DIEp Flap: Recommend or Regret

I knew that I wanted DIEP flap reconstruction because I thoroughly researched my options and concluded that DIEP flap offered the best quality of life for women who choose reconstruction. Get the best plastic surgeon with a lot of experience doing DIEP flap. It takes a very dedicated and highly skilled surgeon who is willing to to dedicate the time to become an expert in mocrovascular surgery. In my opinion there really isn't a risk with the right surgeon.

And, to answer your question, yes, this reconstruction surgery helped me to move on. I needed to wait a few months after my double mastectomy because I had to have radiation and then heal from it. I hated putting on the prosthetic bra every morning. I actually like my new breasts better than the "original" ones. They are more upright, more comfortable, and I have the freedom of not having to wear a bra!

It's very considerate of you to not want to put your family through another surgery and recovery but really, it's not about anyone but you. I took two months off from work but didn't need any help for everyday activities. I wish you the best!

When I was presented with options for reconstruction, the flap immediately felt like the right choice. A year later I still feel the same. I was unable to use the stomach tissue though, so the inner thighs were used. It was a painful and long recovery, but the benefits outweighed the negatives. My breasts feel very much the same as they did before. They are warm, have blood flow, and they are soft and act natually. I have some tactile feeling, more as time goes by. I agree that the surgeon should be researched thouroghly! This is a very delicate and difficult surgery. Very few are specialists. 
I think after any moving around or removal of our "parts" will leave us a little out of sorts for a long time., if not forever. There is a little body dismorphia of sorts to go through, at least for me there is. For me it wasn't like a nice thigh lift and new breasts. It is that my body I've been living in all my life is different, just different. But I'm alive, and healthy. I can't beat that. Listen to your gut. Good luck! 

Hello Juls1921,

I read your message and had to immediately respond. Just a bit of my background; I was diagnosed with Atypical Ductal Hyperplasia of the left breast back in 2015. I ended up getting 2 lumpectomies back to back in November/December of 2015; after the doctor's discovered from my first lumpectomy that there was actually non-invasive cancer (DCIS) found in my pathology report. I was very diligent in attending my every six month checkups. Everything was good until April of 2019 (DCIS/Non-Invasive Cancer in same breast); I had a reoccurrence and after all the multiple biopsies and crap over the years the next and only option was a mastectomy. When I was thinking about a mastectomy prior to choosing the lumpectomy back in 2015 as a preventive option; I did the research and after much thought between implants and DIEP Flap; DIEP Flap would had been my option back then. I did not want to go the implant route because of the potential danger of leakage and perhaps trading off one form of cancer for potentially another (ALCL) https://www.healthline.com/health-news/rare-lymphoma-breast-implant#1. So after taking that Oncotype Test (to test the least likely % of a reoccurrence) I went the lumpectomy route back in 2015 because it was still a low percentage at I think 11% or 13%.

Fast forward/DIEP Flap Graduate (2020): I’m actually glad I did go the Flap route because prior to my surgery one of the members where I instruct and personal train at; told me her daycare worker had implants for 10 years and apparently this whole time her body was treating them like a foreign object and basically got to the point where she couldn’t lift her arms over her head due to so much scar tissue damage. Luckily she got them out and it did not cause any cancer, but she ended up having to go back and get the Flap after all that time just this past year in 2019 as well.

Journey To The Flap: The doctor who has been handling my case all these years has been nothing but great but he knew that I didn’t want implants and sadly we had to part ways, but that was not until after he made sure I was well taken care of and referred me to one of the best surgeons and reconstruction physicians in the area.  I had two surgeries done. One surgery took place in June of 2019 (removal of breast tissue and the DIEP Flap procedure/creation of my new belly button; total around 5 hours) and the final reconstruction that took place after 12 weeks was done in September of 2019 (lift of the right breast and the bells and whistles were done). Now, I was blessed that they found it early and so when they tested some of my lymph nodes it had not spread so this is why I was able to move into my transition quicker. The plastic surgeon agreed to do the DIEP Flap on me by in April of 2019, but that was also in contingent if I gained enough weight by the time of that June surgery or he would have to take it from my butt; and I wasn’t trying to have that…LOL!

The challenge for me was I had just transitioned prior to the cancer diagnosis to Vegan and so I had to do some adjusting to make sure I kept weight on that I gained in order for them to use my abdominal area.

Now the difference from what my understanding is that back then they used to include muscle into the flap procedure; whereas now the focus is more of getting the fat tissue from your butt, stomach, or if you got any back fat. They may cut the muscle but don’t include it when they do the reconstruction and connect the blood vessels. The plastic surgeon said that way of the procedure has changed over the years and the way he made it sound was that majority of the hospitals stopped doing that method. But it doesn’t mean it still don’t exist. Anyhow, my surgeon did end up having to use both sides of fact tissue of my abdominal area to form my left breast because I was a smaller frame.  However, I am sitting here today and it being almost a year…in saying it was the best decision! Also, in March of 2020, I just had my tattooing of the nipple part from the remainder of my reconstruction complete and so we call that graduation day and so I’m done! I had a really good surgeon and that is key with any procedure. So, make sure you get with a physician you trust and go with your gut because this is a major decision to make. It feels much more natural and I lie to you not, if it wasn’t for my surgical scar; my husband was like a person wouldn’t even know I had a mastectomy. Now, my core after this second surgery did get much weaker and I see you are active like me in doing kickboxing, etc…So don’t rush your recovery. I am just now about to start my shuffle jog/walk portion of what my PT wants me to do to stay on track. I am not back to burpees, etc but I feel great and know I’m recovering well because I am doing what I supposed to. A few other things I would suggest a compression sleeve or ask your physical therapy if you can be prescribed one because you are active and watch for any signs of lymphedema due to the nodes removal. I surprisingly experienced a mild case of lymphedema but because again I had good doctors and the man upstairs; it was caught early enough where it was reversed. It has been studies that if you catch lymphedema in stages of 0-1 it can be reversed. I’m living proof it holds true. They tested me back in November 2019 during my check up; this is after getting the proper care on this matter starting back in August; and my tests came by normal in reference to any signs of lymphedema. But you should still be cautious and like for me I have to wear my compression sleeve and do the lymph machine regularly for the first 2 years even though signs are back to normal because the physicians told me your first 2 years post-surgery is a patient’s most critical.  The final thing I like to share that these two thing will be your best friend to help with scarring:

https://www.palmers.com/cocoa-butter-formula-products/85-scar-serum.html

https://www.amazon.com/Rolyan-Massager-Scarring-Sensitivity-Incisions/dp/B0745JL8G6

Hope this helps/Well Wishes,

Dana

When I was diagnosed with breast cancer and was looking at going through chemotherapy I did my homework. I read everything I could about side effects of chemo. I was mentally prepared for anything that chemo could dish out. I prepared my family, my office, my bank, my creditors, my attorney, for all known contingencies. I was ready! When most of those horrible side effects did not effect me I felt blessed.

When I looked into a DIEP flap I could find no horrible side effects. Now I'm 3 1/2 weeks out following my DIEP flap procedure. I do not feel like I was properly prepared for this at all! I was not told that bowel movements would be iffy for a couple weeks. I was not told that bloating would be a real issue. In fact, I was told that "some bloating" would be normal, but I still don't know what that means! I'm still bloated so badly that I have to decide between eating food and drinking water most days because my stomach feels like there's no room. I'm so bloated that some of my stitches tore through the skin and my belly scar line opened up a bit. I'm told this is all normal. I was not told that my back would be in pain every minute of every day. I was not told that when my stitches tore I would then need to debride my scar line twice a day - a painful process - for weeks. The future will let me know what else I am facing that I was not told.

I wanted this surgery. I would most likely have opted for this surgery even if I had known all of these things. But I have the type of personality that NEEDS to be mentally prepared for Everything! By not preparing me for all these things I feel like my surgeon did me a major disservice. He could have told me the horror stories of the worst case scenarios and I would now feel blessed that what I am going through is so easy. Instead I feel like I'm being kicked in the stomach every day. If you, like me, need to know what to expect, here is your information. I trust that the end result is worth it.

I had single mastectomy with immediate Diep Flap reconstruction 3.5 weeks ago. Was an 11.5 hr operation! I had no desire to do implants and found a plastic surgeon who specializes in Diep Flap. So far, so good. Drains are out and surgical tape removed. Boy those scars are ugly, but I assume time will make them less noticeable. I plan on using silicone scar tape to help it along. dlaw1, thank you for the link to the Palmers website. Skin and abdomen tissue are still very tight, so I'm still a little hunched over and sleeping in a recliner. I was very lucky that bowel movements didn't change, maybe because I've always eaten so healthy, and also because I didn't take any narcotics, only Tylenol. I was told that the narcotics are what cause constipation. My breast is still swollen and a bit misshapen, but plastic surgeon said he will do some tweaking in 3 months to even everything out. 

All in all I feel I made the right decision. Hopefully I'll still feel that way in 3, 6 and 12 months!

Good luck with your journey.

I had DIEP flap 7 weeks ago and while it's not looking 'good' yet in my opinion, the plastic surgeon is very pleased and says that once all of the swelling is gone and a few months have passed (everything has to 'settle') that I'll be pleased too. 
There's no question about it--this is hard. Separate of a ca diagnosis (a recurrence in my case) and the joy of drains and tight scars, dealing with a physically changed body is a whole other thing to deal with. I think I've finally located a local therapist who has worked w ca survivors (and is one herself!), as I know that once the physical issues have passed, I'll need to address the emotional. 
At this point I don't regret having had the surgery. I felt like my doctor explained everything to me, but it's definitely a BIG deal. Happy to answer questions from anyone reading this who is considering it.