Question on delayed reconstruction

arabiansrock, I had a BMX last Feb. and had delayed DIEP a few weeks ago. I think most PSs can work with whatever kind of closure you have. I had a flat closure, though if I did not do DIEP I planned on going in for a revision to get rid of the "dog ears" that were left on the sides. I will say this- the less of your own skin you have on your chest, the more of your stomach skin that will show after DIEP. Those who have skin sparing MXs have a more natural looking outcome after DIEP since the stomach tissue is "buried" under their own skin, if that makes sense. I have large flaps of stomach skin showing, though the scars will diminish over time. This doesn't bother me, but it may bother some women. You might research a football-shaped flap vs. a lollipop-shaped flap to see the difference. There is a Facebook DIEP support group page that you can join if you are considering DIEP where lots of women post pictures of the different outcomes that they have. If you don't mind the larger flaps after DIEP, I would go with the flat closure after MX. You may find you are fine with being flat. This was my original intention but I eventually changed my mind because I wasn't at peace being flat. I am still recovering from DIEP, but am already much happier. Every woman is different, so I would give it a chance at least.

So sorry you find yourself here. I wish you all the best.

PS: It occurred to me that I forgot to mention that some women use tissue expanders before DIEP which would also allow less stomach skin to show. This is not an option if you have radiation.

arabiansrock, no problem at all, glad you get the keep them! There is no option that comes close to the real thing. Did your surgeon talk to you about radiation treatment? Generally goes hand in hand with a lumpectomy.

Wishing you well during your upcoming treatments!

arabians - have you checked at UC Davis? Here is a link:

https://health.ucdavis.edu/plasticsurgery/procedures/diep.html

Also, if you are willing to travel to the Bay Area you might check UCSF, they have a very well known breast center.

https://www.ucsfhealth.org/clinics/breast-care-plastic-surgery

You might want to check and see if you are a candidate for BMX with immediate flap reconstruction. If not, some plastic surgeons will place tissue expanders as place holders so that the later tissue transfer can be placed under the existing breast skin rather than using the transferred flap skin

arabiansrock, I am so sorry you're having to make these choices. Many women have no problems at all with radiation, but some have lingering side effects from them (like me, unfortunately). Also, while mastectomy usually means no rads, that is not always the case, just so you're aware of that possibility as well. In my case I ended up with the radiation anyway, though lumpectomy was never an option for me.

SpecialK and MinusTwo make some good points. I didn't think of the TE's being put in at the initial surgery. Just to be clear, they can go in before radiation, but they cannot be used after radiation, or at least that's what I was told. Radiated skin doesn't like to stretch.

You're right that there are no good options. But there is the best option for you. Do your research and advocate for what you want.

MinusTwo, thanks for the correction. I sought the opinion of three different PS's and two of them told me my only option was autologous because of the rads and that TE's wouldn't work. But new things probably take a while to trickle down from the big cancer centers to the rest of the docs. The other consult I got was at NOLA but I was already settled on DIEP at that point and TE's weren't really discussed. Didn't end up going there because they were out of network.

Delayed reconstruction - I explored the DIEP option in another state because it is/was not available where I lived. The surgeon told me that most do it at the time of bilateral to reduce the number of surgeries, but others do not. She had had one patient who did a DIEP 10 years after a bilateral. As it turned out, I was not a good candidate, not the right kind of fat it the right places. So I opted for no reconstruction. One friend suggested I also consult a surgeon who specialized in transgender, didn't do that, but maybe I should have.