SGAP flap reconstruction

Hello ladies

I’ve just been to see PS and have been told I can’t have DIEP flap as not enough spare flesh, I have been told to go away and read up and consider the SCAP flap, has anybody had this and can anybody give me any advice? How painful was it post op, can you sit down! how soon before you are up and walking? Has using the skin from the buttocks compromised your physical performance at all?
How long was recuperation and what about scarring?
I’d be grateful for any responses.

Scone

Hi Scone

Don’t know if you’ve already seen our publication on the subject of reconstruction. But just in case you haven’t, here’s the link.

Thought you could have a quick look whilst you’re waiting for responses from others about their experiences.

breastcancercare.org.uk/healthcare-professionals/publications/treatment-and-side-effects/*/changeTemplate/PublicationDisplay/publicationId/107/

It can be either downloaded or ordered through the link.

Best wishes

Louise
Facilitator

Hi Scone

I had the IGAP which is pretty similar just that it’s taken from the lower part of your bottom rather than further up your buttocks. The scaring is in the crease. I won’t pretend it was easy - it was a very long operation and I felt pretty rough afterwards for a few days - think the morphine didn’t help as it makes you feel sick but I also had anti sickness meds which helped.

The whole area was pretty numb after so actually not much pain however it did affect a nerve in my leg which caused a few short term problems which seem to have resolved mostly now. I have a numb section going from the back of my leg behind the knee going up my leg to the crease in my bottom. Other than that, physically I’m fine although like I said it isn’t an easy operation and I was in hospital for a week and then recovering at home. Once you start feeling better, you pick up really quickly.

If you have any specific questions, please ask.
Ruby xx

Hi Ruby

Thank you so much for the reply, how long ago did you have this op?
How long was your recuperation? I’ve just had 6 months off work for the mx and the chemo so very aware that I’ll be needing more time off.
Has your shape been altered at all with using the lower buttock, I was warned that by using the upper buttock in tight clothing you would notice a difference in the shape of the two buttocks.
Given what you know now, would you go through it again?
I am quite sporty I swim, walk and go to the gym, do you think my physical performance would be affected by the op?
More importantly, what do you think of your new breast?
Did you need a reduction on the non bc breast?

Scone

xx

Hi Scone
I had the operation in April and was back at work within 4 weeks. I had a problem with my leg after which happens in a tiny percent of people whereby the nerve was traumatised and I couldn’t walk on it for a few months so I was on crutches but I’m off them now and things are much better.

I am also sporty and go skiing every year and you have to be really fit for that so I’m planning to go back to the gym asap and start getting fit again.

In terms of would I go through it again - well I am going through it again as the side I had done was the unaffected side - the affected side still needs reconstruction. At the time of the first op I said never again but it does look so good that I need to finish it off and have a perfect set - so yes I would do it again. So I will eventually end up with two hopefully perfect breasts both not natural - it’s a bit like havinig implants I suppose.

xxx

HI Ruby

Thanks so much for that additional information, I have another appointment in Jan with PS to discuss this furthers so I will have some more questions for him on reading your account.

When you first had op done, how did you sleep, I’m presuming you had a drain in the chest and one in the buttock, or was that the least of your worries?! Could you sit down straight away?

It is very encouraging to read that you only had 4 weeks off work, I have just had 6 months off for mx and chemo I assumed it would be months you would need to recuperate.
Did you need an implant as well or was it just your fat, skin and cells which were used - I got the impression that I might need and implant as well and to reduce the other breast by 2 cup sizes.

When do you think that you will go and have your other breast reconstucted?
I am aiming for op in 2012.

Jude

xxx

Hi Jude

no problem please just ask at any time i’ll keep an eye out for out for you as i know it’s not the most common operation so you may not get too much response and i am happy to help anyway.

When I had the first operation, I can honestly say that I was out of it for the first 2 days - partly to do with the anaesthetic which was 9 1/2 hours at least, partly that i lost a lot of blood so needed blood transfusions and partly because i had a morphine pump which I was using and makes you very sleepy. i did’t feel at all great - felt a bit sick but that was resolved with anti sickness drugs, was in discomfort. I actually couldn’t really move on my own for the first few days. I had a catheter in for about 3 days so i didn’t really get out of bed except for about 10 minutes to sit in a chair while my bed was made on day 3. I was bed washed for the first 3 days. Oh yes I slept loads by the way.

I did have drains - I had lots of tubes in me, one in my neck which was a central line to feed drugs straight into my system, a drain in my breast, a drain in my bottom/leg which was quite uncomfortable as hte stitches holding it in place can be a bit sore. Once they came out, it wasn’t so bad. The pain I felt was a bit like a burning feeling but only when I moved. When i was still i was ok.

Once I started recovering after coming home, my strength came back quickly - I’m not old only in my 30s so my body should recover quickly.

I didn’t have an implant and i won’t be able to have one on the affected side anyway as there isn’t enough skin and there is no fat or any covering there any more. my cup size is quite small a b/c cup but I’m happy with it and the other side will be the same when it’s done. It may be that you are able to have an implant as well - that was discussed for me but then discarded due to the condition of my skin.

The next op won’t be until after my next skiing trip at end of March so most likely April time.

Hope this all helps
xxx

Hi Jude
I dont know anything about this operation but I had a strattice reconstruction with an implant on 3rd September. My PS suggested it after a DIEP flap was ruled out due to old abdominal surgery which compromised the muscle but with the strattice no other area of the body is affected as your pec muscle is brought over the implant and held in a hammock effect by the strattice mesh underneath it. Healing was quick and very good, but unfortunately I had problems with my old scar which showed cancer cells 3 yrs after my wle and I have had to had it removed and replaced with an LD flap and expander on 4th November for them to get as much skin off as possible.
I read up a lot about the strattice before I went for it as its relatively new in this country although common in America and they use human tissue though and we use animal tissue.
Hope this can help in your decision, its a big thing,

Take care
Anne

Hi Annabelle

Thanks very much for that indeed, not heard of that method and at a glance it’t not even in my text book, I’ve got appoint in Jan so I’ll mention it then.
What is your verdict on LD flap? Would you recommend that one?
I ruled that out initially as I swim and do resistance training and was told it could impact performance but it does seem to be a more common method.
How are you feeling now?

Jude

Hi Ruby

Thanks for all your info, I remember the drains from the mx!
It does sound a huge op doesn’t it, especially when you mentioned the blood transfusion on top of it.
I’m assuming they wouldn’t do a reduction on my good breast at same time with such a long operation time.
All very daunting isn’t it - so much to consider.
I think it would have been much easier now to have an immediate reconstruction with the expander, but at the time my Surgeon disuaded me from it in case I needed radio after chemo, but as it happens, I only required chemo.
How are you feeling now?

jude

Hi Jude
Yes it is daunting but for me it was worth it - after everything I’ve been through I can handle almost anything - or at least I think that way now! I feel good now. I do get tired or more tired than I used to but I believe it may be to do with the whole combination of all the treatments I’ve been through over the last 3 years. I didn’t have reconstruction immediately after my mastectomy as my medical team wanted to monitor the area for a while but also like you I had radiotherapy and I had to have that first - I’m pleased I waited though.
xx

HI Ruby

we messaged a few months ago when I inquired about your SCAP op.
I have had another meeting with surgical team and I really don’t think that I will go through with this type of reconstruction.
I just don’t think I could bear the recuperation and the pain, being very much a wimp.
I am thinking now that I might go for just the implant/tissue expander option, really feel that this is best option for me at the moment and the only type of surgery I could face.
it’s against everything I ever said I would do, but feel that it would be easiest option for me.
I have another meeting in April and think I will make up my mind by then.
I hope you’re progressing well and you’re pleased with the operation results.
let me know how you’re doing.

Jude
x

Hi Jude
It’s great to hear from you and thank you for coming back to let me know what you’re decided. I’m pleased you know what you want and are doing what you feel is right. The reconstruction i.e. SGAP is very very major surgery and it wasn’t at all easy. If I could have gone for the implants I would have done but there was nothing to put the implant behind and the skin in the area is not strong enough either. I’m doing really well thanks. My recon is looking really good but I still need to have the other side done although it’s hard to make the decision to go for it as having had the other side done - I’m not sure I can face it again but we’ll see. Everything else in my life is going really well. Having had BC is very hard psychologically and I have my ups and downs as I’m sure we all do.
I look forward to hearing how you’re doing and when your op date is and what the results of your meeting are in April
Take care
Ruby x