Second surgery after DIEP

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ishallovercome
ishallovercome Member Posts: 5
edited July 2018 in Breast Reconstruction

Hi lovely ladies!

It is wonderful to read all these stories and our collective resilience pulls us through these tough times!

I am 48 and was diagnosed with DCIS in the left breast and had a simple mastectomy and diep flap on Nov 6, 2017. Now planning stage 2 surgery August 31, 2018 - after a clean mammogram on the remaining breast.

I will need an implant in the reconstructed breast as it is a cup size smaller than the healthy one. I was a 34 B. I would like as much symmetry as possible and want to look okay in gym clothes / swimsuits.

My plastic surgeon says best course of action is an implant in the reconstructed breast. A lift in the good breast and also a smaller implant in it. He says implants on both sides will achieve the best symmetry. My questions for anyone who can offer advice is:

1. Can I do this with just a lift on the good side and implant on the DIEP side? Any ladies who had this done and your thoughts on it a year or two later..

2. My concern is the mammograms each year on the clean side with an implant will be not that accurate. Any experiences with that?

3. What are the best implants to put in considering longevity and comfort?

Thank you in advance! Good healing vibes being sent to all you wonderful strong ladies _/\_

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Comments

  • Lula73
    Lula73 Member Posts: 1,824
    edited July 2018

    yes you can do just implant in DIEP side. Perhaps he’s looking at making your overall breast size proportional to your frame with implants in both. Have you considered stacked flap instead of implant?

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  • ishallovercome
    ishallovercome Member Posts: 5
    edited July 2018

    Hi Lula,

    Per my surgeon when implants are placed on both sides, the shape will be a closer match to each other. Without the implant, the natural breast will be flatter on the top part, while the implant one will be rounded.

    Also I have already finished the DIEP flap surgery in November 2017, so can they do a stacked flap again on top of this one?

    Thanks so much for your reply!

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  • Runrcrb
    Runrcrb Member Posts: 577
    edited July 2018

    ishallovercome,

    If you are adding an implant to the DIEP side, your surgeon is right that the only way to symmetry is an implant on the natural breast. Tissue can match tissue, implant can match implant, but tissue alone will never match implant.

    Have you considered a lift and reduction on the natural breast and skipping implants all the way around?

    I don’t know the answer on your mammogram question- consider asking your oncologist


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  • dml124
    dml124 Member Posts: 3
    edited July 2018

    Hello ishallovercome-

    I had a unilateral mastectomy with DIEP flap in June 2017 and then a reduction and a lift to my healthy breast when stage 2 revisions were done in August of 2017. After that surgery, my ps felt like a small implant added to my DIEP side would be beneficial for projection and volume. I waited a year and only scheduled because my breast surgeon really felt that the size difference was significant and that I should be able to fill the cup of my bra or use something to fill it with. So three weeks ago, I had a small implant added to my DIEP side only. I am not sure what the final outcome/shape will be as there is still some significant swelling but I will say the shape at the top is definitely different. I have since seen both surgeons and they feel like the goal was to fill the bra and look good in clothing-I do look very symmetrical now. It does though feel very different than the healthy breast side. I am not sure if this is helpful and it would be great to hear from others who may have gone this route as well.

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  • ishallovercome
    ishallovercome Member Posts: 5
    edited July 2018

    Thanks for your post dml124!

    I had a consult with my plastic surgeon today and we decided not to mess with the unaffected side, except do a "lift". I think it would be best to get a small (150-200 cc) implant on the diep side to improve projection. He also said he would be doing some liposuction and nipple construction with tattoos.

    So I am happy with this plan and your experience really reinforced my thinking! He said initially the implant will look like it is higher up in the breast, but will take a while to settle down and "MAYBE" in a year both breasts may be at the same level. He also said if I really felt awful about the symmetry a year later, I could always opt for an implant in the good breast. But I will cross that bridge when I get to it :)

    Since you had your implant put in three weeks ago, are you fully recovered? And how was the recovery for stage 2 in August 2017?

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  • ishallovercome
    ishallovercome Member Posts: 5
    edited July 2018

    Runrcb, thank you for weighing in.

    I thought about going smaller, but decided against it as I was not too okay with being an A cup. Just want to look normal / same as before in clothes - thanks for your take on implant / tissue choice.

    Did your DIEP need second surgery?

    Thank you

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  • Lula73
    Lula73 Member Posts: 1,824
    edited July 2018

    yes, you can do a stacked flap after having a single flap if you prefer to not use implants.

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  • dml124
    dml124 Member Posts: 3
    edited July 2018

    ishallovercome-

    I just noticed we are about the same age-I was 48 when diagnosed and am now 49. In terms of my second phase surgery, I had a reduction and a lift on my healthy breast and nipple reconstruction as well as some shaping on my DIEP side. My recovery was fairly quick but I do remember having more pain than I expected in the breast that had the reduction and the lift completed. The plastic surgeon explained that when you have a mastectomy all tissue and nerve endings removed so pain is different than when the nerve endings are still intact. I went back to work approximately five weeks after this surgery but that is only because I teach little ones with special needs and the lifting restrictions kept me out but otherwise I felt great after about three weeks.

    In terms of this past surgery for the implant, the recovery was very easy and not really painful. I would say it was more uncomfortable and felt tight with some spasms versus pain. Sleeping in the first few days was also uncomfortable. I feel great and am back to my usual routine as much as possible with lifting restrictions for another 3 weeks. I also do not work in the summer so I had the time to stay home and heal. I am getting used to the difference in feeling from the DIEP flap that I had before. I will be honest, it is not as soft. It is also still very high in the breast after three weeks and I am very hopeful that it will still drop down more so that the shape is less rounded at the top. My last phase is the nipple and areola tattoo. I met with a tattoo artist last week and he would like to wait a minimum of at least three months from last surgery so that swelling and settling can occur before completing the tattoo.

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  • Runrcrb
    Runrcrb Member Posts: 577
    edited July 2018

    ishallovercome,

    I wouldn’t say i must have a second surgery post DIEP. I have chosen to. In my second surgery the PS will remove a little bit of fat from the DIEP breast as it’s bigger than the natural one. The PS and I can see the difference but it doesn’t show in clothing. I am having a small lift to the natural breast- again, my choice. And some scar work.


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