CONFUSED re: reconstruction after mastectomy - tissue expander vs DIEP or TRAM

dancR22
dancR22 Member Posts: 8
edited March 2014 in Breast Cancer #1
Need to have a mastectomy after reoccurance -I just met with plastic surgeon and am leaning toward DIEP - he said that I am a candidate for this, but due to my "just enough" tummy tissue there is a chance that he will have to take a tiny portion of stomach muscle... anyone out there have any experiences to share? I have to admit I like the idea of the tummy tuck (love for something good to come out of this) but certainly not making my decision based on that!!!

karen

Comments

  • jcarm
    jcarm Member Posts: 1
    #2
    tissue expander
    I have had a rt breat reconstruction using an expander. The expander was put in at the time of my mascetomy. I then had the implant put in and a breast reduction on the lt breast. In two weeks, I go in to get a nipple.Then I will follow up with the tatoo.
    I have had relativley little discomfort. My plastic surgeon did a great job and even my docs say it looks good.
    I found the decision to be very difficult but I am happy with the result.
    Janet
  • quail
    quail Member Posts: 5
    #3
    tram
    At the time of my bilat mast I had expanders placed. During the expansion I had not pain, no senation either but no pain. One deflated shortly after I started chemo and I spent the next year with stuffing on one side, it looked like an oversized shoulder pad. At about 1 year from the mastectomy I had bilat tram flaps. This was just under 3 months ago. I am happy with the resutls, is it perfect? no, can it be revised? yes, will I get nipples? Don't know at this time. The recovery was wicked. I was ready to return to work 2 weeks after my mastectomys but at two weeks I was still not sure I would recover after the Tram flap.
    Would I do it again-Yes.
    Best advise is to take your time and talk to your surgons, and the people who really know you. My husband had a lot of good insight.
    Q
  • jk1952
    jk1952 Member Posts: 613
    #4
    Bilateral mastectomy and DIEP
    I had a bilateral mastectomy done two months ago, and immediately had one breast reconstructed using DIEP and the other with a free TRAM procedure. I had a body built for the DIEP surgery, with lots of abdomen and small breasts. I had a lumpectomy and radiation in 2000, and the reconstruction with expanders was not available to me because of the radiation. In fact, the radiation had affected the blood supply in the breast, so the plastic surgeon was concerned about reconnecting the blood supply. To date, everything seems to be fine.

    The recovery is tough: I missed only a few days of work when I had lumpectomies, but I've been out of work almost eight weeks and plan to go back on my eight-week anniversary and work six hours a day instead of eight for at least a couple weeks. I think that I'll be very happy after I have the follow-up surgeries done, but it is a long process. The biggest advantage is that your own tissue is used, so it will age naturally, and you won't have foreign material in your breasts.

    The most important thing is to have a plastic surgeon who is well-trained and has done a lot of the DIEP procedures. One website showed that there are only about 150 plastic surgeons in the US who are qualified to perform this procedure. I was fortunate that my breast surgeon referred me to a plastic surgeon whose office is 2 miles from my house (in Syracuse, NY), and he is very well known in the Syracuse area and in plastic surgery circles for his expertise for this surgery. My bottom line would be that you need to have a great deal of confidence in your plastic surgeon: he's the one that will be operating for several (for me seven) hours and will be responsible for your care. I'll try to find some of the websites that I found helpful relative to the DIEP procedure.

    Hope this helps. I wish you the best in your decision and your treatment journey.

    Joyce
  • jk1952
    jk1952 Member Posts: 613
    #5
    jk1952 said:

    Bilateral mastectomy and DIEP
    I had a bilateral mastectomy done two months ago, and immediately had one breast reconstructed using DIEP and the other with a free TRAM procedure. I had a body built for the DIEP surgery, with lots of abdomen and small breasts. I had a lumpectomy and radiation in 2000, and the reconstruction with expanders was not available to me because of the radiation. In fact, the radiation had affected the blood supply in the breast, so the plastic surgeon was concerned about reconnecting the blood supply. To date, everything seems to be fine.

    The recovery is tough: I missed only a few days of work when I had lumpectomies, but I've been out of work almost eight weeks and plan to go back on my eight-week anniversary and work six hours a day instead of eight for at least a couple weeks. I think that I'll be very happy after I have the follow-up surgeries done, but it is a long process. The biggest advantage is that your own tissue is used, so it will age naturally, and you won't have foreign material in your breasts.

    The most important thing is to have a plastic surgeon who is well-trained and has done a lot of the DIEP procedures. One website showed that there are only about 150 plastic surgeons in the US who are qualified to perform this procedure. I was fortunate that my breast surgeon referred me to a plastic surgeon whose office is 2 miles from my house (in Syracuse, NY), and he is very well known in the Syracuse area and in plastic surgery circles for his expertise for this surgery. My bottom line would be that you need to have a great deal of confidence in your plastic surgeon: he's the one that will be operating for several (for me seven) hours and will be responsible for your care. I'll try to find some of the websites that I found helpful relative to the DIEP procedure.

    Hope this helps. I wish you the best in your decision and your treatment journey.

    Joyce

    I found the following
    I found the following website to be quite useful when I was researching the DIEP procedure: http://www.prma-enhance.com/index.cfm/PageID/4262

    Hope it helps answer some of your questions.

    Joyce
  • 20questions
    20questions Member Posts: 24
    #6
    www.breastreconstruction.org
    has a wonderful laypersons description of the flap procedures DIEP vs TRAM. Sounds like a free TRAM when using even a little bit of muscle.
  • jk1952
    jk1952 Member Posts: 613
    #7
    Yes, that's right. The
    Yes, that's right. The procedure is a DIEP if no muscle is used. It's a free TRAM if some muscle is used. One of mine was a free TRAM because they needed to take a small amount of muscle to get a good blood supply.

    Joyce
  • dancR22
    dancR22 Member Posts: 8
    #8
    jk1952 said:

    Yes, that's right. The
    Yes, that's right. The procedure is a DIEP if no muscle is used. It's a free TRAM if some muscle is used. One of mine was a free TRAM because they needed to take a small amount of muscle to get a good blood supply.

    Joyce

    free tram
    Hi Joyce - with the free TRAM how has your abdomen been affected? k
  • joannem65
    joannem65 Member Posts: 17
    #9
    I did Tissue Expander
    I did tissue expander...not really a choice, but it worked. I wasn't a good candidate for tram flap and didn't want extended recovery time post op for diep.
    Now that it's done you cant tell "real" vs "Saline" and tomorrow I get my NIPPLE : )
    When I'm dressed (with bra or w/o) you have to really look to see which is the implant. I'm very satisfied with the end result, but for me it was a long hard battle to get to this point. I let my PS lead me in the right direction for choice and type (saline) but that's what we pay them the big bux for...expertise. I'm a full B / sm C cup but very happy and I love the "Lifted" side too.... I don't have to wear a bra if I dont want too. And my breast doesn't touch my tummy anymore!! (NO Sag factor!)
    Good luck
    joannem65
  • tommaseena
    tommaseena Member Posts: 1,769
    #10
    joannem65 said:

    I did Tissue Expander
    I did tissue expander...not really a choice, but it worked. I wasn't a good candidate for tram flap and didn't want extended recovery time post op for diep.
    Now that it's done you cant tell "real" vs "Saline" and tomorrow I get my NIPPLE : )
    When I'm dressed (with bra or w/o) you have to really look to see which is the implant. I'm very satisfied with the end result, but for me it was a long hard battle to get to this point. I let my PS lead me in the right direction for choice and type (saline) but that's what we pay them the big bux for...expertise. I'm a full B / sm C cup but very happy and I love the "Lifted" side too.... I don't have to wear a bra if I dont want too. And my breast doesn't touch my tummy anymore!! (NO Sag factor!)
    Good luck
    joannem65

    Tissue expander
    I had a double mastectomy with tissue expander put in at the time of surgery.
    I will have the expander taken out three months after I finish my chemo treatment and the semi-permanent one put in. I call it semi-permanent because they don't last a life time the life span for the implants are 10-15 years I was told by my PS (plastic surgeon).
    I am going to have the silicone implants because the saline ones feel like the tissue expanders and they are hard. That is my opinion.

    Perky either way.

    Good luck,
    Margo
  • debs615
    debs615 Member Posts: 5
    #11
    I am considering the DIEP
    I am considering the DIEP reconstuction also. Unlike you I have plenty of belly fat! LOL I would probably have enough to replace my D's. I think of it more as a 'plastic surgery' rather than a BC surgery. What state do you live in? I'm in NJ and there are very few docs who do this? I am havinf a bilateral with expanders being put in on July 13. I really like the both my surgeons and my best friend is the anesteseologist(Spelling?). She's worked with both and would use them herself!!
  • seof
    seof Member Posts: 819 Member
    #12
    DIEP for me
    I have had a bilateral mastectomy and have had implants in for about a year while doing chemo, radiation, and recovery. I am going to have bilateral DIEP on July 1. The websites mentioned by the other posts are good resources. Of course your Doctor is the best. I chose the DIEP to preserve muscle (especially since it is bilateral), and because I do not want implants after living with expanders for a year. The recovery from DIEP is the longest, but it only has to be done once, and the tissue is your own so it ages with you and gains and loses weight with you. The tummy tuck is an added bonus too. Be sure to check with your insurance to be sure it's covered. It is true that it can be harder to find a Dr. to do it. Ask your Dr. for a referral. I don't know where you are, but I am in Texas and I know of 3 places it can be done (there may be more, but that's what I know).

    Take your time and make a good decision, then go for it! seof
  • jk1952
    jk1952 Member Posts: 613
    #13
    dancR22 said:

    free tram
    Hi Joyce - with the free TRAM how has your abdomen been affected? k

    I have an incision

    I have an incision horizontally from hip to hip, and my belly button had to be moved. This is all very similar to a tummy tuck. Right now, I am still quite swollen, and I did have quite a bit of drainage when I had the drainage tube. Unfortunately, the last drain had to come out early because it became plugged, so I think that the swelling is going down a bit slower than normal. But, after the swelling goes down, I think that it is going to be great.

    The abdomen is definitely the slower of the two (abdomen and breast) areas to heal, but friends who have had C-sections describe their recovery as being similar to what I've experienced. I've had strep throat and a bad cough this past week, and although it's hurt a little when I cough, it's sooo much better than even two or three weeks ago. (I'm nine weeks past surgery).

    Joyce
  • jk1952
    jk1952 Member Posts: 613
    #14
    debs615 said:

    I am considering the DIEP
    I am considering the DIEP reconstuction also. Unlike you I have plenty of belly fat! LOL I would probably have enough to replace my D's. I think of it more as a 'plastic surgery' rather than a BC surgery. What state do you live in? I'm in NJ and there are very few docs who do this? I am havinf a bilateral with expanders being put in on July 13. I really like the both my surgeons and my best friend is the anesteseologist(Spelling?). She's worked with both and would use them herself!!

    I had the bilateral

    I had the bilateral mastectomy and DIEP reconstruction done at the same time, and I would recommend it, if you can coordinate the doctors. I have a feeling that I would not want to go through another surgery if I waited for the reconstruction.

    Joyce
  • survivorbc09
    survivorbc09 Member Posts: 4,374 Member
    #15
    I had a lumpectomy so I
    I had a lumpectomy so I can't help you about any info, but, I wanted to wish you good luck!
  • Alexis F
    Alexis F Member Posts: 3,598
    #16
    joannem65 said:

    I did Tissue Expander
    I did tissue expander...not really a choice, but it worked. I wasn't a good candidate for tram flap and didn't want extended recovery time post op for diep.
    Now that it's done you cant tell "real" vs "Saline" and tomorrow I get my NIPPLE : )
    When I'm dressed (with bra or w/o) you have to really look to see which is the implant. I'm very satisfied with the end result, but for me it was a long hard battle to get to this point. I let my PS lead me in the right direction for choice and type (saline) but that's what we pay them the big bux for...expertise. I'm a full B / sm C cup but very happy and I love the "Lifted" side too.... I don't have to wear a bra if I dont want too. And my breast doesn't touch my tummy anymore!! (NO Sag factor!)
    Good luck
    joannem65

    So, you have no scars with
    So, you have no scars with reconstruction? And, it feels just like a real breast? I don't understand that, sorry.

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