Can Someone Explain The Qualifications For The DIEP Process??

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hanley50
hanley50 Member Posts: 146
edited October 2016 in Breast Reconstruction

Soooo...Very long story short I ended up having a UMX on right with tissue expander (was planning on implant after.) Then I found out I neened RADs. I would not allow PS to fill up TE quickly prior to RADS due to the pain, since after I learned I needed RADs, that I would have to live with that pain for at least 6 months (after finishing RADs.) Right now it is filled only to 260cc (and I am now in the middle of RADs so they can't go up or down.) I know this is not good and PS pretty much told me it would not work out.

I have a consult scheduled for 10/04/16 with a differennt PS to consult about DIEP (he does lots and lots of DIEP), a PS that actually does them as opposed to my current PS (who does not.) I have cancelled all of my appointments with PS#1 and have essentially "fired him" because I didn't feel like he had my best interests at heart when it comes to my health and physical well being.

What are the qualifications for DIEP? After all of this "crap" treatment I am about 50 pounds overweight and all muscle mass feels like it is gone!

When I venture out into google land...I get very "general" answers that are no help.

Since there are so many women here that have walked this path before me...What does one need to do to qualify for DIEP and what questions should I be asking?

I'm not in a real rush since I am still in RAD's and will most likely be going back on chemo after (so no matter what I do it will not be for months!)

Thank you in advance for your incite!

Maryann

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  • ChiSandy
    ChiSandy Member Posts: 12,133
    edited September 2016

    We “women of substance” might relish the thought of a tummy-tuck combined with reconstruction, but the fact is that DIEP is a very long surgery (up to 9 hrs.) involving connection of blood vessels and even nerves. You really have to be in good shape to get through it, and a higher BMI means a greater likelihood of heart and/or respiratory complications that can be life-threatening.

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  • hanley50
    hanley50 Member Posts: 146
    edited October 2016

    Hi ChiSandy! I am defintetly "a women of substance" (lol) and I saw my new PS today and got my answers!

    My radiated foob with tissue expander is in bad shape! I finished RADS 09/26/16 and didn't really notice anything too bad with my skin or TE at the time, but over the past week - WOW - I've turned red, purple and even almost turning black in some places and I am really peeling all over my foob and under arm (and my back where the RADS past through!) The TE is visably distorted and hard as a rock even though I am only filled to 260 ccs.

    My arm is killing me and the sleeve my LE therapist ordered for me I swear does not even fit anymore due to swelling.

    Needless to say when the new PS saw this he said implant is no longer an option. He said due to skin condition, capsular contraction and scar tissue it's not going to work.

    He was amazing! He spent almost 2 hours going over every available option with me and my husband, even the options that would not work and explained why they would not be an option due to radiation (nothing like PS#1 who had a one track mind on TE and implant only.)

    He went over the differnent types of reconstruction and the pros/cons and possible complications of each one. It was a real education. He also said I did not have to lose any weight if I didn't want to (but I do want to so I will!)

    Other thing I really liked about him....He is not just a "cosmetic" plastic surgeon. Breast reconstruction is what he does. He had a conversation with my BS and had already reviewed my records before I got there and talked to me about my TNBC and could actually carry on a converastion about my "predicament."

    A second opinion was exactly what I needed! I wish I wouldn't have been so scared and slowed things down a bit a few months ago, but I can't change the past. Just keep moving forward.

    On the downside....he will not do lift/reduction on the other side at the same time (same as PS#1) which means more surgery after. It is what it is (I am slowly learning patience!)

    So in oder to qualify for DIEP (in my situation) you just need to have breast cancer, enough fat on your body and of course good insurance

    Maryann

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  • NancyHB
    NancyHB Member Posts: 1,512
    edited October 2016

    Hi hanley,

    Sorry to hear about your post-rads skin changes, but unfortunately that's pretty standard. My skin continued to darken and flake for a couple of weeks post-final rads; eventually my nipple turned dark brown/almost black and peeled for weeks. Afterwards, though, my breast looked almost normal.

    So glad you found a surgeon you like who was helpful and informative. That makes all the difference in how we get through this surgery.

    I had my Stage 1 unilateral DIEP on July 21 (four years post-rads after I had a local recurrence and couldn't do radiation again). DIEP is usually done in "stages", and believe me, you'll have enough surgery during the first stage (MX and tummy tuck/tissue transfer to breast) that you won't want to also be recovering from a breast lift. Now that I'm 2.5 months out and my breast is starting to settle, my PS can lift and sculpt my other breast to more closely match my DIEP breast, so I'm glad it's not done simultaneously.

    Good luck and j hope you heal quickly!!

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  • hanley50
    hanley50 Member Posts: 146
    edited October 2016

    Hi Nancy - Glad to hear you are almost at Stage 2 in the DIEP process! PS said basically what you said....the initial DIEP is going to be enough to recover from. This is such a long process no matter which way we turn. Yes, I just want it all done now, but that's not realistic. I'm learning...this stinks! When I was initially diagnosed I was given an unrealistic time line of how long this would go on. Oh my!

    How much longer until you will be able to move forward to Stage 2 for the other breast? Soon I hope!

    Maryann

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