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I want to hear positive stories of tram and diep flap reconstruction

smbrand158's picture
smbrand158
Posts: 19
Joined: Oct 2011

I am seeing a plastic surgeon this week to discuss reconstruction after having a mastectomy, chemo and radiation a year ago.  I would prefer to use my own tissue rather than an implant because I feel that the implant side will feel different than my remaining breast, and I have come to understand that using an implant under radiated tissue isn't preferred by physicians.

I have researched both the tram and diep flap procedures and would like to hear from surviors that have had positive results. I would like to know what the recovery time was and what, if any, issues they have had with the loss of adominal strength, and I am curious about what the scars will look like 3-5 years out from the surgery. Most of the pictures on the internet are from recent surgeries, and though I know everyone heals differently, I would like to hear how much the scars have faded.

The surgeon that I have been referred to does not do the diep flap (I plan to ask him why he doesn't at my appointment this week), so if I stick with him my only option will be the tram flap, which kind of scares me because of some of the stories that I have been seeing on other posts, and I am fearful of losing muscle control in my abdomen.

Thanks

CypressCynthia's picture
CypressCynthia
Posts: 4015
Joined: Oct 2009

Way back in the Dark Ages (1988), I had a pedicled TRAM.  My PS now only does the free flap TRAM.  In about 1997, I had an SGAP (they take from your butt) free flap on my other side.  The free flap was much, much easier.  The free flap side also looks much better, but, to be fair, I did not have cancer in that breast.  I removed the second breast preventatively after two sisters later turned up with breast cancer--one sister with cancerous cells in both breasts.

Anyway, for me, the reconstruction was worth it.  I am very outdoorsy and love to swim.  I feel much less self conscious and the sisters look better than they did before...lol. 

I also really appreciate that I never have to worry about implants again.  The implant that I had once on my unaffected side after my first surgery (placed to provide a better match for the reconstructed breast) was hardening and hurting with time.  My PS said that is not unusual and he doesn't use implants anymore for that reason.  I know many do not have problems with implants, but my PS said that, for many, about ten years is all most will get before they begin to have problems.  The discomfort with the implant was not only painful but scary because I was never 100% positive if it was the implant or cancer.

It is surgery and there will be a down time, but, for me, the result has been awesome.  It is done and it is me and very natural Smile

lintx's picture
lintx
Posts: 456
Joined: Sep 2012

Mine was done at the same time as the bilateral. I had skin sparing reconstruction and woke up w/breasts.  My recovery time was about two weeks.  I was driving again when the tubes were removed.  I did need someone with me at home in the beginning.  I've always been an active exercise person, so in the third week, I was walking 2 mi a day.  After a month, 4 miles.  I listened to the DR and only did what he knew I'd be able to do.  Had revision surgery in Aug '12 for nipples and to straighten the scar tissue some.  My scar is a thin line from one side of my body to the other.  It has improved beautifully.  Nipple tattooing was in Dec '12.  My DR said to stay out of the gym from May until the beginning of November, and I did.  I've been back to yoga and zumba since.  I can do sit-ups, etc.  There is no muscle involvement w/the diep flap.  Mine was done by PRMA in SA, TX.  People travel from all over to see our DR's.  If you're close, think about it!  Best to you, Linda 

McMarty's picture
McMarty
Posts: 200
Joined: Nov 2012

I had DIEP Flap in 2004.  It was still pretty new back then.  I was told after TRAM you couldn't lift more than 15 pounds ever or you would risk hernia.  I had little kids and a little girl with Down Syndrome so not lifting was not an option.  I was VERY fortunate to find a Dr that could do the DIEP flap her in my area and on my insurance! 

I would drive to the moon to find someone who could do that surgery instead of compromising my abdominal muscles or doing the pedicle thing.  I, like Linda needed help for a couple of weeks and once the drains were out, I could drive and get around pretty well!

The breast scars have faded wonderfully.  The abdominal scars are minimal now too.  My new belly button is a little weird but that was my fault.  I fiddled with the stitches cause they itched and were loose.  (Don't do that) 

After surgery, there is some weird nerve sensations that happen because so many things have been moved around but I'd say in less than a year, it was all better.

Hope that helps!

sal314
Posts: 633
Joined: Jul 2010

I'm so happy to read some "good" stories! I'm scheduled to have my DIEP surgery on one side next Tuesday and I"m freaking out a little bit. I really don't want to be one of those that don't feel back to themselves until a YEAR later! LOL. I have a daughter with DS too! How old is your little girl? Mines 8 and she the light of my life! She's also REALLY stubborn and has quite the attitude. I'm hoping she will be cooperative while I'm recovering! Otherwise, it's gonna be a long couple of months! LOL! Embarassed

 

helen e's picture
helen e
Posts: 223
Joined: Sep 2009

I had the tram flap 3 years ago and although the PS did an excellent job if I had it to do all over again I'd choose the DIEP. I have a big bulge from my ab muscle being flipped. It is still tender and I hate it!! I am very self conscious about it. He told me it wouldn't be so noticeable if I weren't so skinny and that he could go in and take more off but it would leave more scarring and I've had enough of hospitals and surgeries. I was out of work for 2 1/2 months, spent 6 days in the hospital and had to have two more surgeries. I was to build a shelf under the breast and the other was to build me a nipple. Though I think the worst part was the tattooing of the areola. My stomach is still a little sensitive but nothing I can't live with. If the DIEP weren't an option I'd have the tram flap all over again if I had to.

smbrand158's picture
smbrand158
Posts: 19
Joined: Oct 2011

I appreciate all of the input ladie's, thank you so much.

The diep is my preference, but I am still going to see the first surgeon and ask why he doesn't do the diep. My oncologist said that should I choose to to with the diep instead of the tram the surgeon will pass me on to his partner, the surgeon that does do the diep, without any hesitation or hard feelings. She also said that it's good that I know what I want and don't want (implants) and should get very good results. 

McMarty's picture
McMarty
Posts: 200
Joined: Nov 2012

I am so glad your Plastic Surgeon has a partner that does the DIEP Flap.  That is great news!  Keep your ears open and keep looking up everything you hear :)

Keep us posted!

 

mariam_11_09's picture
mariam_11_09
Posts: 693
Joined: Nov 2009

A little late coming in on this discussion but here is my experience anyway.   I had DIEP flap on 1/5/10 (3 yrs ago) on the left.    Immediately following the surgery was a little rough for a couple of weeks and I did need help (the women on this board were very helpful informing me of what I needed).  Went through chemo, then radiation and herceptin.   In 10/14/2011 ( a year and a half ago) I had the final reconstruction, nipple added and right breast lifted along with a hernia repair.   Here is what happened:

1.In a small number of cases the DIEP flap can result in some herniated problem.   Mine was a complication as a result of a number of things, a uterine fibroid, stomach muscled that seperated during pregnancy and didn't knit back tightly enough and  the DIEP flap surgery.

2.I had the DIEP flap before radiation so there was some shrinkage.  Not much but enough to give it a slightly odd shape.   The PS wanted to add a little more fat to the reconstructed breast, I said NO because I am done with surgeries.

3.Here is where I get vain.  While stomach fat was removed, the love handles remained and even though I have lost weight, those love handles remain which look a little odd without the right amount of padding in the front.   Minor I know and I can live with it.

4. 3 year laters on the reconstructed breast you can hardly make out the scars and the lifted breast 1 1/2 years later are fading really well.   1 1/2 years later on the cut on my stomach (was cut in the same place for the hernia repair) again  the scar has faded so much it is not that noticeable, in fact I am not it aware of it anymore. 

I have mixed feelings about the DIEP flap, the surgery itself, the recovery and potential problems.  However I am not sure I would have gone with TRAM or implants either.  So all in all, I think this was the better surgery for me to have.   My breasts are now pretty even now and with clothes on, you would never know.  At the end of the day I am not sure I would want to be dealing with a prothesis so am grateful I have something that allows me some normality.

Wish you well.

smbrand158's picture
smbrand158
Posts: 19
Joined: Oct 2011

I've seen the PS and we discussed the TRAM ans DIEP surgeries. He said both are very viable solutions and that I should have a very good outcome with either; he has encouraged me to meet with a surgeon that does the DIEP so that I can get a feel for if it is what I want. His partner no longer does the DIEP, so he has referred me to a couple of surgeons in the area. I have also contacted the surgeon that did my mastectomy to see if she will give me some advice and a referral as well. She did an excellant job on the mastectomy, the PS was very impressed and said so, and I trust that she would be a very good resource.

The PS said that the major difference between the two surgeries is that the DIEP is micro surgery, a much longer and intense surgery to do. The recovery and failure rate of the two is about the same.  If I were to have the TRAM I wouldn't be back in the gym doing a full workout until about 6 weeks out, the DIEP would allow me to start back at the gym in about 3 weeks. As for going back to work he said that with either I could probably be back to my desk job in 2-3 weeks, and as for the loss of abdominal muscle, he said that it is minimal. Both surgeries cut through the facia which is what really holds things together. The abdominal muscles consist of 10 muscles and I would be losing one. I am in pretty good shape, so all of what he has said makes sense to me.

I hope to hear from my surgeon this week an will make an appointment to see a DIEP surgeon. 

Thanks for all of your input ladies. I have been reading through the Discussion boards since my diagnosis Sept 2011 and have found them very helpful for any questions that I have had.

 

 

smbrand158's picture
smbrand158
Posts: 19
Joined: Oct 2011

Diep flap surgery is scheduled for Sept 18th Cool!

Nervous, but excited at the same time and looking forward to not having the prosthesis. Worried about the scarring and my body image, especially after the first stage because I know that my breasts will not look the same, or even close to the same until after the second stage surgery for nipple reconstruction and symmetry. Feeling good about my decision to have the diep flap and looking forward to having cleavage again.

 
Vecon3res's picture
Vecon3res
Posts: 1
Joined: Aug 2013

I had DIEP flap reconstruction on July 18th and I'm happy to report that I feel terrific. I am even contemplating attempting work this coming week or next (even though the recommended recovery time is 6 weeks). My hospital stay was five long nights and the second and third days were rough (not so much the first because of the anesthesia and pain meds). The first shower and daily showers for the first week were rough (get a bench for your tub or shower so you can sit & take the strain off your lower back). Mostly the first ten days of discomfort were the drains and lower back pain. I needed a lot of assistance the first ten days or so and thankfully had my mother come stay for four week (she just left yesterday :() and my husband to help with our 2.5 and 4.5 year old daughters. I did lots of nothing and napping with some walking laps through the house. Use your recoverytime to get plenty of rest, water and pain meds (stay ahead of the pain).  Follow doctors orders--wearing the abdominal binder and post-surgery bra provide a lot of good support.  Feel free to ask any questions as this is all so fresh in mind... Bottom line, after 9 hours of surgery (two flaps to one breast, some repair to separated and herniated stomach muscles, and a new belly button), a traumatic first few days, awesome cleavage almost immediately (but definitely not asymmetrical yet), lots of rest after, I'm happy. I wish you the same excellent care and speedy recovery.

sal314
Posts: 633
Joined: Jul 2010

I'm scheduled to have mine on the 17th! I'm feeling the same as you are...nervous but excited at the same time! Not looking forward to the recovery, particularly the dreaded drains! My last reconstruction 6 years ago they were in for 4 weeks! I almost went postal on my surgeon! LOL.

 

Wishing you the best! Maybe we can commiserate together during our recoveries! Compare notes! LOL.

sea60's picture
sea60
Posts: 2601
Joined: May 2010

and I would do it again. It was an 8 hour surgery and recovery was slow. After 5 years the scars have faded and are almost invisible. I don't have any abdominal pain and so far, no problems. I have just a bit of permanent numbness on the right breast where the cancer was. Just research each one carefully to make the best decision for you.

Sylvia

sal314
Posts: 633
Joined: Jul 2010

Hi ladies! I'm new to this site, but not to recontruction! LOL. I'm having a DIEP flap done next Tues. on one side to fix the ongoing problems with the implant I have when I had a LAT flap done back in 2006. I've read so many BAD stories, it's nice to finally read some good ones! I usually don't get all that nervous about surgery, but this one is just for whatever reason, kinda of freakin' me out a little bit. I think it's probably a combination of the surgery plus just nervous about how things will be at home with my 2 kids. Being in the hospital for 3 days isn't all that long, but the longest I've been before! I'm sure they'll be fine with their dad and grandma, but it's just that guilty, worried mother thing you can't control! LOL.

 

Anyway, I look forward to chatting with others about my recovery and hopefully HAPPY feelings about my decision after it's over!!

 

Sally

smbrand158's picture
smbrand158
Posts: 19
Joined: Oct 2011

I had my diep flap surgery on Wed as planned and came home yesterday (Fri) afternoon Cool. So far everything looks good and pain is managable. I haven't seen my tummy scar yet, but will tonight when I shower, the breast flap it's self is a little larger than I expected, but the surgeon over filled on purpose so that after everything settles a bit he can remove any extra tissue. I had requested that he try to match my remaining breast as close as possible as I am not wanting to have anything done to it if possible.  

I am able to get up and wander around my house and expect that I will move to outdoor waliking soon. I am a lttle hunched over which affects my back, but it's ok, I feel good about it the whole experience for sure. The doctors, nurses and everyone at the hospital have been great.

 

k79mill
Posts: 1
Joined: Aug 2014

Hi ladies, I'm new to this board.  I was wondering if any of you had PRMA do you nipple tattooing.  They performed my DIEP on March 2014 & the 2nd stage on July 24th.  I'm going to be going there for my nipple tattooing at the end of Oct of 1st of Nov.  I'm just wanting to get some input on some experiences with the tattooing at PRMA.

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