DIEP flap with a little muscle-sparing TRAM?

Hi, I probably won't be much help to you because I haven't had the DIEP yet but I'm also doing it with Dr Choi in a few months time. The DIEP was recommended by a friend who had it (at a different hospital) and had more than a little muscle taken. It was several years ago and she has no weakness or movement restrictions at all. She did say it was extremely painful for the first few days because of the muscle being cut but she's very pleased with the results and the recovery was fairly fast.

Dr Choi did tell me that there is a possibility of muscle being taken depending on where the blood vessels actually are in the abdomen (haven't had the CT angiogram yet). Incidentally we might have crossed paths in her office on Friday (had to wait 1hr and a half as she was running late grrrr)! She did my tissue expander placement 2 weeks ago, so far I'm happy with her and NYU though it was a bit of a battle with the nursing staff to get an adequate pain med schedule right after surgery.

I wasn't too happy about the wait on Friday because I was only a week post op with discomfort, drains etc. Something went wrong with their scheduling and she assured me this was not a common problem.

I wanted BMX with immediate DIEP, but both my surgeons advised against immediate DIEP because I likely need radiation and that can cause the flap to shrivel on the cancer side and it's hard to fix. I was told I would get better cosmetic results using a tissue expander to create a pocket for the flap to go rather than just having the mastectomy with the skin healing attached to chest wall. For the non cancer side that doesn't need radiation, I will have mastectomy and DIEP (both sides) at the same time.

NYU does have a 24-hour visiting policy. I didn't get a single room because my insurance doesn't pay for it but it was a 2-person room with our own bathroom. Very small space though, hard to navigate the IV pole, table, personal effects and visitors chair. The visitors chair doesn't recline so be warned its not comfortable for a visitor to sleep. It is permitted though as long as the roommate is ok with it. I was on my own at night and night nursing staff was wonderful and very responsive at any time of night. Your experience might be different though because after DIEP your room has to be at high temp to maximize blood flow to flap, so I'm not sure you'd have a roommate. You will get a call from a hospital nurse a few days before the surgery so I would ask then, because they do have single rooms, so maybe you can request it. Food is great by the way.

Pain meds: both surgeons warned me just before the surgery that the nurses will give me any pain meds I need, but you have to ask for them. They ask you on a scale 1-10 how much pain you're in and adjust meds on that basis. Nurses told me you have to say at least 4 to get decent painkillers. More than 7 will get you really good stuff like IV morphine or fentanyl. The problem I had was they don't use a schedule of automatically giving you pain meds every so often so you can stay ahead of the pain. For the first day I had to wait for pain to come back, then ask for meds, they would give me several different ones that worked great but all wore off within 2-3 hours and then for safety reasons I had to wait a certain time for the next dose.

The second day I summoned various doctors including the pain attending physician and asked them to come up with a schedule where they stagger the meds so there is always something working and they don't all wear off at the same time. I asked for the list with times and intervals written down so I could track it, I asked them to give me the meds on schedule without me asking and to wake me up at night if it was time for a dose. That worked wonderfully, I just had to learn the hard way how to navigate the system.

I wouldn't worry, I think they learned a lesson that not all patients are equal and they've really tried to make up for it. Today they put me in as the first patient (still with drains, which came out, yay!) so I was guaranteed no wait. It was obvious from even the nurse and office staff that word had gotten around and they were all really considerate. Any other time I wouldn't mind waiting and certainly having a post op patient go ahead of me.

I doubt you'd have a problem with a roommate. Each area of the room is curtained off so as long as your visitor isn't planning on watching TV or listening to loud music at night you'd never know there's someone else there.

With a DIEP the stay is longer so you get a pain pump, but they will want to wean you off that before you leave. One more thing: bring with you a stool softener like Colace and laxative like Miralax or Milk of Magnesia. The pain and anti nausea meds cause constipation and you really don't want that with an abdominal incision.

Best of luck for your surgery! When you're home and recovered I'd be very grateful if you message me and let me know how your experience was.

I hear you, I've been doing it by taxi as well. Drains and subways don't mix. How many nights do they say you will be in the hospital and how long after do they do your post op visit?

Trust me if you could see the hideous monstrosity I'm looking at in the mirror after mastectomy and before reconstruction you wouldn't waver. I get through every day knowing this is temporary and the DIEP is going to give me back some nice soft boobs of my own tissue AND as a bonus get rid of the belly overhang. It won't be perfect straight away but they can fix pretty much anything in the next stage. I chose it because I'm young and although it's a hard surgery upfront I want to get this all over with now and don't want to have to deal with the many complications and additional surgeries that come with implants. Of course this is all premised on the fact that the boobs have to go because of the cancer, so this is the best out of several bad choices. Have you had mastectomy already or are you doing it at the same time?

My therapist (who had DIEP herself) says the surgery is much easier than what I'm fearing. Dr Choi has done hundreds of these over decades and she's only ever seen 1 flap failure in her career. And she says NYU has a great setup for monitoring post surgery so if there's any problem they'll take you right back in there and deal with it.