Out of the Diep…an observation of Diep Flap Reconstructive Breast Surgery

My 56 year old sister, Diann, had double mastectomy with Diep Flap Surgery on October 27, 2016.  It is a grueling surgery.  It is not my goal to discourage women from having this surgery.  Rather, it is my goal to instruct them to do their homework before they make the decision to have a Diep Flap done.  It involves far more than the description reads.

Diep Flap description is:  

DIEP flap is a type of breast reconstruction in which blood vessels called deep inferior epigastric perforators (DIEP), as well as the skin and fat connected to them, are removed from the lower abdomen and transferred to the chest to reconstruct a breast after mastectomy without the sacrifice of any of the abdominal muscles.

Because the DIEP flap procedure requires special surgical training as well as expertise in microsurgery, not all surgeons can offer DIEP and it’s not available at all hospitals

Through the past 5 years of writing my breast cancer blog, I’ve heard from countless women who have had Diep.  Some have done really well, some have had major complications, and others were in the middle.  Age plays a role in it as traditionally younger women bounce back more quickly, however, this is not always the case.

As a woman who has had a single Mastectomy with no reconstruction, I have certainly pondered these surgeries for myself.  It was always my intention to have a reconstructive surgery, but after serious heart issues with Chemo and Herceptin, I decided against it.

I accompanied my sister to her appointments with the Breast Surgeon and the Plastic Surgeon.  Dr. Jeruss, her breast surgeon at the University of Michigan warned her of the severity of the recovery of Diep Flap surgery.  She did not pull any punches, but told her although she would be a good candidate, to really think about if that is how she wished to proceed.

Diann then met with Dr. Mohmoh, a Plastic Surgeon who is well respected in the Diep Flap Surgery also at the University of Michigan.  Dr. Mohmoh spent a lot of time with us explaining what the surgery would entail, drawing pictures, explaining the recovery process, and the unexpected and rare things that can happen after surgery including infections, repeat surgeries, emergency surgeries, etc.

That being said, nothing really prepared Diann or our family for what the Diep meant. Diann had 9 hours of surgery with the breast surgeon and the plastic surgery team working simultaneously.  That is a short surgery as some can last 12 hours or longer.  The breast surgeon finished her work after about 3 hours, and the Plastic Surgery team continues.  From a family perspective, it is beyond stressful having your loved one in surgery for that long.

Diann was rushed back into emergency surgery just before Midnight which was six hours after the initial surgery was completed.  She had one of the complications Dr. Mohmoh warned her previously.    One of the blood vessels that was connected formed a clot within, and a second surgery was required to clear that area to save the flap so blood flow would continue to the transplanted area.

About 24 hours after the second surgery, that same flap began acting up.  The plastic surgery team was checking her flap every few hours for the entire day and night.  It was extremely stressful for Diann and family members because a third surgery was a very real possibility.  Thankfully, things turned around and that was not necessary.

Diann was released on the 7th day after surgery.  She was kept 2 days longer than most patients because of the complications she had.  The University of Michigan has a floor that handles all the DIEP patients.  It is not considered Intensive Care, but it is.  The nurses are assigned only 2 or 3 patients so a very close eye is kept on the patient.

Previous to her release, Dr. Mohmoh ordered visiting nurses to visit Diann 3 times per week and gave them specifics what to look for and how to care for her.  Having those visiting nurses was a great asset to have a set of trained eyes examine her surgery sites.

It is a long recovery compared to most surgeries.  If you are employed, you need to be off work 6 to 8 weeks, more in some instances.  And you cannot do much at all in those first 4 weeks and you will DEFINITELY need care and help.  There are A LOT of pain meds involved.  Mostly, Diann has sat in the recliner and slept in the recliner for the first 2 weeks.  During Week 3, she was able to sleep in her bed with the help of about 6 pillows.   It is a slow recovery period.  Diann was warned if she started doing too much, it would set her back dramatically.

It was four weeks before Diann was able to leave the house and that was me taking her for a ride in the car so she didn’t go totally crazy of being housebound.  Even that wore her out, and she was glad to be home when she returned.  Now at 5 weeks out, she is still in the recliner with daily walks and an occasional short outing.

If you are not a good patient, I would not recommend this surgery for you.  If you follow doctors orders and do what you are told, can sit in a recliner for long periods of time with occasional walks, you might be able to handle it!

As for the surgery sites, Diann is healing well.  She said it is good to look down and still feel like you have breasts, however, the pain is very intense.  She is slowly weaning herself off pain pills, but has endured a lot of pain.  It is unnerving to see her abdomen wound from hip to hip!!

Diann will be writing her take on Diep Flap and offering her advice on the next Blog Post.

 

Please check out my online shop at http://www.hellocourage.com  for chemo caps, scarves and more!

 

 

 

 

 

 

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5 comments

  1. I had TRAM reconstruction, which is similar to DIEP, but did involve sacrificing muscle. It was brutal, and I imagine that DIEP is no less so. At the time, I doubted that I could survive it. Now I am happy with the results and glad that I did it. I’m glad to hear that Diann is doing well.

    • Hi Lisa – thank you so much for telling me how you felt during TRAM reconstruction.
      It is good to hear how glad you are that you did it now that time has elapsed!
      Wishing you MANY, MANY years ahead!!

  2. I am so glad that Lisa and your sister are doing better now. I have a cancer buddy that had similar issues as you both, therefore I opted for breast conserving surgery, (a lift) age 65.

    At time of surgery(3 1/2 years ago)I was initially diagnosed with stage 2, and brachytherapy was thought be all I would need. The implant was placed in my first surgery, then then pathology showed 9 positive lymph nodes and stage 3 tumor. The implant for the brachy.. was in for 9 months due to 16 chemo (adriamycin and Taxol) and 25 radiation tx. I am left with constant tenderness and cramping also a huge rock of scar tissue in the breast. , drs don’t feel that surgery to remove it is necessary. I just wonder if anyone else has this problem. I am feeling I should have had the mastectomy.

    Thank you,
    Betty

    • Betty, I have spoken with alot of patients who have scar tissue, but nothing like you describe It is usually confined to the surgery incision and does not involve a “rock of scar tissue” which sounds very painful. It is understandable you have tenderness.
      I am sorry I cannot be of more help. I also was Stage 3 and had 9 positive nodes. It is a LONG haul and the fears never go away.
      Sending all my best, Denise

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