PS has changed her mind - advice please

Hi
Would welcome opinions/advice on this. I first saw the PS about 6/9 months ago. She looked at me and recommended a DIEP based on body etc… At that time, I would have preferred a less invasive route but she felt that would give me the best result. I had the scans; all ok. Today I went back to finalise arrangements (I wanted to wait until summer as I am a teacher and this would cause the least inconvenience to my school) All ok to go ahead but the PS has changed her mind. She feels now that a LD with an inplant would be more suitable. She explained she had changed her mind and thought that more complications could arise because of the DIEP (She has seen more recently). She made it clear that it is my decision and I could go for either. That puts me in a total quandary. I am leaning towards the LD now and will talk over with my OH and friends but wanted truthful opinions from those who have had either op. Thanks in advance.
Linda

bump

Hi there

I had an LD immediate reconstruction with implant almost 6 years ago, it was the only one suitable for me so had no choice. I have been more than happy with it from day 1, the op itself was virtually painless much to my surprise and looked good straight away.

I suppose it depends what you have to start with, I have always been small so maybe it was easier 34b.

It must be difficult having a choice, I think with our limited knowledge we just have to be guided by the experts.

Good luck with whatever you decide.

Jan

Hi

Thanks for that Janice and Bubble for bumping. I am a 40c so a bit more flesh required. I am still at a loss at what to do. Talked to some of my friends on FB and there are mixed views there. Also, I am a bit concerned (although PS told me not to be) about the lymphoedema on my left arm (left side). It is under control and not noticeable and I want it to stay that way. I am going to be mulling this over for days I think. Again, any other opinions/experiences very welcome.

Linda

Hi, I had ld flap in April 09, with very good results, was very, very scared of the whole thing, but 3 days after op, no pain , up and about, and today my reconn looks and feels the same as my normal old floppy one, only better,

good luck x

HI there, wow its so difficult when you think you are going for one thing and then something changes isn’t it. I have been thinking about recon but not got very far into it cos of exactly what you are facing - the choice! I know some women have no choice but as I do in a way it makes it harder. Don’t know if it helps but my surgeon was obssesed with the mini viens - sorry tamoxifen brain, can’t think of their name. he was really keen to do the op that meant moving the least number of them cos he said sometimes they are tricky to resotre function in…
but sometimes not!!!
not sure this has helped, hopefully some more women who have had the ops will jump on here, best wishes Nicola

Hi
Thanks Nicola/Truffle. Still can’t decide. Surgeon said there is better recovery with ld but not according to a recent audit which favours the diep (longterm). Please keep your experiences/opinions coming as first hand stories give me an idea what to expect (good and bad)

Thanks again everyone and please keep them coming.

Linda

hello
can’t comment on LD flap but had tram flap 12 years ago and friend had one 7 years ago and we are both delighted with our recons. I am back in the system and get a lot of positive comments from doctors about my recon. The op has got much easier to have - I was in hosp 10 days in 1999 and my friend was in 5 days in 2004.
We were both told tram would suit us better because we are heavy breasted (and had no shortage of tummy flab)
what I would say though, is that I have had 3 hernia repairs, bcs in 1999 they used more muscle. My friend hasn’t - they used less muscle for hers, so that is something to consider, something to ask your pS if you opt for the tram.
I have had recurrence on the same side and tram didn’t affect me finding it or anything (was 10 years after tram)
I hope this is in some way helpful - I know a recon is a hard thing to go through, but so worth it, from an emotional perspective.
good luck - I’ll be thinking of you xxx

Hello all, my first ever message and going for the diep next week… I had the option of LD or diep and also was in the same quandary! My breast care nurse was really helpful and gave me the phone numbers of others that had diep or LD, which i followed up. I felt that I’m in pretty good health generally and would recover ok from the longer op. I could live with a tummy scar rather more than one on my back and I’m all for a flat tummy. Be guided by your consultant but you will know when you have made the right decision! My best wishes and I will be happy to update you on how I’ve got on.

Hi

Thanks Daisyleaf for your kind words and sharing your experience, I must say I am leaning towards the diep because less muscle will be involved. Also, more women appear to happier with the results of the diep and finally I am also wary of inplants. I like you am a generously proportioned lass with a large apron of fat (partly from childbirth and partly from gluttony) There really does not seem to be that much on my back. I really wish she hadnt given me the choice and left it with the diep we agreed prior. The hernias you mention are something she mentioned too as a possible problem and it is something for me to consider. I will be mulling this over for some time I think.

Linda

Hiya, thought about your dilemma again…there could be various reasons for your PS to change her mind but has she made it clear what the ‘complications’ are? I can only comment from the viewpoint of having no underlying health issues and am a non smoker. The LD is a simpler op with no micro surgery involved. I must admit, i ffelt my initial surgeon veered towards this ( he did them all the time). Its iimportant to be confident in your PS - ask how experienced she is in performing the DIEP. Since my decision to have the diep, my Key PS has changed. My PS has performed many & v experienced (that’s what the breast care nurse informed me). When I asked about complications, we spoke about the risk of the implant failing /dying. I was informed that this is quite rare with both ops but slightly higher with Diep. I was also reassured that staff are extremely vigilant during your stay in hospital - as it is more likely in the immediate days following op. I’ve probably left you with more questions than answers. Btw diep is a free flap, shouldn’t generally involve the muscle and I’ve not been told of any issues
With hernias.
take care x

Linda,
I had an ld flap with implant last year. Im a 38E so plenty of muscle needed to cover those!!
I have mixed views and will be honest with you. My body rejected the implant 3 times and im now without it. Im going to try one last time to even my breast size up once im post surgery for one year, if it doesnt work then i will have to get used to being slightly lopsided. Im one cup size smaller on my recon size. The “flap” itself and the the “boob” that i have looks fantastic and im very happy with it. The one thing that I wasnt warned about was the chronic backaches that i have received since they have taken my muscle from my back. I do a very physical job (police) and find after a bad shift i cant wait for a hot bath and a hot water bottle to follow.

really hope you make the right decision for you, its not an easy one.

deed
x

Hi Linda,

Havng read all the posts, I thought I would post a comment - don’t do this too often now but do read them fairly often. I had a mx and immediate diep recon back in Oct 09. I was in hospital for 8 days as I suffered with a back problem and this caused me to have a slow recovery mobility wise. I have to say that my recon boob is great and I would not hesitate to do it again!! Pre surgery I was a 38FF and now I am a 38E. I returned to work full time after 10 weeks on a graduated return. I am a nurse and was initially very careful with what I did but soon returned to full clinical duties.
From your comments and the PS changing their mind, I would question her reasons. I think myself lucky that apart from some discomfort and a small area of fat necrosis that resovlved over a few weeks, I had a very good post operative recovery. I do remember my PS informing me that the diep is supposedly the “gold standard” for recon and I feel that your PS may not be experienced enough to be comfortable in recommending it. This would explain the reluctance to undertake the procedure and the mentioning of her seeing more complications just recently. I would make sure that you do your research regardng surgeons who undertake this procedure and ask to be put in contact with someone who has had the procedure performed by your PS. If you decide to go down the diep route, please ensure you have an experienced surgeon which could result in you asking to be referred to another surgeon for a second opinion. You are entitled to this and it may help you reach the right decision for you.
Good luck for which ever method of recon you choose but please don’t rush the decision.

Good luck,
Maggie xxx

Hi all

Thanks for all your input, most appreciated. I presume from the age of my PS that she is quite experienced (I guestimate about 40-50). When I first saw her, she was very confident about diep, said she had never had problems although they could arise and generally sold it to me lock, stock and barrel. This time she was different. She looked at my back and said she now thought there was enough flesh there (and yet I weigh less than the last time I saw her). The complications she mentioned were possible hernias but also a recent patient who could no longer sit up in bed unaided. She felt that as I am an active person, the ld would be better. Given my profession as well, she pointed out that an ld would mean less time off work.

I am reading all your thoughts here and also on FB where I have asked a few people their opinion and I am still veering towards the diep. I wonder if there are underlying financial issues here that are influencing her views. (big London hospital). I have a while to consider this (am on the waiting list but obviously can change my mind between now and then). You are right Maggie in that I should have confidence in my doctor and I do really wonder about the change of heart, especially as I had to suffer an awful scan of my chest (my veins are shot to pieces and I have lymphoedema in other arm) It took several attempts until we had gone up a chain all the way to a consultant who finally managed to get a line in. My arm was covered in bruises for weeks. The scan proved that despite having had heavy rads, the blood supply was good.

Anyway, everything I am looking at points to diep taking much longer to recover from and more risk of infection but ld possibly causing restricted arm/back movement and problems with inplants.

I am not a smoker (did in my youth but not for quite a few years now and mentioned this at original appointment) and I eat well and exercise regularly. I am slightly overweight but fit and well considering what I have been through.

Anyway rambling now. Thanks again to all.
Linda

Hi

I had MX to left breast and immediate LD flap +implant recon on the 26th Jan.

I’m not over-weight (didn’t even have enough tummy fat to consider diep option) but not skinny and was a 34/36 C/D cup (depending on weight and bra make!) before surgery, so needed the implant, but not too big to have to consider a reduction on the ‘good’ side. I’m 49 and my boobs, tho quite good, certainly weren’t as perky as when I was in my 20s.

Even if I could have had the diep option, I’m not sure I would have taken it. It sounded like a massive op and my main hobby is horse riding, for which good tummy muscles and core strength are more important than arm and shoulder strength.

My plastic surgeon (who took over once the BC surgeon had done the MX and lymph node removal) has done a great job of matching my ‘new’ boob to the old one - even down to the right level of ‘droop’!

Had hardly any pain post surgery - didn’t need morphine pump. Had op late Fri, out of bed on Sat and walking the corridor on Sun. A week in hosp - they didn’t let me go til all drains removed. Did get a seroma on back that needed draining a few times, but that resolved itself quite quickly. I was driving and back at work (part time for a couple of weeks at first) 6 weeks post op.

Four months post surgery and the new boob is really starting to feel like it belongs to me - obviously don’t have the same level of feeling and it still feels a bit firmer and heavier than the other one, but improving all the time. It’s a bit bigger than the other one but this may still alter and I have a port in the implant so it can be adjusted at a later date if needed. It’s a bit perkier (they are now nicknamed Pinky and Perky) than the other, but all of this is totally unnoticable in bra and clothes - and I’m wearing lowish cut tops with a totally natural cleavage. Still in a sports bra 24/7, but I think that mainly cos I’ve got used to it and find it v comfy compared to my previous underwired lace numbers!

My scars around nipple area and on back are improving all the time ( I do use Bio Oil). I can see that the nipple area scar will be v difficult to spot in a year or two. The scar on my back is bigger and more ‘serious’, but still improving and is covered by my bra strap. Where they passed the muscle thru under my arm is now a bit bulkier than the other side - but everyone else says that they don’t notice it - and have worn quite fitted t-shirts.

My shoulder and under my arm still feel a bit stiff and tight, but I have virtually full range of movement and am back gardening and horse riding - albeit carefully! Make sure you get and do the exercises!

I’m 1/2 way through chemo and that does make the recon feel worse at times, but I’m assured that this is temporary. I’ve found out that they are also now recommending rads. The recon has no effect on the effectiveness of these, but radiotherapy can adversely effect the recon - mainly due to the risk of capsulation round the implant. This was a calculated risk I took - my plastic surgeon said that even if that happens and, worse case, down the line I need the capsulation removed and a new implant, the final cosmetic result will still be better than a delayed recon.

Overall I’m very pleased. Hope this has helped.

Good luck!

Hi

Thanks DJ for your detailed comments. When I had my MX it wasnt an option because the hospital i was under did not have a PS unit. I would had to have waited several weeks. I choose not to wait - a decision I have never regretted given than it turned out most of my nodes were infected. I had chemo and rads but my skin held up very well and there is no evidence of it. I used a gel from the Penny Brohn centre (radiance gel) and whilst it was expensive, I swear it helped me.

I am still veering towards the diep. I have concerns about the LD for me. I have lymphoedema in that arm which is unnoticeable becaise I manage it well. I would be concerned about any ‘stirring’ it up. I know what you are saying about the tummy and I do have to take that into consideration. I have put down for the diep but can change my mind up until surgery.

Anyway good luck with chemo and if you need them rads. Whilst neither are nice, I found the time went quickly and my life is virtually back to normal now.

All the best
Linda

Good luck Linda with whatever you decide. - We are all different - that’s why it’s good to have choices!

My sis, who came with me for some appts for moral support, said that she quite fancied the idea of a tummy tuck and a boob job all in one!

Diane x