DIEP: SoCal (and who?) or NOLA? Recommendations?

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WC3
WC3 Member Posts: 1,540
edited October 2018 in Breast Reconstruction

I need some opinions on whether I should have my reconstruction done in southern California, and by who, or if I should go to NOLA. SoCal has a lot of DIEP surgeons, but I am a bit of difficult case and would really like nice results. I don't want to look in the mirror at the end of this and think "There are my sh!t excuse for breasts".

My issues with NOLA are mainly that I am fatigued due to anemia from the chemo, and it's a big two or three cross country trip deal with possibly significant out of pocket expense, and I wonder if it would really be worth it or if there is someone in SoCal who can do just as good of a job.

Also, is there anyone in SoCal to avoid? If so, please PM me on that one.

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  • rdeesides
    rdeesides Member Posts: 459
    edited October 2018

    Hi,

    Not sure where you are in SoCal but I got a referral to Dr Mark Kobayashi at UC Irvine and met with him yesterday. I met with four different PS’s and he seems, by far, to be the best. I got his name from another PS who said if he was having this procedure it is who he would go to.

    Let me know where you land. It is surprisingly difficult to find someone that seems really well versed on this procedure.

    Rebekah

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

    so I read on a DIEP FB page that Delta offers free flights to people traveling for cancer treatment. Something to look into. Not sure if Amtrak trains do the same, but something to look into as well as an option. Hope lodge is in NOLA and offers free accommodation with private bath and shared kitchens to patients and 1 companion traveling for treatment. They only ask that you make a donation to them if you’re able to.

    So I did a google search and not many PSs in Southern CA post their before & after photos online...for me that’s a red flag right there. Or they only have 0-4 photos of their DIEP/other free flap recon and tons of photos of implant, lat flap, and other breast procedures not related to recon after mx. This tells me that they don’t do many of the free flap recons in a given year but do plenty of other procedures for recon as well as other plastic surgeries not breast related. Also, many of the photos only showed the breasts and not the abdomen which can be another red flag. Here is what I could find photo-wise for So CA:

    https://www.drorringer.com/before-after/breast-reconstruction

    https://www.drkarenhorton.com/gallery/breast/diep-siea-flap-reconstruction/patient-35

    https://www.lotempioplasticsurgery.com/photo-gallery/breast-reconstruction

    Compare those photos to NOLA photos:

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

    Things that are not mentioned on the So CA sites but can often be deduced include other flaps they do...many still do TRAM, they do DIEP and they do lat flap. That means if your DIEP flap fails, your going to have the option of using back muscle + implant or using ab muscle as alternatives with that particular PS. Not good options if you were trying to avoid implants and avoid compromising muscle. No one lists their conversion rate to TRAM or lat flap, flap failure rate, or infection rate. NOLA’s are 0 conversion rate to TRAM or Lat flap, <1% of their flaps fail, infection rate <2%, they do more free flap surgeries per year than any other group and have done more overall than any other group. And they not only took DIEP to the next level aesthetically, they also pioneered SGAP and APEX flap. Hands down they are the most experienced at this type of recon. That also means (and it shows in the photos) that they’ve operated on just about every size, shape, weight, height, and pre-existing issues imaginable. And it’s all they do day in and day out...no facelifts, no butt implants, etc.

    I’d be happy to share my before and after photos of NOLA’s work if you like. Obviously I can’t post it here but I can PM you. If you’re on Facebook and would like to be added to the NOLA FB group for ladies who are considering NOLA, are going to NOLA, or have gone to NOLA, I’d be happy to add you. It’s a secret group on FB so it cannot be found by a search. You have to be added by a member of the group. You’d be able to talk with 100s of NOLA ladies that way to get their take. There are several who are active on the page now that traveled to NOLA from So CA that you may find helpful.

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  • WC3
    WC3 Member Posts: 1,540
    edited October 2018

    rdeesides, Lula73:

    Thanks for the replies and recommendations. My current facility offers DIEP and is considered the place in my area for it but I don't know how many they actually do. I think they don't post the before and after photos online because of the way the organization is managed and markets itself.

    I've asked to see before and after photos at two different places though and both PSs have told me that I could see them but they don't apply to my situation because I have an uncommon phenotype.

    The plan was that I would have the BMX and temporary expanders placed during the first surgery, and then DIEP a few months later after I put on more weight.

    I'm completely unsure what to do now though because I just had my third PS consultation and this PS said he would forgo the expanders at the moment and leave me flat because he believes I am not well enough to start any reconstruction at the moment.

    But my BS said starting the reconstruction immediately was a must if I am going to do reconstruction at all because she thinks I will have too much tightening and scar tissue that will make future reconstruction impossible if I wait. First PS agrees, third PS disagrees, and the second PS seems to think either way is fine.

    First and third PS think I am a challenging case, second PS wasn't too concerned.

    I guess I will send off some photos to NOLA and see what their thoughts are.

    Lula73:

    Thanks for the links and info about Delta. I will look in to that. I've heard that they sometimes have to cut muscle with DIEP. If that's the case with me then I will have to go NOLA for APEX instead. I'm concerned though about the potential for complications landing me in a general hospital in Louisiana. I don't think my insurance would cover any of it. I don't know how much a hospital stay in Louisiana is but here it's about $150,000 for about four days.




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

    WC3- you wouldn’t go to any hospital if that happened, you’d go back to the one at NOLA. While you’re there they are your drs. I had a hysterectomy during my stage 2. Everything went great, post-op appointment went off without a hitch then next morning I wake up and im shivering, massive headache, weak, fever of 102. Supposed to catch a plane at 2...called NOLA they say come in to be checked out and then got readmitted to NOLA’s hospital for a systemic infection with IV antibiotics for 4 days. They have an IM doc on staff that handled my case in conjunction with the GYN and NOLA PS. Don’t let that potential keep you from going. You will be in great hands. 😀

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  • sbelizabeth
    sbelizabeth Member Posts: 2,889
    edited October 2018

    I had very extensive radiation damage and it was not recommended to put in an expander when I had the mastectomy, due to the extent of my disease. I had a single mx, with plans to do delayed DIEP on the cancer side and immediate DIEP on the healthy side.

    Dr. James Watson in Thousand Oaks did my DIEP in 2013. He trained and practiced at UCLA and was the only doctor locally who did DIEP procedures. His failure rate is very low. He's a perfectionist, doesn't rush you through appointments, and is one of the kindest doctors I've ever met. My results are great.

    If you're anywhere near Ventura County, please PM me. We can talk. SB

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  • WC3
    WC3 Member Posts: 1,540
    edited October 2018

    Lula73:

    I was thinking of some type of complication like a stroke or something where I would have to be sent to a hospital with a specialized unit.

    selizabeth:

    Was it problematic for them to do the DIEP on the side that had been flat for a while? My BS and PS1 seem to think my skin will get too tight but I'm not sure if this is specific to me or the way the BS tends on doing the mastectomy or common complication they see.

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

    The hospital at NOLA is a private but full fledged hospital. They have docs from just about every specialty with privileges to practice medicine there. They have CT scanners, X-rays, ultrasound machines, etc right there to help diagnose. If something like that did happen, NOLA is where I'd want to be. Nurse to patient ratio is 1:1 or 1:2 depending on the patient occupancy. Someone is there within moments of pushing the nurse button and you are checked on quite frequently-much more frequently than any other hospital. Strokes are treated with clot busting meds given via IV that they would simply order up from the in patient pharmacy and a neurologist would be called in to join your medical team.Oschner Medical Center is a short ride away if needed and very well respected.

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  • sbelizabeth
    sbelizabeth Member Posts: 2,889
    edited October 2018

    WC3, no, it wasn't a problem to do a delayed DIEP on the flat, radiated side. After radiation the skin was stiff and damaged, but the plastic surgeon was able to cut out a lot of the damage. The cosmetic result from a delayed DIEP isn't as good as an immediate DIEP but I didn't have a lot of options. Tightness of the skin is more of an issue with tissue expanders, which wasn't a good idea for me.

    For women who have extensive radiation as I had, placement of a tissue expander is frequently fraught with problems. Circulation isn't the greatest to radiated skin and infection is frequent.

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  • MargaretEleanor
    MargaretEleanor Member Posts: 42
    edited October 2018

    Dr. Christopher Crisera at UCLA did my double DIEP reconstruction. Left side was immediate (prophylactic mastectomy), right side (cancer side) was delayed to let skin damage from radiation heal. My girls, Chrissy & Shea, are beautiful! 😉

    Dr. Crisera is the best doctor ever!! He will discuss all of the reconstruction options appropriate for you. He will have plenty of before & after photos to show you reflecting the different types of reconstruction surgery options. He will answer all your questions. I travelled from Phoenix to LA for my reconstuction surgery and revisions.

    Since Dr. Crisera practices at UCLA which is a teaching facility, I’m pretty sure if Dr. James Watson did his DIEP training at UCLA, he trained under Dr. Crisera

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  • Shades5blue
    Shades5blue Member Posts: 19
    edited October 2018

    I’m considering NOLA. Check to see if Southwest has direct affordable flights. I looked at them from San Diego and Phoenix.

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  • CaliKelly
    CaliKelly Member Posts: 474
    edited October 2018

    I didn't have DIEP, I had latissimus dorsai flap reconstruction but my Plastic Surgeon, Mytien Goldberg, who practices in Beverly Hills and Torrance, is also from Ucla. Teaches at Harbor Ucla. She is awesome!

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