TRAM Flap or DIEP Flap
Comments
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Balentine - I had DIEP Reconstructive surgery this last December. It was a very long surgery (8 hours), and I was in the hospital for 5 days. I was in the Intensive care unit for most of that time, because I was hooked up to practically every monitor you can think of. The first two days, the nurse had to check on the circulation in the Flap every hour to make sure it was viable. The big worry with DIEP Flap surgery is that the Flap will die because of bad circulation. This is why it's so important to have a specialist that is very good at this type of surgery. The Flap was taken from my abdominal area, and that's where I had most of my problems. When I left the hospital I still had three drains in (two in my abdomen and one under my arm). Two of the drains were taken out at my first followup. The third drain was left in my abdomen because there was still too much fluid draining. After about three weeks, the drain fell out on it's own and that's when the trouble started. I developed an abdominal seroma (pocket of fluid) that would not resolve itself, so I had to have another drain put in around the first of February. It stayed in for about three weeks, when I developed a fever and spent 3 days in the hospital and had a new drain inserted. Finally, I was able to get it out around the first of April. So a surgery that should have been a 4-6 week recuperation became a 3 and a half month odyssey. I now have a second surgery coming up in June to even my left side up with my new boob, and do some refining of the Flap. After that, I'll have an outpatient surgery to create the areola and nipple.
I would do it all over again to have some normalcy as far as my breasts are concerned. I think we all like to feel feminine. I didn't have the DIEP surgery till 6 months after I finished with my chemo and radiation treatments, and I'm very glad I waited, because I do think I needed to have my strength back, and I know I wouldn't want to dive right into something this intensive right after dealing with all the chemo, etc. I did get pretty down on things when it seemed like the drain was never going to come out. It gets pretty old dragging that thing around. I have a very low tolerance to pain medication but a high tolerance to pain, so after they got me off the IV's in the hospital, I just took ibuprophen when I got home.
I don't know if this helps you at all, if you can make any sense out of my ramblings. I do know that you have to do what is right for you. Discuss your options with your PS and ask every question and concern that you have so you will be prepared. It's a long haul, but I do think it's worth it and I'm glad I did it. Best of luck and keep us informed. Connie0 -
I had a bilateral mastectomycontrail said:Balentine - I had DIEP Reconstructive surgery this last December. It was a very long surgery (8 hours), and I was in the hospital for 5 days. I was in the Intensive care unit for most of that time, because I was hooked up to practically every monitor you can think of. The first two days, the nurse had to check on the circulation in the Flap every hour to make sure it was viable. The big worry with DIEP Flap surgery is that the Flap will die because of bad circulation. This is why it's so important to have a specialist that is very good at this type of surgery. The Flap was taken from my abdominal area, and that's where I had most of my problems. When I left the hospital I still had three drains in (two in my abdomen and one under my arm). Two of the drains were taken out at my first followup. The third drain was left in my abdomen because there was still too much fluid draining. After about three weeks, the drain fell out on it's own and that's when the trouble started. I developed an abdominal seroma (pocket of fluid) that would not resolve itself, so I had to have another drain put in around the first of February. It stayed in for about three weeks, when I developed a fever and spent 3 days in the hospital and had a new drain inserted. Finally, I was able to get it out around the first of April. So a surgery that should have been a 4-6 week recuperation became a 3 and a half month odyssey. I now have a second surgery coming up in June to even my left side up with my new boob, and do some refining of the Flap. After that, I'll have an outpatient surgery to create the areola and nipple.
I would do it all over again to have some normalcy as far as my breasts are concerned. I think we all like to feel feminine. I didn't have the DIEP surgery till 6 months after I finished with my chemo and radiation treatments, and I'm very glad I waited, because I do think I needed to have my strength back, and I know I wouldn't want to dive right into something this intensive right after dealing with all the chemo, etc. I did get pretty down on things when it seemed like the drain was never going to come out. It gets pretty old dragging that thing around. I have a very low tolerance to pain medication but a high tolerance to pain, so after they got me off the IV's in the hospital, I just took ibuprophen when I got home.
I don't know if this helps you at all, if you can make any sense out of my ramblings. I do know that you have to do what is right for you. Discuss your options with your PS and ask every question and concern that you have so you will be prepared. It's a long haul, but I do think it's worth it and I'm glad I did it. Best of luck and keep us informed. Connie
I had a bilateral mastectomy and DIEP reconstruction in April 2009, and I would definitely have it done again. I was very fortunate to have the mastectomy and reconstruction done at the same time and I did not have chemo. I'm not sure what I would have done if I had needed to wait for the reconstruction: I can see why you are on the fence right now. It would be hard for me to go through one recovery period and then do it all over again. It might be better for you to wait for a period of time until you have peace with having another surgery.
A Connie metioned, the surgery is long, and the recovery is 6 - 8 weeks. I have a high pain tolerance, and didn't take any of the narcotics after the second day post-surgery, just Tylenol or Motrin. My biggest problems were with my abdomen also, with a slight infection of my belly button and the last drain becoming plugged and having to be removed. Fortunately, I only had to have fluid aspirated a couple times and then everything was fine.
Joyce0 -
surgery
I know exactly what you are going through. I finished my treatments, chemo & rad in February & am scheduled for a diep flap with a right breast mastectomy. I did a lot of research and spoke with a lot of people. My pl is a specialist in this field & I love my breast surgeon. I know for my piece of my that this will help me put this past year behind me and be a step closer to not stressing about mammograms. Reading posts on this site has been a blessing! My surgery is scheduled for June 14th. I am scared, but I know I am doing the right thing for me. Take your time & you will know what is best for you.
Jean0 -
Diep flapjphilpo said:surgery
I know exactly what you are going through. I finished my treatments, chemo & rad in February & am scheduled for a diep flap with a right breast mastectomy. I did a lot of research and spoke with a lot of people. My pl is a specialist in this field & I love my breast surgeon. I know for my piece of my that this will help me put this past year behind me and be a step closer to not stressing about mammograms. Reading posts on this site has been a blessing! My surgery is scheduled for June 14th. I am scared, but I know I am doing the right thing for me. Take your time & you will know what is best for you.
Jean
Balentine,
I had a double mast and DIEP flap on 2/26/10. One of my flaps did not "take" and I had to go back into OR and have the left flap removed and an expander put in. The right flap did "take" and feels like my original breast. The oncologist and plastic surgeon told me I'd have to wait 6 weeks after finishing up chemo to go back in and get the expander replaced. The Diep surgery is intense and recovery is long. For me, personally, it was worth it. Have you thought of , maybe, the expander route? I've done both and the expander is a quicker recovery time.
Good luck and blessing to you0 -
what to do about reconstructionFabu said:Diep flap
Balentine,
I had a double mast and DIEP flap on 2/26/10. One of my flaps did not "take" and I had to go back into OR and have the left flap removed and an expander put in. The right flap did "take" and feels like my original breast. The oncologist and plastic surgeon told me I'd have to wait 6 weeks after finishing up chemo to go back in and get the expander replaced. The Diep surgery is intense and recovery is long. For me, personally, it was worth it. Have you thought of , maybe, the expander route? I've done both and the expander is a quicker recovery time.
Good luck and blessing to you
I am surprised at how many have had the DIEP since there are only 40 surgeons in the U.S. that do it. I am thinking where I live I will have to have the TRAM. I will find out tomorrow. I have read posts about the expanders and silicone but some people have had some bad experiences with that as well from the pain of continually having to go back to have them filled and then having the possibility of rupturing, sleepless nights, etc. Also having to have them replaced after so many years. You just can't duplicate the way God made you. I am having the hardest time deciding on what to do so until I am sure I guess I will wait unless the plastic surgeon can somehow reassure me and talk me into it. I hate not having one of my breasts but I also don't want to take the chance of it not coming out right or going through infections and problems with drains, etc. It is a difficult decision but I thank all of you for your advise and letting me know your experience so I can be better informed when I finally do make a decision. This network has been such a blessing for me. I thank God for all the new friends I have made with others that really understand what I am feeling. There is nothing else that can compare when you need to reach out to someone for understanding other than reaching out to God....you all have been the closest thing to that for me these past 3 months. Thank you.
Lots of love,
Lorrie Balentine0 -
side noteBalentine said:what to do about reconstruction
I am surprised at how many have had the DIEP since there are only 40 surgeons in the U.S. that do it. I am thinking where I live I will have to have the TRAM. I will find out tomorrow. I have read posts about the expanders and silicone but some people have had some bad experiences with that as well from the pain of continually having to go back to have them filled and then having the possibility of rupturing, sleepless nights, etc. Also having to have them replaced after so many years. You just can't duplicate the way God made you. I am having the hardest time deciding on what to do so until I am sure I guess I will wait unless the plastic surgeon can somehow reassure me and talk me into it. I hate not having one of my breasts but I also don't want to take the chance of it not coming out right or going through infections and problems with drains, etc. It is a difficult decision but I thank all of you for your advise and letting me know your experience so I can be better informed when I finally do make a decision. This network has been such a blessing for me. I thank God for all the new friends I have made with others that really understand what I am feeling. There is nothing else that can compare when you need to reach out to someone for understanding other than reaching out to God....you all have been the closest thing to that for me these past 3 months. Thank you.
Lots of love,
Lorrie Balentine
My plastic surgeon in california says he does not know to many doctors that do the diep except for those connected with research or teaching hospitals, because the surgery takes a long time and the insurance does not pay them enough for the amount of work they do. My plastic surgeon use to do it, but does not anymore for the reason listed above. I have chosen the expander the implant route. I have expanders in and then will have to wait 10 months after radiation for the exchange.
With regard to the constipation. I found eating 2 prunes a day, eating a cup of apples sauce a day and drinking as much water as I could helped. I also took a laxative that I was given when I was in the hospital for my first surgery. I did this until I had finished chemo and as needed for when I knew it could be a problem. (I usually drank lemonade or Crystal light to get some extra water)
Hope this helps
rm221110 -
constipationrm22111 said:side note
My plastic surgeon in california says he does not know to many doctors that do the diep except for those connected with research or teaching hospitals, because the surgery takes a long time and the insurance does not pay them enough for the amount of work they do. My plastic surgeon use to do it, but does not anymore for the reason listed above. I have chosen the expander the implant route. I have expanders in and then will have to wait 10 months after radiation for the exchange.
With regard to the constipation. I found eating 2 prunes a day, eating a cup of apples sauce a day and drinking as much water as I could helped. I also took a laxative that I was given when I was in the hospital for my first surgery. I did this until I had finished chemo and as needed for when I knew it could be a problem. (I usually drank lemonade or Crystal light to get some extra water)
Hope this helps
rm22111
Thanks for the advice on the constipation. As I get older it seems to be getting worse and the chemo really makes it worse. I have been eating berries in the morning with breakfast but I will add the prunes and apple sauce to that and see how it works. I drink water all day long. Everywhere I go I carry a bottle of water with me.
We will find out tomorrow more info on the TRAM flap reconstruction and if I get better insight i will post it to this site and let others know. Thanks and God bless!
Lorrie0 -
Where do you live, Lorrie?Balentine said:constipation
Thanks for the advice on the constipation. As I get older it seems to be getting worse and the chemo really makes it worse. I have been eating berries in the morning with breakfast but I will add the prunes and apple sauce to that and see how it works. I drink water all day long. Everywhere I go I carry a bottle of water with me.
We will find out tomorrow more info on the TRAM flap reconstruction and if I get better insight i will post it to this site and let others know. Thanks and God bless!
Lorrie
Where do you live, Lorrie? I live in Syracuse, NY, which isn't huge and we have an excellent plastic surgeon who does the procedure, and he is not connected to the teaching hosptial in town. It is my understanding that this surgeon is very well-known in his field, so you never know where you'll find the right doctor.
Joyce0 -
LorrieBalentine said:constipation
Thanks for the advice on the constipation. As I get older it seems to be getting worse and the chemo really makes it worse. I have been eating berries in the morning with breakfast but I will add the prunes and apple sauce to that and see how it works. I drink water all day long. Everywhere I go I carry a bottle of water with me.
We will find out tomorrow more info on the TRAM flap reconstruction and if I get better insight i will post it to this site and let others know. Thanks and God bless!
Lorrie
I had the Diep Flap last July and had no problems at all! I had a both breasts removed even though only one was affected. I didn't want the worry of the other breast and the tests that would follow. MRI's an Mammograms.... yes it was a long surgery 9 hrs. and I came home with 5 drains. 2 in my abdomen and 2 under one breast and 1 under the other. The last drain was removed at my 2 week check up. My ps specializes in this surgery and has done it many times! I only had morphine the first night and other than being sore i was fine. I also have a high tolerance to pain so I didn't atke any other pain meds. I didn't hurt I was just uncomfortable. I would do it again. I like how I look... I so far have chosen not to have nipples put back on and am thinking just doing a 3D tattoo instead..
Calleen0 -
Lorrie, with a littleCalleen said:Lorrie
I had the Diep Flap last July and had no problems at all! I had a both breasts removed even though only one was affected. I didn't want the worry of the other breast and the tests that would follow. MRI's an Mammograms.... yes it was a long surgery 9 hrs. and I came home with 5 drains. 2 in my abdomen and 2 under one breast and 1 under the other. The last drain was removed at my 2 week check up. My ps specializes in this surgery and has done it many times! I only had morphine the first night and other than being sore i was fine. I also have a high tolerance to pain so I didn't atke any other pain meds. I didn't hurt I was just uncomfortable. I would do it again. I like how I look... I so far have chosen not to have nipples put back on and am thinking just doing a 3D tattoo instead..
Calleen
Lorrie, with a little research, I think you might be in TX. I know that there are plastic surgeons in San Antonio that do this surgery.
Joyce0 -
FlapCalleen said:Lorrie
I had the Diep Flap last July and had no problems at all! I had a both breasts removed even though only one was affected. I didn't want the worry of the other breast and the tests that would follow. MRI's an Mammograms.... yes it was a long surgery 9 hrs. and I came home with 5 drains. 2 in my abdomen and 2 under one breast and 1 under the other. The last drain was removed at my 2 week check up. My ps specializes in this surgery and has done it many times! I only had morphine the first night and other than being sore i was fine. I also have a high tolerance to pain so I didn't atke any other pain meds. I didn't hurt I was just uncomfortable. I would do it again. I like how I look... I so far have chosen not to have nipples put back on and am thinking just doing a 3D tattoo instead..
Calleen
Hi Calleen,
I have heard about those 3D tattoos on this network also before. As I said, I do not think they do the DIEP at the hospital I will be going to...probably do the TRAM Flap and no one has come back to tell me they had that one done so don't have anyone yet to talk to about that one. I know I am going to take some time and be sure this is what I want to do before I agree to do it. You said you have a high tolerance for pain....well...I don't think I do...5 drains...you're a real trooper compared to me....I was upset with the 1 drain I had during my mastectomy and could hardly wait to get that one out. By the way....it hurt really bad when they ripped that out. I could not believe they just told me to take a deep breath and just quickly pulled it out....I refer to it as 'ripping it out' because that is what it felt like....it felt like they ripped a piece of my insides out and my right side still hurts 3 months later. Also having both breasts done at the same time may actually be better than doing one because they can make them both look the same. When you have just one done then you have to go back later to have the other lifted. We will see. I will let you guys know tomorrow what they say. Thanks for your advice as always. God Bless!
Lorrie0 -
In Texasjk1952 said:Lorrie, with a little
Lorrie, with a little research, I think you might be in TX. I know that there are plastic surgeons in San Antonio that do this surgery.
Joyce
Yes I am in Texas...San Antonio is about 2 hours from me. I just wonder how much different the DIEP is from the TRAM flap? Does it really matter which one you do and what the success rates are of each of them and satisfaction levels? I have to wonder.
Lorrie0 -
I just wanted to wish youBalentine said:what to do about reconstruction
I am surprised at how many have had the DIEP since there are only 40 surgeons in the U.S. that do it. I am thinking where I live I will have to have the TRAM. I will find out tomorrow. I have read posts about the expanders and silicone but some people have had some bad experiences with that as well from the pain of continually having to go back to have them filled and then having the possibility of rupturing, sleepless nights, etc. Also having to have them replaced after so many years. You just can't duplicate the way God made you. I am having the hardest time deciding on what to do so until I am sure I guess I will wait unless the plastic surgeon can somehow reassure me and talk me into it. I hate not having one of my breasts but I also don't want to take the chance of it not coming out right or going through infections and problems with drains, etc. It is a difficult decision but I thank all of you for your advise and letting me know your experience so I can be better informed when I finally do make a decision. This network has been such a blessing for me. I thank God for all the new friends I have made with others that really understand what I am feeling. There is nothing else that can compare when you need to reach out to someone for understanding other than reaching out to God....you all have been the closest thing to that for me these past 3 months. Thank you.
Lots of love,
Lorrie Balentine
I just wanted to wish you good luck Lorrie with whatever you decide to do.
Hugs, Megan0 -
DIEP vs TRAMBalentine said:Flap
Hi Calleen,
I have heard about those 3D tattoos on this network also before. As I said, I do not think they do the DIEP at the hospital I will be going to...probably do the TRAM Flap and no one has come back to tell me they had that one done so don't have anyone yet to talk to about that one. I know I am going to take some time and be sure this is what I want to do before I agree to do it. You said you have a high tolerance for pain....well...I don't think I do...5 drains...you're a real trooper compared to me....I was upset with the 1 drain I had during my mastectomy and could hardly wait to get that one out. By the way....it hurt really bad when they ripped that out. I could not believe they just told me to take a deep breath and just quickly pulled it out....I refer to it as 'ripping it out' because that is what it felt like....it felt like they ripped a piece of my insides out and my right side still hurts 3 months later. Also having both breasts done at the same time may actually be better than doing one because they can make them both look the same. When you have just one done then you have to go back later to have the other lifted. We will see. I will let you guys know tomorrow what they say. Thanks for your advice as always. God Bless!
Lorrie
Hi Lorrie -
I did not choose either of these procedures, but I work in as operating room nurse in a large teaching hospital in CA and have seen these procedures multiple times. Both are Major surgeries with risks and complications (as are all surgeries). The resulting breast mound from both surgeries are cosmetically pleasing, but be aware you will have triangle type scars that will fade with time. But you will have scars no matter which route you choose. The advantages of TRAM is you also get a tummy tuck, the disadvantage will be additional pain (skin stretching), there will be multiple drains with both procedures, probable ICU admission and additional recovery time. You may also need a small implant depending on your skin, your transfer site, and the size that you wish to be after all is said and done.
You say you have a low pain threshold, but there are amazing pain medications available, so DON'T suffer, ask for something else if one medication is not working. There are also additional medications that potentiate the pain medications and help with nausea. Your MD will be aware of these and just ask your nurses for more if needed. They will possibly set you up with a PCA (patient controlled anesthetic) that you will be able to self deliver your pain medication without fear of overdose. (there is a lock out so you cannot over do it)
Here is a great website for those on the fence:
http://www.breastreconstruction.org/
Look at the personal stories and there are wonderful actual patient before and after photos, make sure to ask your PS about his actual photos (he should have them).
Best of Luck with whatever decision you make - Carrie0 -
I recommend the website thatCarrWilson said:DIEP vs TRAM
Hi Lorrie -
I did not choose either of these procedures, but I work in as operating room nurse in a large teaching hospital in CA and have seen these procedures multiple times. Both are Major surgeries with risks and complications (as are all surgeries). The resulting breast mound from both surgeries are cosmetically pleasing, but be aware you will have triangle type scars that will fade with time. But you will have scars no matter which route you choose. The advantages of TRAM is you also get a tummy tuck, the disadvantage will be additional pain (skin stretching), there will be multiple drains with both procedures, probable ICU admission and additional recovery time. You may also need a small implant depending on your skin, your transfer site, and the size that you wish to be after all is said and done.
You say you have a low pain threshold, but there are amazing pain medications available, so DON'T suffer, ask for something else if one medication is not working. There are also additional medications that potentiate the pain medications and help with nausea. Your MD will be aware of these and just ask your nurses for more if needed. They will possibly set you up with a PCA (patient controlled anesthetic) that you will be able to self deliver your pain medication without fear of overdose. (there is a lock out so you cannot over do it)
Here is a great website for those on the fence:
http://www.breastreconstruction.org/
Look at the personal stories and there are wonderful actual patient before and after photos, make sure to ask your PS about his actual photos (he should have them).
Best of Luck with whatever decision you make - Carrie
I recommend the website that Carrie includes in her post. My surgeries were actually one free TRAM flap and one DIEP. The free TRAM was done on the breast that had cancer and had been radiated. My breast surgeon recommended the DIEP or free flap and said that the pediculed TRAM isn't done much (if at all) in our area anymore.
Joyce0 -
Question for Joycejk1952 said:Where do you live, Lorrie?
Where do you live, Lorrie? I live in Syracuse, NY, which isn't huge and we have an excellent plastic surgeon who does the procedure, and he is not connected to the teaching hosptial in town. It is my understanding that this surgeon is very well-known in his field, so you never know where you'll find the right doctor.
Joyce
Sorry to be jumping into this conversation so late, but I was just dx with BC for the 2nd time and I am looking at options for bilateral masectomy and this thread came up in one of my searches.
Joyce, I am in Syracuse, NY too and was wondering if you would mind sharing your surgeon's name with me. I was living in NYC the first time, so I sort of feel like I'm starting from scratch.
Thanks, Karen0 -
I would do it all over againBalentine said:In Texas
Yes I am in Texas...San Antonio is about 2 hours from me. I just wonder how much different the DIEP is from the TRAM flap? Does it really matter which one you do and what the success rates are of each of them and satisfaction levels? I have to wonder.
Lorrie
I had the DIEP reconstruction in San Antonio Texas, where I live from a wonderful team who are experts in that field. This is their website: http://www.prma-enhance.com/
Dr. Peter Ledoux is amazing. So caring and compassionate and darn good at what he does. I am very impressed with my results. He had Dr. Chet Nastala assist and it took about 8 hours.
I was in the hospital about 5 days and the first 2-3 day were the toughest for me. I was hot as it is (hot flashes) and they kept the room really warm so that it could accelerate the circulation. It is considered transplant surgery since you're moving one body part to another part of your body so they do come in quite frequently and check that.
I was out of work for about 7 weeks but felt good once my drains came out about 2 weeks after I came home.
Pray for discernment and guidance from God. He'll lead you to the right decision.
If you have any other questions, you can call me at 210-383-3901.
Blessings!!
Sylvia0 -
Lorrie, I plugged in a reply
Lorrie, I plugged in a reply right after yours stating you were from Texas. Please go back up there and read it. I sent you the web site of a team of experts that are well respected for this type of surgery (DIEP). I highly recommend them, especially Peter Ledoux.
Call me if you have any questions.0 -
Thanks sea60sea60 said:Lorrie, I plugged in a reply
Lorrie, I plugged in a reply right after yours stating you were from Texas. Please go back up there and read it. I sent you the web site of a team of experts that are well respected for this type of surgery (DIEP). I highly recommend them, especially Peter Ledoux.
Call me if you have any questions.
I will talk to my plastic surgeon again on 7/13 and see what he says but I know the last time I talked to him, he wanted to do the muscle sparing free tram flap on me after examining me. I am also considering having my other breast removed since I am a poor metabolizer of tamoxifen. I will be discussing this with a 2nd onc tomorrow to get a 2nd opinion before we take off for the weekend to St. Louis so I will try to check in with you again over the weekend if I get some wifi where we are going. Thanks for the information and I will definitely consider all my options and do my research before I make a final decision.
Lorrie0 -
Hi Karen, I'll PM you withKC1969 said:Question for Joyce
Sorry to be jumping into this conversation so late, but I was just dx with BC for the 2nd time and I am looking at options for bilateral masectomy and this thread came up in one of my searches.
Joyce, I am in Syracuse, NY too and was wondering if you would mind sharing your surgeon's name with me. I was living in NYC the first time, so I sort of feel like I'm starting from scratch.
Thanks, Karen
Hi Karen, I'll PM you with the information including the breast surgeon and plastic surgeon's name and phone number.
Joyce0
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