The BS and PS worked together for that first surgery.  The BS did the mastectomies, then the PS came in and placed the tissue expanders.  They were placed to keep the skin from healing flat.  I had the TEs in throughout active treatment.  Once active treatment was over, the PS did my DIEP flap recon.  That was 6 years ago.  I am very pleased with my recon.  I have no scars on the top of my breasts at all, and can wear bathing suits or lower cut necklines with no scars showing - most of my scars are under the breasts or to the side, and at this point have healed to a thin white line and are barely visible when I look at myself in the mirror.  I honestly forget most of the time that they are not the original "girls".  

    DLB is right - you need to be sure to get a very experienced PS to do a DIEP flap. I'd started out with a local surgeon who didn't explain my options at all, but just told me what he was going to do. I didn't feel he gave me the information I needed to make an informed decision.  I finally went to a NCI certified cancer center's breast center, and never looked back.  At my first consult, they reviewed my case from top to bottom.  The BS spent a lot of time with me, reviewing my options for lumpectomy, single mastectomy, or bilateral.  The PS then went over all my recon options, from no recon to implants to immediate DIEP to staged DIEP.  They gave me all the time I needed to ask questions, and made sure that I understood my options completely.  I felt that they gave me the knowledge I needed to make an informed decision.

    Read, ask questions, and get a second or even third opinion.  It's a lot better to find someone skilled enough to your surgery right in the first place then to try to fix something that's gone wrong later.  Good luck!

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  • Justmarried
    Justmarried Member Posts: 3
    edited August 2014

    thank you so much for this information.  I have done a lot of my own research because my doctors are to quick and always feel rushed to get out.  NOW I have done enough and decided I do not want the diep.  I want the silicone or saline.  Why was I not explained all the different procedures I don't know.  But refused to go in blind.  Now that I know what I want I will begin looking for a PS to my liking.  I like my BS but still need a PS. I ok with the silicone.  I am a smoker and also don't feel like havering a scar as my stomach is small as I am and will be noticed by me.  I'm glad yours came out good but I have read some not so good stories. They say the silicone is not natural and will not age like I will.  My husband laughed when I said honey when I am old and wringled will you mind that my beast still look great.  Lol.  I don't have to tell you his answer. Why are the doctors trying to sell me on diep I don't know.  I think it's about the money.  Will now I going back to research saline or silicone and look for PS.  I have. 2 months before surgery unless this chemo does not work. Then it's in to surgery when they say go.  I have lots to decide on and not a long time.  Thanks again so much.  

    L

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  • Justmarried
    Justmarried Member Posts: 3
    edited August 2014

    btw I c

    Have to have rad. And cannot spare my nipple because of invasive cancer. I am assuming they can't spare my skin either but will check. I have to have delayed reconstruction and decided to keep my other. Breast  and just have them tweet it.  

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