Tram vs DIEP

I received a bilateral mastectomy in 2014 with immediate reconstruction--tissue expanders and ultimately TEs were exchanged for saline implants. Ever since the process I have continued to have pain in the radiated, cancer affected side. Once the TEs were exchanged I received some relief, but now, I wake up several times a night with significant pain and feeling as thought the implant "is stuck" I have to massage it and eventually find some relief. I continue to have pain down my arm, as well. Now, even slight reaching or movement results in the same pain. The initial PS basically said nothing could be done, that if he went back in, due to radiated skin I could end up worse. The implants also look disfigured, wrinkling, and ripply. After much discussion with my oncologist, she suggested seeking out a new PS to discuss options. I met with one who stated that saline shouldn't have been used and that he would swap them out for silicone, but couldn't guarantee that would help. Second opinion with another PS who initially said swap out the implants, but then after reading my history said to go for a Tram flap using the abdominal muscles and scheduled the surgery for next week (7/20).

I started doing some reading and learned about the DIEP. I was able to get into a consult yesterday with one of the gurus in my area that performs this procedure as has a great reputation. I waited in the waiting room for 2 hours to go in and meet with the PA for maybe 5 minutes, she suggested I should do more physical therapy and "why would I want to put myself through a long intense surgery, when they can't guarantee I will be pain free afterwards?" The PS then came in for a matter of probably 3 minutes saying what do you want to do? Said that he doesn't recommend tram for bilateral reconstruction and that if I wanted to use him I need to go with the DIEP. He isn't able to schedule surgery date until December. He suggested scheduling surgery with one of his colleagues who could get me in sooner and he would assist, since they use two surgeons for the surgery. He then said you can come back another time and talk about it more if you want or if you want to move forward with our practice we can take pictures today. I explained that I lived 2 hours away and wanted to take the pictures in case I went that route. Afterward the surgery scheduler took me back and confirmed his schedule wasn't open until December. When I mentioned what he said about his colleague, she rudely stated 'no, that's not how it works, why wouldn't he just do it himself, obviously if he is this busy he's not going to have time to assist, so do you want to schedule with he or his colleague." I mentioned that I had the tram scheduled for next week and that I would have to discuss with my employer to see if I could get the time off approved in December as opposed to July/August...to which she replied "I don't know what you are looking for, we have urgent patients with active cancer we are trying to schedule, you are not getting in any sooner." I explained I wasn't asking them to get me in urgently, just trying to get an idea of the availability of either of the surgeons. I then asked how many they typically provide--for which she picked up the calendar flipping through and said "a lot." I asked if I could see pictures of their work and was told they don't have any. Needless to say I walked out without scheduling the surgery.

So....my dilemma is do I go with the Tram that I already have scheduled since the surgeon and staff are awesome and sacrifice abdominal muscles or is the DIEP a better procedure, so much so, that I deal with what I perceive as bad customer service and bedside manner of the other PS?? Unfortunately, there are not other DIEP providers that my insurance will cover, and the practice that does this is considered the best medical center in the state. I am worried about all of the issues that the tram can bring with lack of muscle strength impacting sitting, getting out of chairs/bed, etc. I spoke with my general surgeon and he won't make an opinion either way since he isn't experiences in either procedure, my PCP says to go with the tram stating the DIEP is too new?!?

Any insight would be much appreciated as I am so stressed out. Also a huge thanks to anyone taking the time to read all of this...I know it's a lot