Or Live-surgery - Diep Flap Breast Reconstruction

Joanne S · 12-03-2007, 03:25 AM

www.or-live.com

Note: Live Webcast of actual surgery

DIEP Flap Breast Reconstruction Surgery

Newer breast reconstruction techniques that rebuild the breasts in the most natural way possible

January 11, 2008 at 5:00 PM EST
(22:00 UTC)
From Beth Israel Medical Center, New York, NY

http://www.or-live.com/bethisrael/1896/index.cfm?r=orlive

Advances in breast reconstruction techniques have dramatically improved the options for breast cancer treatment. At Beth Israel Medical Center, our renowned reconstructive plastic surgeons are using the DIEP (deep inferior epigastric perforator) flap technique in which the surgeon removes skin and fat from the abdomen and transplants it to the mastectomy site. Unlike older procedures, the DIEP flap doesn't require the removal of abdominal muscle when forming the breast mound. The skin and fat along with the small blood vessels that go into them are detached and reconnected in the breast area so that the tissues can live up there. In addition to an improvement in the abdominal contour, another benefit of DIEP flap surgery is faster recovery and less abdominal discomfort. Beth Israel Medical Center presents a live Webcast of the DIEP flap breast reconstruction surgery on Friday, January 11, 2007 from 5:00 – 6:00 PM.

Preparing Media Players and testing http://www.or-live.com/testing.cfm

harrie · 12-03-2007, 11:40 PM

I had the DIEP flap reconstruction done Nov 2006 in So. California. The plastic surgeon who did mine was fantastic. In you are interested in him, go to plasticsurgery.la and you can read about him.
Harrie

Blanche · 05-11-2008, 08:02 AM

Hi Maryann, could you tell me about recovery time and maybe some realistic expectations I should have if I decide to go this route, like failure rate, pain , how long operation was? what would be my limitations? Were you happy with results, please just some of your personal pros and cons. Please believe me I understand that everyone is different , how many time have we heard that. Blanche 3a,6 positive nodes, ac, taxatere with herceptin all completed, breast plant exchange was March with silicone, failed in radiated side this week in hospital for treatment of infection and remove one silcone. Looking for some insight. blance

harrie · 05-11-2008, 06:11 PM

Blanche,
I had my DIEP done 11/06. It was a bilateral mastectomy with the DIEP. Recovery time I was told was between 4 - 6 wks. I had it done in California and flew back home to Hawaii a bit after 4 wks. My operation took 17 hrs which is longer then most. The surgeon had problems with my skin since it was radiated and I believe that is why it took so long. I was in this hospital for about 5 days which is normal. 3 months after the surgery is stage 2 of the reconstruction where they modified the scarring, put in small silicone implants for me, and constructed a nipple. That operation took about 6 hrs.
The recovery was not easy. Pain wasn't that much of an issue for me. The meds worked well. I took myself off the heavy duty IV pain meds after a couple of days. I had a time release pain med that I had to wear the first few days. Mobility was probably probably the biggest problem because I was bent over like 90 degrees the first wk. Luckily I was able to raise my arms halfway up. Some have to keep their arms against the sides of their body.
Anyways....What is nice about the DIEP is that they spare the muscle and only take the fat. I always wanted a tummy tuck so this worked out great! I didn't have all that much fat and that is why I had implants. Recovery is quicker when they do not take your muscle.
The operation is much more highly technical then a TRAM flap because the vessels are actually cut and reattached as opposed to a tRAM where the vessels are tethered up. So it is critical that the microscopic surgery is done well so there is no necrosis. So for the first 48 hrs the tissue is monitered with a dopler to hear the bloodflow.
There are not a lot of drs in the US that are qualified to do this procedure.
When I look at my results i am still totally amazed.
I absolutely love the results.
Blanche, I will PM you with my phone number in case you have any questions and would like to talk to me.
I just kind of skimmed over briefly what it was like.
Maryanne

Mary Jo · 05-11-2008, 06:24 PM

....and Blanche, I can attest to the fact that "harrie" aka Maryanne is very helpful. I spoke with her over the telephone and she shared a lot of information about DIEP with me. Things like getting ready for the surgery - the surgery and hospital stay and the recovery. Her information was so helpful because I knew she had been through it.

My DIEP is scheduled for June 17. I'll be happy when it's June 18th and all is well.

Mary Jo

michka · 05-12-2008, 02:53 AM

Mary-Jo,
Terrific. I will think of you on June 17th! I am sure everything will go well.
I hope I can do the same one day. Right now my surgeon refuses to plan a reconstruction because of the neuropathy in my arm. It gets me down. I will wait until the end of my Tykerb treatment in October and then find another surgeon. Some women feel better without reconstruction. I don't.
Go Marie-Jo!
Michka

Mary Jo · 05-12-2008, 04:11 AM

Hi Michka,

Thank you. As you can see from my signature, I did wait for my reconstruction. I will be a 3 year survivor in July and am first now being reconstructed.

That being said, my plan all along was to not reconstruct. I've always been fine with being breastless and am a happy, confident person either way. But, for some reason, about 6 months ago I started thinking about - "putting myself back together" again. After doing a lot of research on the different types of reconstructions (never knowing a thing about any of them) I decided that DIEP is right for me.

It is an exciting, yet scary time, for me but am trying to look forward with confidence. My mind keeps wanting to go to the "what if this disease comes back" mode and "what if this disease comes back while in this proces of reconstruction" BUT am trying to put those thoughts out of my mind and concentrate on the good. To grab a hold of whats good and not think on what I have no control over anyway.

So, thank you for your nice post. Yes,June 17th is the date and it is almost here. YIKES

Please pray for me that surgery and recovery is a complete success and NED continues to follow me.

Love to you ....

Mary Jo

swimangel72 · 05-12-2008, 11:11 AM

Michka and Mary Jo - you will both be in my prayers to get you to the point of being "whole" again! I love that book "Reconstructing Aphrodite" that was in my PS's office - did you both read that? Very inspirational - it was what impelled me to do my immediate Diep surgery.

I'm feeling so much better now that my abdominal incision is almost healed - and I can't wait to get my Stage 2 revisions done next year (after my chemo is done.) I watched the Diep surgery online (thanks Joanne for posting the link!) and was fascinated! It answered many technical questions I had concerning my own surgery (especially about the belly-button and the recepient blood vessels location - I believe mine were actually under my armpit since my surgeon used the incision from my SNB to reduce scarring on the front of my breast.) My mastecomy was a "skin-sparing" kind - but not "nipple-sparing" since my breast cancer surgeon was very worried about recurrence in the areola complex. Also - by removing the tissue THROUGH the areola complex, I have less scarring in the front - just the "circle" which will be disguised by the tattooing (I hope!) Oh - just remember though - your new breast won't have much "feeling" at first on the skin because of the nerves that are cut, but I'm told sensation can return over time to some patients.

Anyway - just wanted you ladies to know that I'm thinking about you - and I'll be praying for you both!

Joan M · 05-12-2008, 06:25 PM

Hi Mary Jo,

I think you'll be very pleased with the results. I had immediate DIEP flap reconstruction, so from the first I never felt like my breast was missing. This has nothing to do with not having a breast but more to do with the comfort of being able to wear my regular bras, clothes, etc., without skipping a beat. Since you did not do reconstruction immediately, the effects of it will be even more dramatic for you.

I'll be praying for you on June 17.

And, by the way, great picture of you and your family!

Best, Joan

harrie · 05-12-2008, 11:49 PM

MaryJo and Blanche,
when I look back I might make a few suggestions. One of the challenges was getting out of bed a day or two after the surgery. If you could have some fairly decent upper body strength to begin with, I think that would be extremely helpful. Also, for the first wk I was bent in half. Having a strong back to support yourself is also good to have.
Then after the surgery, to me everything felt very tight. Range of motion for my arms was very limited. The good thing is every single day I could see improvement.
AFTER you get your drs OK....what I felt helped immensly was yoga. That really helped me stretch out my muscles and skin. I am not the expert on yoga since I have only been taking it for a yr, but I do know it helped. Maybe you can find other ways of stretching out really good.
It was all very challenging, but worth it in the end.
Maryanne

Blanche · 05-16-2008, 12:45 PM

Hi Maryanne, I was just reading over the posts again and I was reading your profile, if you don't mind me asking what does arimidex with sore it thumb mean. I'm on arimidex and you got my curiousity. I'm still waiting to meet with the new ps to see if I'm a canidate for diep and still just trying gather information and let my body heal. Thanks Blanche

harrie · 05-16-2008, 05:19 PM

Blanche,
It means I am (was) on Arimidex and I had a sore thumb (joint problem) as a side effect from the med. It actually gave me "trigger finger" in my thumb. As of April, I switched to Femara. My thumb is close to back to normal now.
I should update my profile.
Maryanne

harrie · 05-16-2008, 07:44 PM

I watched that online video of the DIEP from Beth Isreal Med Ctr. Was very interesting. The questions that came up were really good also. Issues I didn't even think to consider when I was considering the DIEP.
BTW...for the record, my plastic surgeon corrected me on my 17 hr surgery. He said the 17 hrs included the prep time, going under, waking up from anesthesia and everthing inbetween. He said the actual surgery for the DIEP flaps only took a few hrs per side. A substantial amt of time, but not as long as I had inferred.

Also, after viewing the video, it's true I found it to be fascinating, but I am glad I viewed it AFTER the fact and not before my surgery. Actually, it is a lot less invasive then what it appears on screen since they are not actually entering the body cavity. So if you happen to see it, keep that in mind.
Maryanne