New here, deciding between IGAP and DIEP reconstruction

lorel
lorel Member Posts: 6
edited March 2014 in Breast Cancer #1
Hi,

I am new to the board. A little bit about me: I am 37 and have been diagnosed with low grade DCIS in my left breast. I had a quadrectomy done at the end of august but they did not get clean margins, so now it is on to mastectomy.

I am planning to have reconstruction done at the same time as the mastectomy and after consulting with two different plastic surgeons, it looks like I am a good candidate for either a DIEP or an IGAP reconstruction. It is now up to me to decide which I prefer to have done and I am weighing the plusses and minuses for each. I'd appreciate input from anyone who has had these procedures and what the esperience was like for you.

Thanks,
Lore

Comments

  • MyTurnNow
    MyTurnNow Member Posts: 2,686 Member
    #2
    Welcome, Lore
    I just wanted to welcome you to this amazing group. I am not in the same situation as you but I'm sure there will be someone along shortly to share their experience.
  • jk1952
    jk1952 Member Posts: 613
    #3
    MyTurnNow said:

    Welcome, Lore
    I just wanted to welcome you to this amazing group. I am not in the same situation as you but I'm sure there will be someone along shortly to share their experience.

    DIEP Reconstruction
    Hi Lore,

    Welcome to the boards, but I'm sorry for the reason that you have become a member of the group. In April, I had a bilateral mastectomy and immediate DIEP reconstruction. I would definitely recommend it (and have both surgeries done at the same time, if possible).

    It is a relatively long recovery period, but there isn't much that needs to be done after the recovery time. I didn't really have any problems with the breasts, but I did have a few issues with the abdominal surgery, but nothing that you couldn't have with a Casearean or tummy tuck.

    I was out of work for eight weeks, but I was able to drive after 2-1/2 weeks, so I wasn't too dependent on others. I stopped taking pain killers other than Advil and Tylenol two days after surgery, so that helped me start driving sooner than if I had continued on them. You will definitely need help during the recovery time, since you are somewhat limited in what you can do. I tended to do well for a few hours and then crash after I had done too much.

    I had a small amount of invasive cancer in 2000 which was treated by a lumpectomy and radiation, so when DCIS was discovered earlier this year in the same breast, DIEP reconstruction was recommended, partly because we have an excellent plastic surgeon in the area that does the procedure. I decided to have the bilateral mastectomy, since I was told that the DIEP could only be done once (any extra tummy tissue is discarded), and I wanted both breasts to look alike. Also, I had already had some scares with the other breast, so I knew that it was possible that I would eventually have cancer in it, too.

    Joyce
  • puppylover
    puppylover Member Posts: 1
    #4
    IGAP vs DIEP
    I have been diagnosed and will have surgery (bilateral mastectomy) next week. I explored all the reconstruction options and have settled on a DIEP flap. This is microvascular surgery(surgery on blood vessels under a microscope), and requires a great deal of surgical skill and experience with this type of surgery. The IGAP is similar to the DIEP, but the tissue comes from the buttocks rather than the belly as in the DIEP. Here are a couple of important considerations. If you need radiation, you will want to wait to have reconstruction because the "transplanted" tissue will be potentially damaged by the radiation. My surgeon said that we would need to wait at least 9 months after radiation to do the reconstruction. I will have my surgery at MD Anderson Orlando where they have a team of two doctors that have done many of these operations. Because there are two, my bilateral DIEP flap reconstruction surgery will be "only" about 6 hours. If only one surgeon does the surgery it is quite a bit longer. Recovery is long and because you have the tummy tuck, you have to use a walker initially. My doctors said that you must also stay off of caffeine and chocolate for 6 weeks after DIEP and I suspect the same for IGAP. Caffeine and chocolate contracts the arteries and that isn't good for the transplanted tissue until it heals for a while.

    The selection is probably somewhat dependent on where you have extra tissue. I have a belly that I want to get rid of, so the DIEP is great for me. I get a bit of an extra bonus in that I will have a flat tummy when I am done.

    I hope this helps, and good luck with your treatment.
  • lorel
    lorel Member Posts: 6
    #5
    puppylover said:

    IGAP vs DIEP
    I have been diagnosed and will have surgery (bilateral mastectomy) next week. I explored all the reconstruction options and have settled on a DIEP flap. This is microvascular surgery(surgery on blood vessels under a microscope), and requires a great deal of surgical skill and experience with this type of surgery. The IGAP is similar to the DIEP, but the tissue comes from the buttocks rather than the belly as in the DIEP. Here are a couple of important considerations. If you need radiation, you will want to wait to have reconstruction because the "transplanted" tissue will be potentially damaged by the radiation. My surgeon said that we would need to wait at least 9 months after radiation to do the reconstruction. I will have my surgery at MD Anderson Orlando where they have a team of two doctors that have done many of these operations. Because there are two, my bilateral DIEP flap reconstruction surgery will be "only" about 6 hours. If only one surgeon does the surgery it is quite a bit longer. Recovery is long and because you have the tummy tuck, you have to use a walker initially. My doctors said that you must also stay off of caffeine and chocolate for 6 weeks after DIEP and I suspect the same for IGAP. Caffeine and chocolate contracts the arteries and that isn't good for the transplanted tissue until it heals for a while.

    The selection is probably somewhat dependent on where you have extra tissue. I have a belly that I want to get rid of, so the DIEP is great for me. I get a bit of an extra bonus in that I will have a flat tummy when I am done.

    I hope this helps, and good luck with your treatment.

    IGAP vs DIEP
    Thanks for the input so far. The doctors do not think I will need radiation, so they are going ahead with the immediate reconstruction. Of course there is always a slim chance that I will be the one who needs the radiation anyway, but since the outlook is good that I won't, it seems better to have everything done in one procedure.

    There will be three teams of doctors involved one to do the mastectomy and two to do the DIEP or IGAP. So they do think they can get it done in 6 hours. The IGAP would take a bit longer, because they will have to turn me over a couple of times.

    I carry around maybe 10 pounds more than what I would consider an ideal weight for myself. The doctors think I have enough fat for either of these options, so it comes down to what I prefer. There seems to be pros and cons to both. I like my bottom as it is, while I have always had a small pot belly that I wouldn't mind having flatter. However the scarring seems to be much more discreet with the IGAP. I am not thrilled about the long scar from the DIEP. So aesthetically speaking, I would probably be pretty happy with the tummy tuck with my clothes on, but no as happy with my clothes off due to the scar. Another consideration, is that we have been trying to get pregnant and I won't have to wait as long to start trying again after an IGAP. However, in terms of the experience of the doctor's I am seeing, they have years and years of experience with DIEPs, but only recently started doing IGAPs. So it is a lot of weighing back and forth.

    Thanks for mentioning the caffeine and chocolate issue. I hadn't thought about it and the doctors haven't mentioned it so far, but it makes sense to avoid them. That will be tough for me, since I like my coffee and chocolate. I already knew about no smoking and second hand smoke though. The smoke won't be a problem at home, since neither my husband nor I smoke, but I live in Paris and the streets are filled with smokers here. At least it has been banned from most indoor locations though.

    Thanks,
    Lore
  • lorel
    lorel Member Posts: 6
    #6
    puppylover said:

    IGAP vs DIEP
    I have been diagnosed and will have surgery (bilateral mastectomy) next week. I explored all the reconstruction options and have settled on a DIEP flap. This is microvascular surgery(surgery on blood vessels under a microscope), and requires a great deal of surgical skill and experience with this type of surgery. The IGAP is similar to the DIEP, but the tissue comes from the buttocks rather than the belly as in the DIEP. Here are a couple of important considerations. If you need radiation, you will want to wait to have reconstruction because the "transplanted" tissue will be potentially damaged by the radiation. My surgeon said that we would need to wait at least 9 months after radiation to do the reconstruction. I will have my surgery at MD Anderson Orlando where they have a team of two doctors that have done many of these operations. Because there are two, my bilateral DIEP flap reconstruction surgery will be "only" about 6 hours. If only one surgeon does the surgery it is quite a bit longer. Recovery is long and because you have the tummy tuck, you have to use a walker initially. My doctors said that you must also stay off of caffeine and chocolate for 6 weeks after DIEP and I suspect the same for IGAP. Caffeine and chocolate contracts the arteries and that isn't good for the transplanted tissue until it heals for a while.

    The selection is probably somewhat dependent on where you have extra tissue. I have a belly that I want to get rid of, so the DIEP is great for me. I get a bit of an extra bonus in that I will have a flat tummy when I am done.

    I hope this helps, and good luck with your treatment.

    IGAP vs DIEP
    Deleted a double posting due to internet problems.
  • jk1952
    jk1952 Member Posts: 613
    #7
    lorel said:

    IGAP vs DIEP
    Thanks for the input so far. The doctors do not think I will need radiation, so they are going ahead with the immediate reconstruction. Of course there is always a slim chance that I will be the one who needs the radiation anyway, but since the outlook is good that I won't, it seems better to have everything done in one procedure.

    There will be three teams of doctors involved one to do the mastectomy and two to do the DIEP or IGAP. So they do think they can get it done in 6 hours. The IGAP would take a bit longer, because they will have to turn me over a couple of times.

    I carry around maybe 10 pounds more than what I would consider an ideal weight for myself. The doctors think I have enough fat for either of these options, so it comes down to what I prefer. There seems to be pros and cons to both. I like my bottom as it is, while I have always had a small pot belly that I wouldn't mind having flatter. However the scarring seems to be much more discreet with the IGAP. I am not thrilled about the long scar from the DIEP. So aesthetically speaking, I would probably be pretty happy with the tummy tuck with my clothes on, but no as happy with my clothes off due to the scar. Another consideration, is that we have been trying to get pregnant and I won't have to wait as long to start trying again after an IGAP. However, in terms of the experience of the doctor's I am seeing, they have years and years of experience with DIEPs, but only recently started doing IGAPs. So it is a lot of weighing back and forth.

    Thanks for mentioning the caffeine and chocolate issue. I hadn't thought about it and the doctors haven't mentioned it so far, but it makes sense to avoid them. That will be tough for me, since I like my coffee and chocolate. I already knew about no smoking and second hand smoke though. The smoke won't be a problem at home, since neither my husband nor I smoke, but I live in Paris and the streets are filled with smokers here. At least it has been banned from most indoor locations though.

    Thanks,
    Lore

    I was wondering where you

    I was wondering where you lived since you have both surgeries readily available. The IGAP isn't used much in the US; it's very new. And, for the whole country, we only have about 150 plastic surgeons who have significant experience with the DIEP surgery. The older procedure, the TRAM flap, is much more common. We tend to be behind much of the rest of the world because of the testing required here. It ends up being both a good and a bad thing.

    My doctor didn't say anything about coffee and chocolate; nor did I use a walker post-surgery.

    Joyce
  • meena1
    meena1 Member Posts: 1,003
    #8
    lorel said:

    IGAP vs DIEP
    Deleted a double posting due to internet problems.

    My doctor wants to do a
    My doctor wants to do a Latissimus Flap breast reconstruction. This is where they take a muscle from your back with a small piece of skin placed over the expander. This is what he frequently recommends. I had radiation after my masectomy. The other option is a a Tram Flap reconstruction. I am not familiar with the Diep surgery. I do not want the tram flap, actually I do not want any surgery! I have a tissue expander, so it is like a small bowling bowl on my chest.
  • lorel
    lorel Member Posts: 6
    #9
    jk1952 said:

    I was wondering where you

    I was wondering where you lived since you have both surgeries readily available. The IGAP isn't used much in the US; it's very new. And, for the whole country, we only have about 150 plastic surgeons who have significant experience with the DIEP surgery. The older procedure, the TRAM flap, is much more common. We tend to be behind much of the rest of the world because of the testing required here. It ends up being both a good and a bad thing.

    My doctor didn't say anything about coffee and chocolate; nor did I use a walker post-surgery.

    Joyce

    Location
    Yes, I have been in France for about 2 1/2 years now. I am American, but my husband is a French speaking Belgian who was living in Paris when we met. Being in France for this has its benefits. Everything for the surgeries will be paid for by the public health care and the social security system will pay my salary during medical leave. They are pretty generous with medical leave and the doctor is expecting to give me 2 months leave after my hospital release. Also, being in the city, I rely on public transport, so driving is not an issue.

    I didn't realize quite how new the IGAP was, but it makes sense, since my surgeon here says he has only done 8 of them. They have all been successful so far, but still it is only 8. I guess it makes sense that he would have a good success rate since he has been doing DIEPs for 15 years and I assume the procedure isn't too different, just a different donor site anatomy. He also does the surgery using the thigh flap, but I don't have enough fat there so it is not an option.

    My doctor here did not mention anything about a walker either, but he said I would need to wear a girdle for 6-8 weeks if I have the DIEP. I hadn't thought about the caffeine issue, but it makes sense to me scientifically to avoid these things, since you want to keep up as much blood flow as possible to the new breast and caffeine does constrict vessels.

    Lore
  • marilyndbk
    marilyndbk Member Posts: 238 Member
    #10
    meena1 said:

    My doctor wants to do a
    My doctor wants to do a Latissimus Flap breast reconstruction. This is where they take a muscle from your back with a small piece of skin placed over the expander. This is what he frequently recommends. I had radiation after my masectomy. The other option is a a Tram Flap reconstruction. I am not familiar with the Diep surgery. I do not want the tram flap, actually I do not want any surgery! I have a tissue expander, so it is like a small bowling bowl on my chest.

    I had bilateral
    I had bilateral mastectomies with Latissimus flap reconstruction 3 wks ago. I did have to have additional surgery a week later to take out some unhealthy tissue. I am glad the slow recovery was mentioned. My recovery seems to be going very slow. I tried to go into surgery as healthy and strong as possible but it has been difficult. I did ask the nurse at plastic surgeons office about that pressure (bowling ball good description). She said it was normal and every time I go in for "filling" I would be uncomfortable. SHe said I needed to think about final outcome and how it would be worth it when perky boobs would be complete in about 5 months. I think she meant it in the positive aspect but I never had a problem with my old breasts and it was a hard decision to accept. All we can do is try to learn as much as possible about choices and do what we think is best for us. I am sure my family and friends got tired of me going back and forth about what I was going to do. I am so grateful for support of family and friends and this site. It is invaluable. Take care. Marilyn
  • meena1
    meena1 Member Posts: 1,003
    #11
    marilyndbk said:

    I had bilateral
    I had bilateral mastectomies with Latissimus flap reconstruction 3 wks ago. I did have to have additional surgery a week later to take out some unhealthy tissue. I am glad the slow recovery was mentioned. My recovery seems to be going very slow. I tried to go into surgery as healthy and strong as possible but it has been difficult. I did ask the nurse at plastic surgeons office about that pressure (bowling ball good description). She said it was normal and every time I go in for "filling" I would be uncomfortable. SHe said I needed to think about final outcome and how it would be worth it when perky boobs would be complete in about 5 months. I think she meant it in the positive aspect but I never had a problem with my old breasts and it was a hard decision to accept. All we can do is try to learn as much as possible about choices and do what we think is best for us. I am sure my family and friends got tired of me going back and forth about what I was going to do. I am so grateful for support of family and friends and this site. It is invaluable. Take care. Marilyn

    Marilyn, thank you for your
    Marilyn, thank you for your post. I haven,t heard from too many woman who had this type of surgery. Do your breasts feel softer now? I keep going back and forth also, I know I do not want the tram flap! I had a rough time with the masectomy and it took 8 weeks of recovery for that, I think I may plan my surgery in January so i can hibernate the whole winter. I am glad you told me about the recovery time, they make it sound so easy. Something more to think about! I thought it all sounded so easy, like "hey, I'm getting new boobs". My mantra is "I will get through this, I will get through this". Be strong.
  • lorel
    lorel Member Posts: 6
    #12
    meena1 said:

    My doctor wants to do a
    My doctor wants to do a Latissimus Flap breast reconstruction. This is where they take a muscle from your back with a small piece of skin placed over the expander. This is what he frequently recommends. I had radiation after my masectomy. The other option is a a Tram Flap reconstruction. I am not familiar with the Diep surgery. I do not want the tram flap, actually I do not want any surgery! I have a tissue expander, so it is like a small bowling bowl on my chest.

    DIEP and IGAP are microsurgeries
    The DIEP and IGAP procedures are both microsurgeries that do not involve moving a muscle to the breast location like the Latissimus Flap and the TRAM procedures. Instead they just use skin and fat and they dissect out blood vessels from the muscle at the donor site, but leave the muscles in place. Then the blood vessels are reattached to blood vessels at the breast site in order to provide enough blood to the transplanted fat and skin. The DIEP takes tissue from the tummy area similar to the TRAM procedure and the IGAP takes tissue from the fanny.
  • meena1
    meena1 Member Posts: 1,003
    #13
    lorel said:

    DIEP and IGAP are microsurgeries
    The DIEP and IGAP procedures are both microsurgeries that do not involve moving a muscle to the breast location like the Latissimus Flap and the TRAM procedures. Instead they just use skin and fat and they dissect out blood vessels from the muscle at the donor site, but leave the muscles in place. Then the blood vessels are reattached to blood vessels at the breast site in order to provide enough blood to the transplanted fat and skin. The DIEP takes tissue from the tummy area similar to the TRAM procedure and the IGAP takes tissue from the fanny.

    Lorel, do you know if the
    Lorel, do you know if the recovery time is easier and shorter
  • lorel
    lorel Member Posts: 6
    #14
    meena1 said:

    Lorel, do you know if the
    Lorel, do you know if the recovery time is easier and shorter

    No, the recovery time is basically the same as the TRAM recovery time. I've been told around 8 weeks to resume normal activity.
  • marilyndbk
    marilyndbk Member Posts: 238 Member
    #15
    meena1 said:

    Marilyn, thank you for your
    Marilyn, thank you for your post. I haven,t heard from too many woman who had this type of surgery. Do your breasts feel softer now? I keep going back and forth also, I know I do not want the tram flap! I had a rough time with the masectomy and it took 8 weeks of recovery for that, I think I may plan my surgery in January so i can hibernate the whole winter. I am glad you told me about the recovery time, they make it sound so easy. Something more to think about! I thought it all sounded so easy, like "hey, I'm getting new boobs". My mantra is "I will get through this, I will get through this". Be strong.

    Meena, We will get thru this
    Meena, We will get thru this and we are strong women. It is a very hard decision to make. Both my breast surgeon and plastic surgeon were very good to me. They both told me there is no wrong decision. They would both support me and do the best possible job with whatever I decided. I had decided on starting reconstruction at time of mastectomies. Then plastic surgeon sort of recommended waiting to heal because my left breast was so damaged from radiation 8 yrs ago. Breast surgeon said it was better to have it done at the same time. I went with her recommendation. She did my original lumpectomy and I had complete faith in her. As it turned out plastic surgeon was right and some of the tissue did not survive and I ended up having an extra surgery. My right breast or whats left is soft. My left side is very hard maybe because of swelling. Our state of mind is important to healing and we will be ok no matter what. Take care. Marilyn
  • 20questions
    20questions Member Posts: 24
    #16
    lorel said:

    No, the recovery time is basically the same as the TRAM recovery time. I've been told around 8 weeks to resume normal activity.

    Once you find a physician who successfully performs DIEP/GAP
    Ask to speak to a few of his or her patients who have had the procedure and are similar to you in age, general health, lifestyle, activity level. That's the best indicator I've found to help women get an idea of what type of recovery to expect. 8 weeks seems really long - most of our patients (I am the manager for one of the groups in SC) are out of bed the day after the surgery, out of the hospital on day 4, able to resume driving and activities of daily living by week 4, and return to work by week 6.

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