Hardness in reconstructed breast after DIEP flap op

Public Archive
1

Just wondering whether anyone out there has had problems in the reconstructed breast after DIEP flap op with hardness. I had my op about 4 months ago and the area below the nipple area is still very hard and rather tender. It feels like bruising and certainly the surface appearance of the breast still has a bluish tinge. I am wondering whether the hardness is scar tissue or an area of necrotic tissue and whether it will soften in time or need to be dealt with somehow.

I also have a pocket of fluid in my abdomen, which swells up during the day and is quite pronounced by tea time. I think it will need aspirating, but am wondering whether ultra sound could help with either problem.

I would be really interested to hear of anyone else’s experiences post DIEP flap surgery and how either of these issues have been resolved.

Lotty

2

Hi Lotty

I had a Diep around 6 months ago. My reconstructed breast (Esmeralda) seems to go in phases of feeling fine and soft and then occasionally it will feel a bit like a concrete boulder.

Like you, I had a bruised area after the op. However, the bruising did dissipate but in its place is a very slight indentation so I think there might have been some very slight necrosis. I can also feel a little scar tissue where the tummy flap meets the breast skin just to the bottom right of my new nipple. This feels hard, but in a different way to the rest of the breast when it hardens up (if this makes sense?)

Oh, and the lower half of Esmeralda recently turned quite an alarming shade of red. I rang the hospital and they asked me to come in to outpatients. The surgeon (not the one who did the op) scratched his chin and said he couldn’t fathom out why! Insect bite, he suggested…or the weather?!! I think it was neither of those and that there had been a small bleed in the breast. Strangely, as the bruising disappeared (it turned yellowish blue after the red phase) the breast has softened amazingly and I’m not conscious of it now being different in texture to its partner.

Have you already had the pocket of abdo fluid aspirated? For the first couple of months, I kept feeling that there was an air or fluid pocket just above the right end of my wound, but the surgeon was adamant that things were fine and so far they have been. He explained that they have to do quite a bit of stitching of abdo muscle in addition to sticking down the tummy so it takes a fair bit of time to feel normal again. I find mine occasionally feels odd towards the end of the day or if I’ve been walking a fair few miles.

Whereabouts did you have your op? I guess you’ll soon have another check-up with your plastic surgeon and it will be useful to see what they say…but if you’re still worried, it might be worth giving the hospital a ring.

All the best.

Lizzie xx

3

Hi Lotty, I had a tram flap 8 months ago, and had an infection in one breast which made it go hard and lumpy, red and it felt like a boulder in places, I did not think iot would ever feel ok again. It did though, the infection took about 3 weeks to go, and the area is nice and soft and normal looking now. At the time one surgeon said it was an area of necrotic tissue, but it is really weird the way it all disappeared, it is a distant memory now, but at the time I was really worried. So good luck, hope all turns out well.

4

Hi ladies,Im in my 4th week post Diep,Ive already chatted to Lotty but will explain my probs…my tummy is constantly needing draining and has some infection so Im on anti biotics,and my boob which beleive it or not I also call esmerelda lol is being scanned tomorrow.My PS said on the night of my op my new boob was almost an ideal match but when he saw me a day later it had turned into a hard football.Nothing was said then but now he admits all is not as it should be,Im just not healing up.He has warned me that I may have my tummy plus new breast reopened to be cleaned out.Any advice??? Debs

5

I am 5 weeks post op (tram flap) My stomach wound started leaking 2 weeks post p and I had some precautionary antibiotics. Things are moving slowly, my wound is on the red colum o the wound scale, pink being the lowest moving up to res, yellow, green and black. My breast wound has noe sprung open a little bit so going back to St Johns to have it checked. It doesnt look infected but need to keep on top of it. My tummy is very hard some of the time and my new bob is hard in places but apparently that can last for up to teo years.

Louise xx

6

Hi ladies

 

Well this is an incredibly old thread so I suspect you may not still be on here… but I am 3 months post double MX with SIEA flap one side (lovely job that side, zero pain, nice and flat!) and DIEP flap on the other side - which is causing me nothing but trouble!

 

Like one of the ladies I also had my wound around one of my noobs fell apart.

I caught an infection - psudomonas.

Was just awful, the stitches dissolved too soon and the wound failed and if it weren’t for fab breast surgeon interjecting and overiding the PS and DNs  and putting me on a great antibiotic (that it responded to within 2 days), I’d have had to have a skin graft to close it up.

That was after 8 weeks of having to re-dress it and watch it fall apart more each time!

It’s now horribly scarred that side.

 

I also have the swollen/inflamed patch around and slightly to the right of my new umbilicle (I had a terrible chest infection when I came to after the op - pneumonia for 2 days - convinced all that coughing caused some kind of tear)

Despite my disomfort, my plastic surgeon says (via email!) that he is not concerned and he’ll see me in another 3 months! (how can he state that without seeing me and feeling my bulgy tum??) I see some of you appear to have the same issue and it did resolve itself?

 

I also have a large lump of tissue that runs under my left breast nipple very similar sounding to many of you… reassures me to hear it does eventually go (my surgeon suggests ‘massage’ but not how to actually go about it!) Can’t wait for it to soften.

 

Would be fantastic to hear how you are all now doing. And in retrospect what you feel about the operation/procedure? (Double mx and DIEP recon was a bit of a big op, and I think I overestimated my super human powers of recovery!)

 

Did any of you have revision surgery after 6 mths to get the final result you wanted?/ Deal with scars/ improve breast shape etc?

 

I have huge lumps of fat under each armpit that is the ‘tail’ of the flaps - surgeon says he can ‘liposculpt’ that in another 3 months once all settled/ healed.

He also says he can get rid of the excessive scarring around my right nipple from where the wound failed, and lift that boob back up (it drooped badly when the wound failed… sits an inch lower than left, and nipple massive and on lower bit of boob - looks awful right now!)

 

Sorry to go on, I really need a bit of encouragement righ now as I am 3 months post surgery and was expecting to feel better than this at this stage.

 

Left boob hurts, abdomen super tight and bulging one side, abdo scar feels like a thick rope pulling me in from the sides, sore as hell if I stretch (around new umbilicus).

 

This is harder than chemo was! Seriously. I flew through chemo, I’m a super positive person.

My surgeon claims he has not seen a breast wound fail like mind did before (he’s done over 340 of these ops!) - but reading the below thread I think it is indeed more common that he let on.

Not 100% sure I’d have chosen this option if I knew then what I know now… please tell me it gets better? :frowning:

 

 

 

 

7

That is really helpful advice Ann! Better thanI have been given to date!!
I think part of my struggle is that I used my private health insurance for this treatment.
I have found it a nightmare logistically. NHS has excellent support wrap around BC treatment. But soon as you go private you are in silos. I had chemo in Basingstoke but had to go up to Charing Cross for the DIEP surgery as no-one round here does it.
That was a huge issue for visitors(I had 3 in 7 days! In a private room on a private ward with only a 80 year old Saudi woman with dementia to keep me company (getting woken ip by someone screaming ‘Allahu Akbar’ repeatedly is a little scary!)
Was given no hand out to take home for post operative care.
Had just arm exercise sheet (printed my this site!) In the end I printed the 24 page guide that Guy’s and St Thomas produced for DIEP patients. Brilliant.
And I went on youtube learn how to help get rid of cording… (Should have been referred to a physio for this, but again, fall between the gaps with private)

I’ll try your massage tips, really helpful.
Better than I got from my PS!!
(All I got in response to my detailed list of 5 areas of concern was this from his secretary:
‘I have spoken to Mr.xxx.
He is not concerned and it sounds like you are progressing.
With regards to the pain in the breast he has suggested massage.’

That is literally it… he has not actually examined my abdomen at all since Jan so has no clue if it is herniated or whatever!
Just bothers me because it feels SO swollen and inflamed on one side.
I was ambulanced into A&E 4 days after my release in Dec because of searing pain that side possibly caused by the drain rubbing my belly skin from the inside!
That same area is where it still feels swollen.

Plastic surgeon’s attitude reminds me of my GP all over again (the one who told me I was imagining things when I said my boobs felt lumpy in Oct 2014!!)

Wish there was someone local I could get a second opinion from on my abdomen.
I’m not exactly running marathons, so why is it not healing??

8

Ps The breast where the wound failed so badly was the one he did the SIEA flap transfer to… wonder if lesser blood supply contributed to poor healing?
(The SIEA donor site in tummy healed well)

I could not believe they did not cover the breast wounds… I just had gauze flaps taped on loosely… what about you?

9

I do have to admit I was not desperate for visitors the week of the op whilst in hospital… the 3 people I did ‘allow’ to see me were 3 very old friends, one of whom flew over from San Fransisco to see me so that was actually really special and lifted my spirits. (He made me laugh too, which was much needed:)
One of the others lived in London and had not seen me since chemo and was SO upset when she saw me and me post surgery that she just burst into tears and could not stop! I ended up comforting her…

There was zero handover from Charing Cross hospital back into local NHS care… no Fistrict Nurses booked to come change my dressings at home so I had to get my neighbour (who is a DN) to do it for me at home on my bed (I have 2 cats and a dog that I tried to nanfrom the bed but I do wonder if their dirty paws may have contributed to the infection?)

I would not advocate private over NHS for breast cancer treatment. I had access to better drugs and had my own room, but there has been no continuity of support and now no local post operative support.

Love my breast surgeon (he is based at Cromwell hospital), but my PS kinda makes me feel like an irritant. (Was fabulous at the beginning, but now he has done his bit it’s like he can’t be bothered with the post op minutiae … I would not mind if he could at least refer me to some subordinate or physio or something)
Bit confusing at times as to whom I should speak to.

I’m calling GP today to ask for physio referral for cording and massage

10

(Sorry about typos… numb thumbs on iphone!!)

11

Hi ladies. 8m 10 days oost op double mastecomy an double DIEP first op 15 hrs then emergency 3 days later on one side 3 hrs. Came home last night. Altho i used the private healthcare my company provides both my breast surgeon an plastic surgeons ( I had 2 due the length of time of reconstructin.But they ALL also worked within NHS Ive had my wounds changed twice. Theve been ok . Its very very early days for me. i realise that. Had 9 drains. last 1 removed yesterday. im sore as hell. Even had to have my belly button repositioned following DIEP. but my wounds are just taped with dressings on the drain an belly button sites. According to senior plastics nurse doing dressings change yesterday alls healing well. No issues of non healing. Even the difficult T bit I also had skin Reduction on my previous HH cup breasts. It was a bloody tough op I will agree. Tougher than I think you can prepare yourself 4. Me thinking ive had 4 children with a bit of gas an air. So itta be ok!!! ER underestimated the pain level. But then I had a drain kinked inder a rib which until they realised was agony . Im fairly drug intolant. So everything sent me into space so in the end just had good old paracemol an ibrophen. Have to say im expecting a 12 week recovery. At the moment everything hurts but ive not had any previous chemo or radiotherapy which is why i may not be having healing issues. I was told by team to wear certain firm support knickers from M & S. To help compress stomach which ive done from day 5. Theve also told me massage technique but from week 3. Got app for 3rd dressing change this friday. Got some discolouration on 1 boob. but assume thats bruising. Thank you for info regarding Guys & St Thomas for DIEP HELPSHEET. just got my husband to print it out for me. Youve all had horrendous recoveries. And your all a long way further than me. Maybe mine is to come. But I just wanted to post incase someone else is just about to undergo this an its obviously a massive operation. To say that so far for me. Even tho I had to return to surgery for a second op due to a bleed. And im sore as hell all over and my stomache feels so tight i cant stand staight. YET. its been ok for me with regards to healing an surgeon follow ups. I have appointments in place for results and checks. I hope all you lovely ladies stop suffering all these awful complications soon. We think after surgery thats it dont we. If it were only true.
Sending Hugs to you all
Love Bloss xxx

12

Oh PS had mine done at the ROYAL FREE on london. 70 miles from us
love bloss xxxx

13

Hiya blossum …Just popped into your board’s and just wanted to send you some hugs and hope u have a good recovery now u r home.

Hugs xxxx

14

Blossom… ref support pants the lady at M&S advised getting 2 sizes bigger than you are normally… great advice! Was like getting into a wetsuit when I tried their pre-op!!
I EVENTUALLY went back to M&S and bought the bigger version (they go up to my bra line, nice firm panel all the way up the front. Bit tight around my ribs cos I have a large ribcage, but definitely made me feel ‘safe’ and protected.
(The tight rib thing meant I could not wear them all day and not at night thought)

Spent a fortune on ‘cheap’ support wear… in retrospect it would have been a better investment to splurge on Maicom post surgery garments day 1.
Their bra is the ONLY one that I feel supports me properly and does not hurt! (I had a reduction too, but they are still E cup and need a bit of support so they don’t turn into burger bun shape!)
M&S do a great twin pack of wire free bras that are really nice in the cup, soft, seam free and supportive (£24.99 for 2!), but kinda hurt under my arms where the tail of my flaps is still settling down (bit bulgy where bra fits under arms)

I eventually also bought their smaller corset but I must have a short torso as the bones dig in under boobs and into tops of thighs when sat down… disappointing because when standing it gave me a lovely feeling of support. I have since been told the ‘sexy’ one that has shoulder straps and shorts (like spanx) is the best one for abdominal surgery. Bit late for me to get one now :frowning:

Wish I’d invested wiser.

Misread your post… did not realise only 10 days post surgery! Very early days.

Hope you have help at home, don’t lift a finger. (You will be tempted! I was up the loft ladder helping neighbour get my decorations out 2 weeks post op! Somehow managed not to hurt myself, but have to wonder if some of the issuesI have now are because I did not rest up properly.

Was easy to start with, but I did get frustrated in week 3 post op. You will be tempted… don’t give in :wink: