Reconstruction Options, etc
I met with Dr. Bernie Lee at Beth Israel yesterday. He is the second plastic surgeon I have met with (the other being at Lahey). I have an appointment next week to meet with another surgeon from Beth Israel. Both of these do the DIEP type of reconstruction. I thought I would post the different options for reconstruction and some of the positives and negatives for each.
The first is a breast implant. Because of my radiation and positive nodes at he beginning, this is not a very good option. Plus, the implants never look like the other breast and since I don't want to touch the other one right now, it is out.
The second is Tram Flap which uses your own tissue. A large portion of muscle, some fat and skin are all tunneled underneath your chest and the beast is made at the location. No blood supplies are cut but there is a full lose of that one side of your "six-pack" muscles. The other side of the muscle can come back to 110% but most people will have muscle weakness, some back pain from the loss of stomach muscle, etc. This is the most popular method since, it is a relatively easy and short surgery. I wanted more options.
The Free Flap is like above but the muscle, tissue and skin are actually cut out and then replaced at the site of the breast. However, there is still a small portion of the muscle excised completely and it does still effect movement and strength as above. The reason muscle is still taken is the fact that it holds the blood supply to be reconnected at the breast site. Again, easier to harvest muscle with the blood supply already in it.
There is also a method using muscle from your back again tunneling beneath the skin to the front. Since my right arm has already been compromised from the removal of the nodes, this is certainly not my first choice. And then there is the butt one! Like a free flap but using your butt! Again, not the first choice.
The procedure that I have sought out is called DIEP. This procedure using our stomach area fat and tissue, and harvests a blood supply from the muscles but the muscles are never cut "across the grain" nor removed. The muscle is separated with the grain to get the blood supply and then everything is transplanted to the breast and reconnected to one of three main veins in the area (under-arm, mid-line chest, or in between). Because there is no muscle cut, the recovery in both the long and short run is much easier and shorter. The surgery itself is longer because of the use of micro-surgery both when extracting the tiny arteries from he muscle as well as reconnecting them. Instead of 4 - 5 hours from Tram flap, I am looking at 5 - 9 hours of surgery. I would be kept in the recovery room for 24 hours in order to monitor the blood flow at the newly connected site. The percentage of there being a problem is very small. If there were a problem within those 24 hours, I would be brought back to surgery and the problem would be resolved. Most are a tiny kink in the artery or something like that.
There is another part of this surgery that could be done as well. In 15% of the cases, there is an exposed small artery above the muscle. In that case, that one is used and there is no touching the muscle at all!
Either way, I am looking at a fabulous tummy tuck, a very natural breast, a much shorter recovery, and much fewer side effects. I would spend up to 7 days in the hospital. I would have to return in about a month for "shaping" because it is very important for my surgeon that I have the best possible match. There is alot of other information on this at www.bostondiep.com. Please have a look.
So, as of now, I have a surgery date in Boston at Beth Israel on February 7, 2007. I am not sure whether I am going to bother meeting with the other surgeon next week because I really loved Dr. Lee. His enthusiasm, his knowledge and training, his constant contact with the other few surgeons who do this, as well as his general nice-ness has really got me excited for the procedure and what I will look like afterward!
As for my status right now, I am a very burned little chickie. Especially under my arm. I have been changed over to 1% hydrocortisone and will probably be given an even stronger prescription called Silvadene for the remainder. Wearing a bra is many times quite painful so I only do it when I need to. I have really no problems with my lopsided look when just around my family and my radiation buddies. My two therapists Frank and Chris are always looking out for me and they were concerned about my burns yesterday. It is neat seeing two people every day and we have got to know each other pretty well. Chris is actually one year older than me and from Amherst so we have lots to talk about. He actually just adopted a dog from the same place we adopt: Nevins Farm MSPCA. I am so looking forward to seeing a picture on Monday.
Also, we had a brokers' open house on Thursday and had 21 agents come! I know it is because they had lunch there! Anyways, another open house tomorrow so I am really hopeful that between 21 brokers, we will have an offer soon.
The first is a breast implant. Because of my radiation and positive nodes at he beginning, this is not a very good option. Plus, the implants never look like the other breast and since I don't want to touch the other one right now, it is out.
The second is Tram Flap which uses your own tissue. A large portion of muscle, some fat and skin are all tunneled underneath your chest and the beast is made at the location. No blood supplies are cut but there is a full lose of that one side of your "six-pack" muscles. The other side of the muscle can come back to 110% but most people will have muscle weakness, some back pain from the loss of stomach muscle, etc. This is the most popular method since, it is a relatively easy and short surgery. I wanted more options.
The Free Flap is like above but the muscle, tissue and skin are actually cut out and then replaced at the site of the breast. However, there is still a small portion of the muscle excised completely and it does still effect movement and strength as above. The reason muscle is still taken is the fact that it holds the blood supply to be reconnected at the breast site. Again, easier to harvest muscle with the blood supply already in it.
There is also a method using muscle from your back again tunneling beneath the skin to the front. Since my right arm has already been compromised from the removal of the nodes, this is certainly not my first choice. And then there is the butt one! Like a free flap but using your butt! Again, not the first choice.
The procedure that I have sought out is called DIEP. This procedure using our stomach area fat and tissue, and harvests a blood supply from the muscles but the muscles are never cut "across the grain" nor removed. The muscle is separated with the grain to get the blood supply and then everything is transplanted to the breast and reconnected to one of three main veins in the area (under-arm, mid-line chest, or in between). Because there is no muscle cut, the recovery in both the long and short run is much easier and shorter. The surgery itself is longer because of the use of micro-surgery both when extracting the tiny arteries from he muscle as well as reconnecting them. Instead of 4 - 5 hours from Tram flap, I am looking at 5 - 9 hours of surgery. I would be kept in the recovery room for 24 hours in order to monitor the blood flow at the newly connected site. The percentage of there being a problem is very small. If there were a problem within those 24 hours, I would be brought back to surgery and the problem would be resolved. Most are a tiny kink in the artery or something like that.
There is another part of this surgery that could be done as well. In 15% of the cases, there is an exposed small artery above the muscle. In that case, that one is used and there is no touching the muscle at all!
Either way, I am looking at a fabulous tummy tuck, a very natural breast, a much shorter recovery, and much fewer side effects. I would spend up to 7 days in the hospital. I would have to return in about a month for "shaping" because it is very important for my surgeon that I have the best possible match. There is alot of other information on this at www.bostondiep.com. Please have a look.
So, as of now, I have a surgery date in Boston at Beth Israel on February 7, 2007. I am not sure whether I am going to bother meeting with the other surgeon next week because I really loved Dr. Lee. His enthusiasm, his knowledge and training, his constant contact with the other few surgeons who do this, as well as his general nice-ness has really got me excited for the procedure and what I will look like afterward!
As for my status right now, I am a very burned little chickie. Especially under my arm. I have been changed over to 1% hydrocortisone and will probably be given an even stronger prescription called Silvadene for the remainder. Wearing a bra is many times quite painful so I only do it when I need to. I have really no problems with my lopsided look when just around my family and my radiation buddies. My two therapists Frank and Chris are always looking out for me and they were concerned about my burns yesterday. It is neat seeing two people every day and we have got to know each other pretty well. Chris is actually one year older than me and from Amherst so we have lots to talk about. He actually just adopted a dog from the same place we adopt: Nevins Farm MSPCA. I am so looking forward to seeing a picture on Monday.
Also, we had a brokers' open house on Thursday and had 21 agents come! I know it is because they had lunch there! Anyways, another open house tomorrow so I am really hopeful that between 21 brokers, we will have an offer soon.
posted by Kimberly O @ 1:04 PM
1 Comments:
At 10:28 AM,
Judith said…
DIEPs can develop so many complications as well as completely fail. My surgery was 9/13/06 and, I have lost about half the flap with 3 huge open wounds that will not heal. The only positive note regarding the whole experience is, as of yesterday, I got my "new constant companion" - a 3 lb. portable vac that is connected to 6' of 1/4 inch tubing attached to my wounds (a more aggressive approach to wound healing) which eliminates the need for me to do dressing changes twice a day - now I have to fit time into my schedule for Home Health nurses to come to my home 3 times per week to change the foam-vac dressings. But as I mentioned, for me this is a good thing following 8 weeks of dressing changes during which I have gotten nauseated every time since the wounds are so deep and look so bad, and for me it is just really hard looking at gaping holes where my reconstructed breast should be. Afterall, I've done the hard part, right - lumpectomy, mastectomy, chemo, radiation, more surgery due to infection on chest wall, and failed LD Flap reconstruction. I did my research for experienced DIEP Plastic surgeons, spoke to previous patients, learned all the specifics of the procedure, just as you have. I went into my DIEP journey very informed and hopeful. I am sharing my experience in an effort to let others know what is possible following DIEP. A female plastic surgeon I recently saw told me she learned, while at the 2006 DIEP Conference, that many surgeons reported having failed flaps. I knew there was a potential for problems - we have to sign the consent, right - but I wish I had talked w/ someone who had actually experienced complications so I might have had a more realistic picture.
Best wishes for a perfect reconstruction!
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