Where do you gain weight/fat after diep flap?

I would also be interested in the answer to where the fat goes when you gain (or lose) weight. I forgot to ask my PS that question when I had my DIEP consultation. He did tell me that liposuction would be necessary to make my waist defined and that insurance won't pay for the lipo. I'm post-menopausal and have that post-menopausal belly.

I went ahead and had a UMX w/o recon because I didn't (yet) feel comfortable going with DIEP. I am considering having DIEP in the future.

Yes, you will gain weight and lose weight in your bust like just as anyone would who gains or loses weight.

Hi,

Had died flap surgery almost five years ago. Everything went very well. Now as time is going by my breasts are getting larger and larger. Almost to the point where I would love to have a breast reduction. They are huge and very heavy. Look amazing and very real. The only good thing is that my belly is totally flat. No weight gain there at all.

I'll see if I can answer the questions throughout this thread...Fair warning-it's a little Long but it is thorough:

If you usually gain weight in your tummy will your new DIEP breasts gain the weight or will it still go to the tummy?

The harvested fat has a memory. If you're a pear shape where you gain weight most noticeably in your lower tummy/hips, your breasts will now gain that weight. You'll still gain weight other places as well, but most moticeably the breasts. If you're an apple shape it will likely be a little different than for pears because apple shape gains from upper abdomen to lower abdomen where pears typically gain lower abdomen with upper abdomen being flatter/smaller. So an apple shape would likely have somewhat of a 50/50 - 70/30 split between the two areas. *See the 'boxy' section below*

On the flip side you will also lose weight the same way. Additionally if your tummy was where you lost /gained weight noticeably first, you'll now lose/gain noticeably in your breasts first. Maintaining your weight after stage 2 DIEP is very important. If you do lose weight you can always go back in for a little nip/tuck that should be covered by insurance.

Will I look boxy and have a scar around my middle?

After stage 1 DIEP, the answer is not necessarily. After stage 2 DIEP the answer should be no. In stage 1, the goal is do mx (if needed), harvest the fat, and transplant it to the chest wall creating new breast mounds. after they've removed the swath of skin and tissue from your abdomen the will pull/stretch the skin back together. This is what gives you the boxy shorter waisted look after stage 1. Ideally the scar should sit low on the abdomen so that it can be easily hidden under a bikini bottom (and not one of the high waisted ones either). Sometimes they place it low from the start, sometimes they lower the incision line in stage 2. It's important to ask this question during your consult.

During stage 2, your PS should recontour your lower half. This in addition to a lift on your new breasts helps restore a natural breast to waist to hip ratio. Additionally, they will do some light lipo across your abdomen (upper and lower) to help reduce any uncomfortable tightness you may be experiencing. For women who have the apple shape, they can do more aggressive lipo And something called plication in the waist area to recontour it to your preference. It's important to also ask about this during your consult.

And they should be able to get all the recontouring procedures for your lower half covered by insurance. It's important to ask about this too.

*Note that not all PSs agree with recontouring your lower half - their thought process is, 'you have boobs now and this is breast recon not a total makeover. Hit the gym!' The problem is hitting the gym does not fix the short waisted/boxy issue or correct the new breast to waist to hip ratio that's out of whack and can cause your pants not to stay up. The new shape is a direct result from the recon and correcting it should be too. Not all PSs know how/want to know how to get it covered by insurance so they either don't do it or have you pay out of pocket. The reality is, the new bottom shape is a direct result of reconstruction which is covered by insurance so insurance should and will pay for recontouring it. If your PS is committed to superior quality outcomes for you as a whole, not just you and your breasts, none of this should be an issue.

What will Tamoxifen be like? Will it create new fat cells?

Everyone's experience with tamoxifen is different. Some have horrible side effects, some have mild or no side effects. There is no way to predict it. The only thing you can do is try it and see how your body responds. You can also research different methods to deal with any SEs you may have (ie Curcumin supplements for joint pain & hot flashes). We all get BC at a different point in our lives. I've seen where many women who are in their 60-70s say they're discontinuing their anti-hormonal due to severe SEs after they've tried them all and tried to alleviate the SEs with any and all suggestions given to them. They usually also state that if they were younger, in their 30s or 40s or even 50s it would be different and they would continue to take them because they still would have decades more potential years ahead of them vs at their current age.

Not everyone gains weight on tamoxifen. It's not like a steroid where you just blow up really quick. You also have to look at menopausal women from an age standpoint too when trying to compare. The older we get we tend to not be as active as we were in our 20s, 30s, 40s. Active = burning excess calories. Not as active and eating the same = weight gain thru excess calories. Plus our metabolisms start to slow significantly starting at around age 30. This means our bodies don't burn as many calories just to function (heart beat, breathing, etc). This also results in excess calories. All those excess calories result in weight gain. As a younger woman taking tamoxifen all of these factors apply somewhat but are still quite different than someone who older than you.

New fat cells are not created because of menopause or because we're on an anti-hormonal. We are born with a set number of fat cells (granted they are very small and usually quite deflated). Those fat cells grow larger over time. They have a huge potential for growth. That's why once removed by lipo or surgery or freezing them literally til they die, you don't gain weight back in that area again. The only way we get new fat cells is when the original fat cell grows beyond its capability and (for lack of a better layman's term) splits in half creating 2 chat cells that can then grow. Again, a fat cell's capacity for growth is many times it's original size. And the splits usually occur when you hit the mid to upper end if the obese range.

What's the point of going through all this reconstruction crap if it's not going to make me feel better? Maybe I'm asking too much...

You are NOT asking too much. You should be able to honestly say you are happy with the results you get thru recon (not just happy considering you had BC and mx) or even thrilled with the results - you deserve it. Finding the right PS is a huge part of this. Ask your questions plus the ones i posted above in my comments. If you're not hearing the right answers move on to the next PS. If you're investigating a DIEP or SGAP flap, be sure you're only discussing your candidacy for the procedure with a plastics microsurgeon who does the procedure. A PS who does not do those types of procedures will almost always tell you you're not a candidate for it or you won't like the results. It's not in his best interest for you to go somewhere else to have your recon done. And he is not trained to even evaluate you for one of the flap procedures. It's like asking the butcher in the grocery store how to select a ripe cantaloupe. When you do start doing consults with PSs who do DIEP/SGAP, be sure to look at their before & after photos. Make sure they are photos of their work and not their partner's work or someone else's. If no pics, cross them off your list and move onto the next DIEP PS. If you look at their pics and wouldn't be thrilled to have the results you're looking at for you, cross them off your list and move onto the next DIEP PS. Don't think your outcome will be any better than what you see in those photos-odds are the photos are of their best work.

Keep in mind that the vast majority of women travel for their DIEP or SGAP recon. Even with major nationally recognized teaching hospitals with cancer centers that have gotten every award imaginable that is right in your backyard, they may not have DIEP surgeons or may not have good outcomes. It's not the size or prestige of the facility, it's the skill of the surgeon and whether they are committed to superior quality outcomes. The more DIEPs they do, the better their skill gets. The more committed that are to superior quality vs just average quality outcomes, the more attention to detail/incision placement/recontouring they will have. They will also have flap failure rates well below the national average of 10% and they will have low infection rates (<2-4% is ideal).

How do i know so much about this topic?

I am a HUGE researcher. I've researched this procedure and many of the centers that do them from just about every angle you can imagine. And I've had BMX with immediate DIEP flap recon done. I chose The Center for Restorative Breast Surgery in New Orleans (aka NOLA on the BCO boards). I Traveled there from NC. I was worried about traveling, but in the end it was not a big deal. I am thrilled with my results. The results you see in their online before & after photos are the real deal - I'm living proof. (Link to their before & after DIEP flap page is at the bottom of this post.) I recently had the opportunity to compare my before photo with my 6 months post stage 2 photo and I look better now than I did then (and I looked pretty darn good then.) I can and do wear a skimpy bikini no problem, all the scars have faded nicely, the short waisted look from after stage 1 is no more, I don't have to wear a bra (but I do because my nipples still respond to cold), I can wear a non-underwire comfortable short cami style bra no problem and look like I did before wearing a push-up underwire, I do not get stares in the locker room at the spa when I'm changing-no one can even tell anything was done unless they look really closely (which in normal everyday interaction no one is that close where they basically have their face within an inch of my breasts/bikini line). Bottom line: with a highly skilled DIEP/SGAP Plastic Microsurgeon who is committed to superior quality outcomes, you can be truly happy or even thrilled with your results. I hope my answers have been helpful! I am happy to answer additional questions and/or communicate 1 on 1 if you would like

https://www.breastcenter.com/result-photos/diep-photos/

Dear SantaFeNM,

Welcome to the BCO community. Thanks for reaching out and sharing your story. This particular topic has not seen activity since May. That doesn't mean others will not see your post and respond but if you don't get a timely response you may want to start a new topic. Let us know if we can be of help. The Mods

I love your reply. I had my surgery done in Mount Pleasant, SC and my surgeon was assisted by one of the surgeons from New Orleans. Question since you seem so very wise on the topic. Have you heard of intestinal issues after DIEP? I’m nine weeks out and have been having horrible gas pains that wake me up at night. The pain feels like an ovarian cyst. Same pain and location. I no longer have ovaries. They hit me at night and almost bring me to tears. If I wake up and take some gas x and message the area to release it, I can get relief.

Sincerely

“Boxy Waist”