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Has anyone had a DIEP flap reconstruction on just one side, then a second surgery to make the breasts match?

Silver_Mama's picture
Silver_Mama
Posts: 7
Joined: Nov 2012

I am new to CSN and to breast cancer. I have surgery scheduled for Friday 11/16/12 for "in situ" CA with immediate reconstruction after a total mastectomy, preserving all the skin and hopefully the nipple. The doctor said if I have a mastectomy rather than a lumpectomy, I will not need radiation or drug treatment and will have a much lower incidence of recurrence than I would have with the lumpectomy even WITH radiation. This seems like a no-brainer to me. I have chosen getting a DIEP flap rather than implant. What concerns me is not that he plans to further adjust the reconstruction about 3 months later but he also plans to move the nipple on the normal breast higher to match the reconstructed breast. I think this is what is called a breast lift. I think it is supposed to make you look younger, which is nice, but it will probably take away sensation in the normal breast which seems like yet another loss. Does anyone know what this will do, how it will feel after it heals? Maybe this is necessary to make the breasts match. Maybe you can't shape a flap to match a saggy, middle aged breast. Has anyone here had this done?

RozHopkins
Posts: 451
Joined: Dec 2010

No didn't have this done but had two mastectomies one month apart. Even then the two sides were totally mismatched then one side greatly reduced and now doesn't look perfect but totally acceptable. I had implants hopefully someone on sight can help you more. Good luck to you.

Kylez's picture
Kylez
Posts: 3765
Joined: May 2009

Hoping your surgery went well for you. Post an update when you are feeling like it.

Hugs, Kylez

CypressCynthia's picture
CypressCynthia
Posts: 3933
Joined: Oct 2009

I have a diep on one side and an sgap on the other. I had a mastectomy in 1987 and reconstruction a year later (diep). In about 1995, I had a second preventive mastectomy (after 2 sisters subsequently also had IDC) with SGAP (used butt).

My results are not perfect as my original side is quite a bit smaller. Also, probably because the second breast did not have cancer and also techniques have just gotten better and better, the later reconstruction is just beautiful (if I do say so myself).

As to sensation, I think your instincts are right, because after each surgery that I have had (breast or elsewhere), I have always lost some feeling at the site.

BTW, after my first reconstruction, my physician put an implant behind the healthy breast because it too was saggy and small and impossible to match. It then matched, but I have to tell you that I hated the implant. After a few years, it began to hurt more and more. I was happy to have it out when they did the second mastectomy and I personally can't recommend implants. My surgeon said that they do have a "shelf life" and most women will need them replaced in about ten years. The worst part about the pain and tenderness associated with the implant was the worry that it could be cancer--bot the implant. Not for me!

P.S. I apologize if this is rather rambling...lol--just home from a 24 hour shift.

Silver_Mama's picture
Silver_Mama
Posts: 7
Joined: Nov 2012

My plastic surgeon said the implants have improved and no longer need to be replaced over time. He said this when I brought up the issue about the leaking implants that reportedly caused neurological damage. He said the silicon implants are a solid gel now and will not leak into the body if damaged; however, I have read about scar tissue forming around the implant and maybe that is why you had pain.

I am planning to have the DIEP flap not an implant. So you didn't have the nipple moved up when the implant was added to the healthy breast? That is my question. Should I just get him to leave it alone. I really dislike the thought of losing the normal feeling in both breasts, but I don't want to look like a freak with one breast pointing north and the other south, if you get my meaning.

cinnamonsmile
Posts: 1049
Joined: Dec 2010

Odds are you probably won't need radiation after a mastectomy for DCIS. However, there have been instances where people have needed it.Having a mastectomy for DCIS is not a 100% guarantee that you won't need it. Sometimes, after a pathology report comes back, IDC is also found.
What kind of doctor said you won't need any other drugs? Was it an oncologist or surgeon? I would consult with an oncologist for that. Sometimes people who have DCIS and get a single mastectomy require hormonal therapies that block the cell's ability to use hormones like estrogen. If your cancer was not hormone positive, I can totally understand that.

When I saw a plastic surgeon for a consult, and was planning on a single mastectomy at the time, I told her I wanted the new breast to match the saggy one. She looked at me like I was speaking a different language. My breasts were old and saggy. That was me. That's what I wanted. Turns out that was the one and only time I saw her because I opted for a bilateral mastectomy with no reconstruction.

I think it is common for many women to get both breasts to match as close as they can get it.

Are you having two surgeons in your surgery? One, a breast surgeon and the other the plastic surgeon?

Silver_Mama's picture
Silver_Mama
Posts: 7
Joined: Nov 2012

The surgeon doing the mastectomy is an oncological surgeon. He said I am Stage 0 and barring any evidence of further CA in the signal lymph node, and of course the breast tissue will be examined further, also, I will have a lower chance of re-occurrence with the mastectomy alone than I would have with a lumpectomy with radiation and Tamoxifen. The problem with taking Tamoxifen is there were not enough cancer cells to test for hormone sensitivity. The biopsy only found cancer in one duct out of all 6 samples taken. I believe I read where most in-situ cancer is estrogen sensitive, so I guess that is what he assumed. I am small breasted, so a lump that included all the calcification would be about 30% of my breast and so disfiguring I can't see the advantage in trying to save anything more than the skin and nipple, esp. with the significantly reduced chance of re-occurrence if I get the mastectomy.

To answer your second question, I will have 3 surgeons. The oncologist will do the mastectomy, which he said will take about 40 minutes. The 2 plastic surgeons will work on doing the flap (and resulting tummy tuck) and the breast reconstruction which will take 4 to 5 hours. Sounds like a fun day.

I have only been lightly anesthetized for about an hour once (skin graft following radical melanoma surgery--30 years ago, not to worry). Also, I have many, many antibiotic allergies, a problem I have dealt with by not taking ANY antibiotic for about the past 12 years (trust me, staying home, plenty of fluids and extra sleep will get you to the point after a few years that you have less colds, etc.) So I do have some anxiety about this surgery. The good news to my way of thinking is I will wake up with a breast of some sort and I won't have to face further treatment. AND I got to tell my elderly parents that I have a much better chance of survival than when I got the melanoma surgery.

cinnamonsmile
Posts: 1049
Joined: Dec 2010

I had DCIS,too but had a double mastectomy. Good to hear you have such a good team! I hope everything goes well. Do you have a date for surgery,yet?

DianeBC's picture
DianeBC
Posts: 3888
Joined: Jun 2009

Just wishing you good luck with your surgery!

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