Reconstruction - decisions TRAM Flap - DIEP

candlegranny · 03-20-2012, 07:15 PM

Met with my surgeon today for follow up on port removal. I askd about reconstruction. He said because of the radiation, i was not a good candidate for implant. Skin is tight and hard to stretch. Complication prone. He said the TRAM flap is ok, but leaves room for hernia's and weakening of the adominal wall. He mentioned DIEP said i would have to travel to haver this done.. no where in Kentucky. Has anyone had DIEP or TRAM flap? what is your experience and input? I have to research for doctors and check with insurance company too. He said the best is to rebuild teh one i am missing and then after it has healed nad complete, then concentrate on fixing my other brest or a reduction. I am a bigger woman... 200 pounds. i dont want to sound vain but i would like to have matchimg boobs and as close to my normal size as possible.. am i being bad? hoping to hear from you soon... Bonita

NEDenise · 03-21-2012, 05:12 AM

Hi Bonita!
I had my DIEP flap done at the University of Pennsylvania, in October. My breasts are healing nicely...still not quite like the originals, but the surgeon says it takes 18 months-2 years for everything to "soften up" and look natural again.
The part that's troublesome for me, is my abdomen. Believe me when I tell you that I love having a flat tummy again...but...

My abdominal incision has been a pain since the day of surgery. The healing time for it, and the amount of pain involved were both much worse than I had anticipated.

In fact, I'm having surgery again in April to remove scar tissue that has formed and interferes with waistbands of any kind. It feels like I'm smuggling a dozen large pebbles under my skin!

And, I still get fluid build up and numbness between that incision and my new breasts. (which BTW are still quite numb as well). But they match, and look about the same as my original ones in all my clothes.

Having said all that...I'm still very glad I had the surgery...but I wish someone had told me it was no walk in the park.

It was an 11 hour surgery (because I had my mastectomy at the same time), followed by 6 days in a special "step-down unit", not quite ICU, but lots of attention and people checking on the new breasts' blood flow every hour. I also had a pain medicine pump for the abdominal incision for the first 2 days...and I was very grateful for it.

My breasts were fine...no pain, good blood flow to the transplanted tissue. Then, home with 4 drainage bulbs (I had both sides done, so the finished products would match from the get-go).

I'd say I was back up and out of the house about 10 days later, but I couldn't drive for about a month because of the drains and pain meds...which BTW I needed, at least once every day for about a month...and I'm not a pansy when it comes to pain. My abdomen HURT...mostly at night, because the fluid built up throughout the day!

As far as insurance is concerned, I was told that I was entitled by law to whatever recon surgery my doctors and I thought was appropriate...and that my insurance was obligated to pay for it. I'm not sure whether that's a state or federal law, but it seems worth a check. And, your AFLAC should pay travel expenses, right?

I posted my experiences after surgery, here on the forum, but I can't get the link to post here for you to click on. If you search "DIEP" it should pop up.

If you have any more specific questions, please don't hesitate to PM me. Some of the other ladies have had this surgery too. Hopefully, they'll chime in with their thoughts too.

Bottom line...not a walk in the park...but I'm glad I did it.
Be well!
Denise

snolan · 03-21-2012, 05:27 PM

Icouldn't do the tram at the stomach not enough fat. I couldn't afford to travel to get the DIEP. I had the latissimus muscle transplant. I haven't regreted it at all. I still work out at the gym and haven't felt that the lack of the muscle has affected me that much. I just had my expanders taken out on Monday and the silicon put in and they look and feel great. I do need some physical therapy to work on the scar tissue on my back but all is doing well. Hope this helps.

Mary Jo · 03-21-2012, 07:17 PM

Hi Bonita,

I was diagnosed in 2005..(see signature) and I had delayed bilateral DIEP in 2008. It was a complete success. The surgery was 10 hours and all went well. My new breasts look amazing and to be honest with you, I feel as if these are the breasts I was born with. They look so natural.

If you have any questions please feel free to contact me and I can explain further.

For me personally, the TRAM would never do. I am a very active person and messing with my traverse abdominal muscle would inhibit me in ways I would never allow. My DIEP left my muscle alone COMPLETELY and as a silver lining my abdominal "fat" was removed. LOL!

Mary Jo

chemteach · 03-22-2012, 04:55 AM

I had expanders and implants. I really didn't want to take the recovery time and so on with the other options, though I would have liked the tummy tuck. At least there is something there even though it isn't perfect. I'm pretty happy!

'lizbeth · 03-22-2012, 09:27 AM

I did the TRAM and if I would have had an opportunity to do the DIEP instead it would have been a much better choice.

What I did know at the time is the muscle tissue could atrophy and become necrotic due to disuse. The body is thrifty and will reabsorb muscles fibers that are not being used.

I had calcifications on the last mammogram that showed necrosis had started.

I'm really bummed out after all I went through with the TRAM. I had a partial loss, months of debridement with an open wound, 5 weeks on a VAC pump to get the palm sized wound to heal.

If I had known how the body reabsorbed muscle fibers that are not being used - I would have made a better decision.

My vote is DIEP from my experience. Lets hear from some others and you can have the benefit of their experience too!

candlegranny · 03-22-2012, 08:34 PM

thank you everyone. i have to find a doctor that does the DIEP not done in my local area. i thought i would get an implant and be done but surgeon says not good for patients that had radiation. i got lots of fat in my tummy but not looking forward to all the long healing process. i have stage 2 lyphedema in my left arm...will the reconstruction on that side effect my arm? will make an appt with a doctor that does the tram flap to see what he says and then get an opinion from a doctor that does the DIEP too.