DIEP question

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Trvler
Trvler Member Posts: 3,159
edited February 2015 in Breast Reconstruction

I can't really get a feel for this but do most people have this at the same time as their mx or later on?

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  • besa
    besa Member Posts: 1,088
    edited February 2015

    Trvler- Generally there is a better cosmetic result when a skin sparing mastectomy is done (preserves the skin envelope of the breast) and DIEP reconstruction is done at the same time. What a woman does depends on her circumstances and many woman do, of course, have delayed reconstructions. There are also other options that will also preserve the skin envelope - a skin sparing mastectomy can be done and then tissue expanders put in place to preserve the skin envelope and then at a later time (and this can be after treatment) the tissue expanders are removed and the DIEP reconstruction is done. Or sometimes a woman can have a lumpectomy, go through treatment and then have a mastectomy and DIEP reconstruction later. You would want to talk to your breast surgeon and the plastic surgeon that will be doing the reconstruction down the line to see if this was an option.

    http://drmarga.com/burn-no-bridges.html (This is an explanation of tissue expander placement with future DIEP, there are other ps who will place tissue expanders in with a future planned DIEP)


    Another good place to get answers to microvascular reconstruction questions --you could post on Dr. Dellacroce's (a very experience New Orleans based microvascular ps, he did my sGAP reconstruction), "Ask the Doctor" web site. You can look at past questions other woman have posted and also have your own questions answered.

    http://members.boardhost.com/plastic/


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  • Trvler
    Trvler Member Posts: 3,159
    edited February 2015

    Thanks, Besa! You are always helpful. I just am so afraid of making a decision that I can't undo that I am stuck and petrified of moving forward with ANYTHING.

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  • besa
    besa Member Posts: 1,088
    edited February 2015

    Nice to feel I am helping :-)

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  • debiann
    debiann Member Posts: 1,200
    edited February 2015

    I had the lumpectomy first, because I couldn't make up my mind about mx. Then I had chemo and researched my choices. A few weeks after chemo I had a bi-lat mx with immediate DIEP recon. 

    What was expected to be a 9 hour surgery turned into 13 because there was a problem getting the blood flow to one flap. After surgery they check you frequently with a doppler to hear the blood flow. They couldn't pick up any sound on my right side for a couple days, but the color and tempetature were good, so they weren't worried. Of course I was. The third day, when they placed the doppler on it I could faintly hear the sound, "its singing!" I shouted.

    This is such a difficult decision and as you read about other's good or bad outcomes you just get more confused. There are no guarantees with any option and there is no right answer, just the one that suites you best.

    Most consider implants an "easier" option with less recovery time. I truly think I could never adjust to having you that in my body, but before DIEP the PS did ask me what he should do if he could not get blood flow during surgery, did I want to be flat or should he place a tissue expander. I agreed to try the TE. I'm so happy this wasn't necessary.

    Have you meet with a PS to discuss if you are a good candidate for DIEP? At first my PS thought I had enough fat to get me to a B cup. I laughed, "I have more fat than that!" In the end he was able to make two nice full C cups. It is so wonderful to not have my belly anymore! I look better, feel more energetic and I can move better. I started excercising and eating healthier because I never want to grow that belly back. Cancer sucks, especially the chemo, but for me, this recon gave me a little boost of confidence that I can get healthy and fight back.


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  • Trvler
    Trvler Member Posts: 3,159
    edited February 2015

    I know what you mean, Besa. I am convinced it will become my job when this is over to help other people going through it. It is because I sooooo appreciate the help of people like you. I feel like it's my first day of kindergarten when it comes to BC.

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  • dlb823
    dlb823 Member Posts: 9,430
    edited February 2015

    Trvler, I had mine at the same time as my mx, but it seems like there are benefits to doing it either way. I was thrilled to get it done at the same time as my mx, but I have noticed that women who do it later may sometimes have a bit of an easier time with it. That's not any kind of formal research -- just something I've observed from watching so many women go through it here on BCO. It just seems like women who delay doing it until after they're done with everything else, often seem to sail through it with extremely fast healing, vs. my situation -- with a top PS @ UCLA -- but a small complication w/just a bit of necrosis that required debriding that meant a delay in starting chemo until everything was totally healed.

    Whatever you do, just be sure you use a PS who has done a lot of DIEP surgery and is also a micro/vascular surgeon. This is not a surgery for a general PS who is may not do them on a regular basis. Also, using a PS within a comprehensive medical facility (as opposed to coordinating with one who is not) will ensure that everything about your dx and tx is looked at and properly coordinated for your situation and needs. (((Hugs))) & good luck! Deanna

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