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Reconstruction surgery implant vs DIEP flap need to make decision in 24 hours
Lorax1
16 Posts
I just came back from meeting with Plastic surgeon for my bi-lateral reconstruction. I am now in a panic situation as I found out they only offer one type of reconstruction, implants, at this hospital. If I want any other option (eg:DIEP flap) I must be referred to VGH and this must be done quickly. Would appreciate any comments of anyone who has had either surgery. I was leaning towards the flap as it made sense to me that you use your own body to reconstruct the breasts. I just wish I had known prior to the meeting that all types of surgeries were not available!
19 Replies
ACH2015
2007 Posts
Lorax1

I have a question for you, and I hope you don't mind my asking. Have you considered no reconstruction? I know many women that have had bi-lateral mastectomies with no reconstruction. Reasons vary, but risks of additional surgery, foreign materials (implants) and the risks of those materials. Personally, if my wife was in your situation, I'd suggest just having the surgery to have the breasts removed and leave it at that. Sometimes less is more, and I have been through cancer twice ( I am male) and have had multiple surgeries myself. I always shied away from any additional plastic surgery - and always went with what was necessary.

Times are a changing, and many men and women today don't have the same expectations of what women should look like. Its more important to be healthy and do things for yourself vs others. I just wanted to give you some different perspective. And again, I hope you don't mind.

Keep well

ACH2015
Runner Girl
1510 Posts
Hi Lorax1

I had a lumpectomy, so I'm no help. But I'm going to tag a few ladies who could possibly share their perspectives.

Buffythevampire
ashcon
Kims1961
cancertakesflight

Thanks Ladies,

Runner Girl

#Breastcancer #reconstruction
Lorax1
16 Posts
Thanks ACH2015, I have thought this through and do want reconstruction. I do appreciate you providing your input! Thank you!
Lorax1
16 Posts
Thank you!
ACH2015
2007 Posts
Lorax1

Glad to hear! And I appreciate the reply.

Keep well and all the best to you moving forward.

ACH2015
Lorax1‍ Does VGH mean Vancouver? Only asking as I had my surgery done in Surrey, BC. I wanted my breast made from my stomach but was told that I was too heavy and needed to lose 10 to 15 lbs and ended up going through chemo first and gained even more weight. My reconstruction started with an expander placed first and then after my treatment was finished I had the implant put in one side and the other was reduced/lifted. My Plastic Surgeon told me that an expander then an implant was the safest, less complications. And I believe the size of my breasts made a difference too.

With DIEP surgery you would have a larger recovery time as two areas have to heal. With my mastectomy/expander surgery I had 4-6 weeks off work. My implant placement with the reduced/lifted surgery I had 2 weeks off work. My Plastic Surgeon also told me that if I didn't want the reconstruction done, he still would have reduced/lifted the other side.

Good luck with your decision. Hopefully someone will respond that has experience with something other then implants.
Lorax1
16 Posts
Thank you Buffythevampire! ...Yes VGH is Vancouver general. I was advised that it is the only hospital that would be able to perform either surgery. (I am currently being treated at Abbotsford) I have asked for a referral to VGH so that I have the option. I was leaning towards the DIEP flap option, even though the surgery is more extensive and recovery is longer. I just want to be able to make an informed decision and not be stuck with taking only what is available.
ashcon
1853 Posts
Hi Lorax1
Good for you for wanting to ensure you have all the information to make an informed decision, and to pursue all ways to ensure you have access to all possible options!
I had a prophylactic double mastectomy, no reconstruction (my choice) so I'm not much help to you, but I believe that both Lulu Paris‍ and HazelGirl‍ have had reconstruction and may be able to offer some helpful insight based on their experiences.

I hope that referral comes through for you, and you get the answers and surgery that you want!

Lorax1‍ I can appreciate how frustrating and stressful this be for you. While I have not had reconstruction I did go and talk to a plastic surgeon.

I went to Sunnybrook Hospital in Toronto. There were two doctors who gave a presentation to a room of about 30 women. These doctors said that would not consider implants if you were over a particular size cup because the implants would be too large and heavy. As for deip, I was told I would feel like I got hit by a truck the first day and would leave the hospital in 5 days when I felt like I was hit by a motorcycle.

I was still interested but I weighed too much. I was told I would have to lose a lot of weight before the doctor would so the surgery. This coupled with having epilepsy and a recent experience with blood I considered as signs not to go there.

I also found out that I would need surgery on both sides. On one side I would have reconstruction and on the other side a breast reduction. I wasn't expecting surgery on both sides.

I know someone who went to a different hospital and had implants. She had some problems but eventually it worked out. Im not sure if it was the timing of her surgery...possibly too soon after radiation or if it was the size of the implants. Whatever the reason, she is happy with the results.

I also know someone who had the diep surgery. It went well and she is happy with the results. She talked about how closely she was monitored after the surgery to make sure the blood flow was good in the breast.

Each person's experience is different. I hope some of this information helps.

cancertakesflight
MCoaster
507 Posts
Lorax1

When I was diagnosed with breast cancer I opted for a bilateral mastectomy although the cancer was found in only one breast and I decided to stay flat. The right decision for me. You have received a good cross-section of experiences here and I can add nothing to them but, and not wanting to add to a stressful situation for you, have you any input from the your surgical team about what the impact of COVID might be on timing? I don't know where your present hospital is but quite a few in BC have been closing wards and I do know that VGH has some wards close but it is such a large campus and hopefully the facility you will be going to will not be effected.

You have done your research and I am sure will make the best decision for you.

Warm and healing wishes for the next step in your journey

MCoaster.
Lulu Paris
23 Posts
Lorax1‍ 1 as mentioned I did have a double mastectomy with immediate implant reconstruction. I chose implants as I wanted a quicker recovery and less invasive surgery. As it turned out if I had chosen flap surgery it would have been delayed as it wasn't available at the time due to COVID. My surgery was outpatient. Scheduled for 7:30 am and I was home by late afternoon. Minimal pain. Recovery was a little rocky as I ended up with fluid on non-cancer side resulting in a second surgery (also outpatient) to clean out and replace implant. It's been 2 months from second surgery and recovery is going well. Starting to lift some light weights to regain muscle lost over the last year.

As to how it feels, I can't deny it feels foreign. During the day I mostly don't notice or feel a difference. I wear a light bra to sleep in as they don't move the same way (whole thing shifts). There are areas where I have no feeling and I don't know if that will ever change.

It's hard to say if I would recommend as I don't have any idea what I would feel like after the flap surgery. I was happy with the recovery and am ok with how the implants turned out. I still have some additional procedures to come to deal with improving the overall look and plan for tattoos (not nipple tattoos) after I'm healed.

Good luck with your decision. Let me know if I can offer any other information.

Lulu
Kims1961
2052 Posts
Hello Lorax1
I also choose not to do reconstruction and i see you have had some excellent responses.

I”m glad you reached out. I remember that i was sometimes tempted to make the decision that was the “quickest” and maybe not the best one for me long term. Hopefully you can gather all of the info you need, for the best decision for you.

Good luck! Kim
Lorax1‍ We must live close to each other as I had my chemo treatment in Abbotsford. TT53‍ Did have her surgery at Abbotsford. Maybe she might be able to tell you what she had done.
TT53
187 Posts
Lorax1‍ hello,

I live in the eastern part of the Fraser Valley. I had my lumpectomy surgeries in Chilliwack and when I opted for a mastectomy, I had to be referred to Abbotsford, because Chilliwack did not do reconstruction. I had a female plastic surgeon and when I asked if she could do the Diep Flap, I wasn't a good candidate because I did not have enough fat on my tummy. From what I understood, she would have done it. I know she is on maternity leave, so not sure who is doing plastic surgery in Abby.
I ended up having a mastectomy with immediate reconstruction. My implant was inserted just under the skin. Mine did not go under the muscle, like some other ladies on here. My recovery was quite easy . The Diep surgery is a harder surgery to recover from, but totally personal preference.
Wishing you best of luck with your decision and outcome.
Hugs,
M..
Ten_minutes
75 Posts
Hi Lorax1


In September 2019 I had a double mastectomy and DIEP immediately. I didnt have to go for Chemo prior to the surgery. Actually, from finding out i had cancer and then actually being in surgery it was about a 3 week span. Not much time to think. My sister had died of breast cancer 6 months prior to my diagnosis so I was somewhat informed on things. My sister’s cancer was triple negative and stage 3 (probably was already 4 but who knows) She had a double mastectomy and DIEP as well as chemo prior to surgery, chemo after surgery, radiation after surgery and then more chemo. I had a double mastectomy with immediate reconstruction. I am stage one, grade one, estrogen positive, progesterone positive, HER2 negative. I stared radiation in January, 2020. 30 sessions. I started tamoxifen December 2019. My sister died of breast cancer in February of 2019, less than 2 years after her diagnosis.
. I am taking a long time to recover from double mastectomy and DIEP surgery and the pain was super hard to deal with and still is.

Specifically about DIEP, I would do it again, I dont think my sister should have had DIEP because the time and energy a body needs to recover from such a big surgery takes the energy she needed to fight the remaining cancer. That being said, I did get the DIEP and both breast mastectomy.

Good things were: i still had ‘breasts’ that looked somewhat the same when dressed. No one would notice a change in me except that maybe they were smaller. I had a really great plastic surgeon, apparently patients come from all over the continent to get him as a doctor. He did a fantastic job. I think emotionally I needed to have something in place when i woke up from the double mastectomies because it was really hard for me to loose my breasts. So emotionally it was a great idea. He took the tissue from my abdomen and stitched it up really tight so I have less of a fat stomach.

Not so good things: i ended up with an infection and i was in the hospital for over a week on IV antibiotics, then months of seeing a community nurse everyday to get the wound washed and repacked. Because of the infection my radiation treatments were months behind schedule. After the surgery i was told my margins were not clear, so i still had cancer cells under my new tissue breasts. I couldn’t understand how i could have such a small tumour and after such a drastic amputation there could still be breast cancer. No doctor was able to really explain this to me. But it scares me. I dont think they would have treated me with another surgery to remove more breast cancer cells even if i didnt have DIEP.

WHat no one tells you: WHen i read on the internet that people get the surgery and then are back at work, all is fine, after just a few weeks. This is a lie. I dont know how that is possible. The surgery was 12 hours and it involved removing both breasts, retaining the breast skin, removal of the nipples, cutting the tissue from the abdomen then stitching it all back together. I am still recovering and my surgery was Sept 2019!months. The large abdomen incision is large and they use lots of stitches and on both sides by your hip they place tubes to gather the drainage. Then the breast tissue is sewed up with lots of stitches and large staples. And on either side 2 more tubes are placed for drainage. You leave the hospital with these tubes and it is something you really need to have another person help you with. You are very swollen and it hurts lots. Every week or two a new milestone - removal of tube - removal of some staples, removal of other tube. Etc it is a long process. I couldn’t have done any of this without my husband. WHen you first come home you cant lift your arms so you need someone to get in the shower with you and wash your hair etc. Then when drying off the towel hurts so it is better to dry using a hair dryer. Also if you have tubes and have a shower you need to first cover them with a plastic type bandage that keeps it dry. Again you need help with this. Sleeping is different for awhile. You have to sleep at an angle, head up knees up. I got 2 triangle type pillows and other pillows to prop myself up. Sleeping is really hard in this position. My sister bought herself a large comfortable lazy boy type chair to sleep in. When getting up for a few weeks you need help. It takes lots of time to heal and get back to feeling a bit like your old self. Walking for a few minutes at a time then building up your stamina is good but it has been over a year and I have just made it to a 20 minute walk.

Maybe telling you all this might not seem like a good idea, i dont want to scare you. I didnt know any of this before the surgery, no one told me. I still think if i had known how hard the recovery was I still would have had the double mastectomy and DIEP. Especially since this was when i was 48. If I was maybe ten years older or more I dont think i would do the DIEP. The older i get the harder it is to recover from things. I dont have feeling in parts of my leg, on my stomach and under/on my arm. When i do have feeling it is tight pain or sharp nerve pain. I get frustrated that things are taking so long to heal but maybe this is my new reality and i will always face these troubles.

If you want you can ask me anything about DIEP and I will be honest.
Please let me know how your surgery goes.

Trish
Lorax1
16 Posts
Thank you TT53‍ the replacement plastic surgeon said that it was the hospital that would not perform the surgery. Maybe it has something to do with Covid as well..not sure. Thank you again for your response
Lorax1
16 Posts
Ten_minutes
Hi Trish, thank you for your information! You are right in saying that you read about these surgeries but don't really know the full picture unless you speak to someone who has had it. I have asked for a referral to a surgeon that can perform all types of surgeries so that I can make an informed decision. I hope that I will be a candidate for the DIEP but will have to wait until the consultation. Again thank you so much for sharing...it helps knowing what I am in for!
DCB
4 Posts
Lorax1
Hi! I just had the diep surgery two weeks ago and am home and comfortable. I have had no complications at all with my surgery. My drains were all out within a week and a half and I am moving around really well.
I am also young, at 37, which may make the difference in recovery. My cancer was in the right breast but I did have a double mastectomy.
If you have any questions please feel free to contact me 😊
Lorax1

In October we had a virtual Breast Reconstruction Awareness Day. The video recordings from the day are available here: Women's College Hospital - Breast Cancer Awareness Month

I hope you check them out and find them helpful!

Lacey
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