Diep reconstruction? Or Braxon implant?

Hi, does anyone have experience of having DIEP done at University Hospital in Coventry? I’m being referred from my local hospital for an assessment to see if I’m a “suitable candidate”. My consultant has said they may not accept me as I’m an ex smoker (I smoked the occasional social fag but gave up over 3 years ago). I felt she was being quite judgemental! Anyway just wondering what the waiting times are. I’ve got a provisional date in mid June for mx at local hospital but they don’t do DIEP there. The other option is to have a braxon implant at my local hospital but I’m worried about potential infections/problems down the line, plus I think it will look very different to my left breast. I’m a 34e and the surgeon said she’d have to reduce my right breast but didn’t mention about having surgery to my left breast to even them up? I’ve got to have rad after wire guided local excision on that side so maybe that’s why? Don’t know yet if having rad on right side. Sorry for the rambling post but my head’s spinning at the mo and I don’t know which way to turn! ?

Hello Daisy - I used to smoke quite heavily but gave up 8 years ago and that was considered no problem for a DIEP.  So I understand from your post that you are having a mx on one side and a lumpectomy on the other side - so cancer surgery to both breasts.  You need to see a really good plastic surgeon (who can do DIEP etc) and discuss ALL the options because long term you want them to match as well as possible.  I was an E cup - they will struggle to match that with any reconstruction but the lumpectomy will of course reduce your other side as well.  However, the other side can’t be adjusted to match the DIEP side until about 6 months later when the DIEP has found its final shape, whereas you will be having the lumpectomy now and then rads which more or less precludes further surgery.  So in that case I’m guessing the surgeon(s) will be aiming to create the same cup size in both breasts through different ops performed around the same time and hoping they turn out similar-ish I assume.  What happens if you don’t get clear margins on the lumpectomy and need a mx in the end?  You can only have the DIEP done once although you can sometimes have both breasts created from the DIEP if done at the same time.  Or is there an option of having a saline expander and going back to do a reconstruction later when you have seen where you are with the lumpectomy side? Sorry, that doesn’t give you answers but I think you need someone to look at the overall cosmetic outcome for both breasts holistically.  Hope all goes well for you whatever you choose.  Xx

Hi MsMerton and thanks for your reply. I have heard today that I have an appointment at Coventry with the plastic surgery team. So hopefully I can find out more and look at all the options in greater depth. I’m having a wire guided local excision on the left breast, is that the same as a lumpectomy? (Please excuse my ignorance, this is all new for me); the DCIS is 7mm so not massive. Then radiation on that side to zap anything that might be still lurking. On the right breast a mx and I could possibly have a delayed reconstruction but they seem to think it’s better to have it all done at the same time? The nurse said the scarring can be worse if they have to open up the mx scar at a later stage? It’s all so confusing! But these are questions I need to ask at my appointment so thanks once again for your input! xx

Ooh thanks I shall have a look at that website and I’ll google for some pics. I don’t know if I’ll need radio after mx on right breast yet. The wire procedure and mammogram does sound a bit weird but then again nothing surprises me any more! I did ask if it would be better to have a double mx but they seem to think it’s better to save the breast where they can. Just worried about it coming back in the future xx

Hi Daisy, if there is a chance you will have radiotherapy on your right breast, I would ask about potential damage to a DIEP reconstruction.  It would be a shame to go through this surgery, only for the tissues to be damaged by rads.  This is why many places will offer temporary reconstruction as MrsMerton mentioned.

Hi Argymargy, that’s a good point and I don’t know why they’re not suggesting it. Even if they think I won’t need radiotherapy on right side surely there’s no way of knowing until lymph nodes are tested? I’ll ask the question when I meet the plastic surgery team. Thanks so much for your input! xx

Hi Daisy yes I had my DIEP at Coventry in November last year! I am not a smoker but you should be ok if you gave up 3 years ago!
I was warned that there was a year waiting list as the surgeon is sought after. Also,they only do one a week as it blocks a theatre for the day!!! I waited 5 months I was lucky! I had a history of failed implants!!!?

Hi rosie14 - wow - a years’ waiting list eek!! I’ve got an appointment tomorrow with the head of plastic surgery to see if I’m suitable and/or discuss other options. I know that Jo Skillman is booked up until at least August but I’ve been told she may be able to do the mastectomy and someone else would do the reconstruction (Mr Park maybe?) Are you happy with the results and did you have any complications? I’m assuming from your comment about implants this was a better option for you? Thanks for posting ? xx

Hi rosie14 I have an appointment to see Jo Skillman on Thursday! I’m still unsure whether to have DIEP or implants. They could possibly do a double mastectomy then 2 implants which would give a more even appearance but it’s a big step when I don’t really need a left side mastectomy. With DIEP I’m just put off by the long recovery time as I have two young children and I’ll be laid up during the school holidays. I’m lucky that as I’m classed as an emergency they can fit me in within 4-6 weeks. I’ve done a list of pros and cons and I guess I’ll wait to see what Miss Parkman says on Thursday then make a decision ?Thanks so much for your help ?xx

Hi waveylocks, thanks for all the brilliant tips and advice! The plastic surgeon who I met last Friday is very confident and has done around 300 DIEP surgeries, so I feel really happy that he will give me the best result possible. I’m still not 100% sure if I want to have the op or with to go with implants. I’m mainly worried about the recovery time as I have two young children and they’ll be on their school holidays when I’m still trying to recover. Although I do have a great group of girlfriends nearby who I’m sure will help plus a husband who will have to learn to clean and cook :wink: xx

Hi ladies, I had mx with immediate implant reconstruction sept 14. At the time DIEP was not an option as no belly fat and LD clap out of the question due to back issues.

I went to have chemo and rads - this would have been delayed dramatically if I had to wait for DIEP to heal. As it was I had problems with infection and ended up with five ops in all to remove implant, later had an expander before rads and replacement and uplift on good breast six months after all treatment was finished.

My implant side is very lumpy and much smaller than the natural side. I have put on two stone since treatment so natural breast has grown. I have decided now to put my weight gain to good use and have DIEP booked for end of August!

I do not regret having implant first it was the best option for me as did not want to be flat. I was warned that rads might damage it which is why I ended up with expander before rads.

So I guess what I’m trying to say is don’t rush into making your final decision. You need to do what is necessary to kill cancer first. My hairdresser had chemo followed by DIEP and rads. She felt pressured to have DIEP before rads as surgeon didn’t want her to be flat, but long term she would have preferred to wait til after rads as that made her DIEP boob go hard.

Good luck with decision: and treatment, wavylocks your recovery sounds great - hope mines the same!

Hi Jacqui, in the end I had a bilateral mastectomy with implants and lymph node excision. I found out a few days before the surgery that I’d have to have radiotherapy but the surgeon said go ahead with the implants and if there were any problems with them, e.g. infection or damage from radiotherapy, I’d then have the option of having diep at a later stage! It’s a tough decision to make especially when you’re under time pressure but just remember whatever you decide, it may not be straightforward and you may have to have further surgery down the line. I’m 4-5 weeks post op and still very sore (mainly from the lymph node excision) but up and about and able to drive etc. It feels like a tight band around my chest and is quite constrictive. The implants look pretty good but a little uneven and lumpy; I’m hoping this will settle down in time. It’s been an emotional rollercoaster, I found out on Wednesday that I have to have chemo as well which I’d hoped to avoid. I had to wait 4 1/2 weeks for my results which hasn’t helped. Good luck with your op, I hope everything goes well for you ?