One Year Post DIEP flap Breast Reconstruction
I am now one year post DIEP flap breast reconstruction. I was finalizing my surgical prep exactly one year ago today as I write this blog. My surgery was the morning of December 1, 2014. So how am I doing now? How does my body feel? Do I have any regrets? Would I suggest having DIEP flap surgery to other women? Was I truly able to “just get on with it”?
I’m doing just splendidly!
I honestly believe that I’m doing quite well, in fact splendidly, and enjoying many benefits from having DIEP flap surgery after a second breast cancer diagnosis and double mastectomy. I want the reader to know so that you have hope. I just opened my social media accounts this morning before I began writing this blog post. I read a statement from a woman who was just going in for her DIEP flap surgery this morning. She was scared and second guessing her decision even as I looked at the picture she posted on line in her surgical gown. I want readers to know I have zero regrets about my decision.
You will soon be on “the flap side”!
This procedure will not be easy and I won’t sugar coat that reality but profit from the fact that you are reading about a patient who is “on the flap side’, as I frequently say. I have been rebuilt and my self-confidence is restored after living as an amputee for seven months while waiting on test results and doing research to find a qualified plastic micro-surgeon. In order for DIEP flap surgery to be successful it is imperative that you follow a line of research and I hope that my website and social media outreach continues to eliminate some of that footwork for women. You will get through this and you, too, will be on “the flap side”. There were days when the process will seem slow and arduous, challenging and time-consuming. Take comfort in the fact that when I think back to a year ago, it seems like the time has passed at bullet-train speed.
Benefits and Remaining Side Effects
There are caveats to having this long and intricate surgery so let’s take a look at the benefits as well as the remaining side effects and see how the patient is doing after one year.
Benefit: I have full function of my arms after having a bilateral mastectomy and DIEP flap surgery to rebuild my breasts. The lingering effects of radiation twelve years previous to my DIEP flap surgery have been resolved by my plastic surgeon. He removed the scar tissue that was hindering movement and giving me that tight feeling whenever I raised my arm above my head. This was on my left side where the tumor was removed and radiated from my first diagnosis. I can also lay comfortably on my left side now with new soft, warm tissue that replaced the radiated tissue. It was uncomfortable before reconstruction.
Having a plastic surgeon who was a Burn (Research) Fellow was an important qualification as I searched for the “just right” person to do my DIEP flap. Many patients come to a plastic surgeon, present company included, with skin issues from radiation or the prospect of future radiation. Dr. Chrysopoulo wrote an honest, informative and straight forward blog, Breast Reconstruction – Impact of Radiation Therapy. It is worth reading and I always appreciate his depth of knowledge and candor in driving home an important message for optimal outcomes in breast reconstruction.
Remaining Side Effect: There was a lot of work done in and around my arm pit area, to rebuild the breast and remove the scar tissue. The left side likely had more surgically invasive work done than my right side due to that scar tissue. The area behind my left armpit at my upper back continues to be numb to the touch. This truly is of little consequence unless I get an itch in that area. When I do get an internal itch and scratch the area where the skin is numb it is an odd sensation but really nothing more.
Numbness is a fact of many types of surgery, not just breast reconstruction. When you assess the various areas where layers of skin and nerves have been cut through, numbness is part of the process. This is also true for the nipple sensation and breast area. Your nipple, if you had a nipple sparing mastectomy (NSM), will remain sensitive to touch and temperature but the actually feeling is quite minimized, if that makes sense. Some sensation has returned in the flap area of my breasts. The plastic surgery group I chose frequently tries to reattach nerves as well as blood vessels during DIEP flap surgery. The purpose is to restore some sense of feeling. There is one spot in particular on my new flap that is very sensitive to the touch and I consider this a true bonus!
Benefit: I have breasts that are more beautiful now than they were before my mastectomy. They are larger by almost two cup sizes. I was a generous “A” cup before my mastectomy and my expectations as well as what my surgeon felt he could achieve were discussed at my initial consultation. This is a true example of what is defined as “shared decision making” with your plastic surgeon. There were no false expectations with this gentleman and it shouldn’t be with the plastic surgeon you have chosen either. My breasts are well proportioned and followed that magic; 45:55 tool that breast surgeon’s use and work to achieve the “perfect breast” during DIEP flap surgery.
Remaining Side Effect: I continue to be numb at the abdominal scar site where they take the tummy tissue to form the new breast mounds. This is a very large scar, hip bone to hip bone, and many layers of fascia, both deep and superficial, have been cut through to reach the deep inferior epigastric perforator. I have one very small area, about 6″ across, that is still red in color but the remainder of the scars have faded dramatically. I continue to use scar therapy lotion on the areas that are red in color. It was painful at times after phase one going through several sessions of physical therapy to break up scar adhesion and keep the them pliable and softened. It was not painful to the point that I was in tears or needed medication during or afterwards. It was short-lived at the time of the physical therapy sessions. I always speak to other women about the benefits of physical therapy after phase one and to at least ask their plastic surgeon if they would recommend it. Again, the numbness in my abdominal area is really insignificant. The funny thing is that I only notice it at the end of the day when I’m doing the evening dishes and my belly rubs up against the cabinet where the sink is. I know I’m touching it because I’m rubbing up against the cabinet but really can’t feel it because of the numbness. I think I should just quit doing the after dinner dishes and clean up to completely avoid that odd, numb sensation. Oh my! I may have to switch to paper plates!!
Benefits: I have a rocking flat tummy and for a woman in her late fifties who had two very large baby boys and a bit of extra middle age tummy tissue; Benefit, definite benefit! In fact, after I completed phase 2 of the symmetry, fat grafting, and scar revision portion of my DIEP flap surgery, I actually went down a pant size. Up two cup sizes in my bra and down a pant size? Come on ladies! What’s not to like about that benefit? Many women told me they had the same results but it’s hard to wrap your mind around that before surgery and even during recovery when you’re wearing surgical garments. I told my plastic surgeon after our 6 week phone call consult, “I’m enjoying my new wardrobe choices.”
My exercise routine is great but has changed.
I was able to do a one minute plank on my toes and hands the day before my double mastectomy. I don’t do planks any more although I was told I could return to those very slowly a few weeks after phase two. What I do now instead are yoga-like stretches and strengthening exercises to maintain my core. I also walk a lot. I walk daily and try to get in between 12-15 miles/week. When I walk, I contract my stomach muscles and really concentrate on my posture as I move along. A good plastic surgeon will do their skilled and very best method of preserving nerves and muscles during DIEP flap surgery. Again, this is another reason to choose a micro-surgeon who knows their business. Not to drive home a point but my surgeon is my reference point and this is another article he wrote on preserving as much of the abdominal wall muscle as possible given the patients anatomy. It is worth a read. Honesty, experience and candor are the key take away when you discuss your individual case and outcome for DIEP flap surgery. When your plastic surgeon knows what to do with the abdominal wall and preserving nerves and muscles, it might very well eliminate hernia or abdominal wall bulging post surgery.
I also find that my posture is better now and I eat less. Again, this is a result of that beneficial and added bonus of a tummy tuck after DIEP flap surgery. I lost seven pounds this past year, not intentionally, but I really do stop eating now before I get full, something we should all do. Having those tight tummy muscles does not lend itself well to over-eating. I also feel so much better when I have an upright posture. We tend to slump over by the end of the day from tired muscles and our daily routine. Having the tummy tuck and the tighter abs for me is a constant reminder to sit up straight.
So what is the meaning of that poster?
The morning of my surgery my husband was a good sport and agreed to carry this poster into the surgical waiting room to have it there when my plastic surgeon arrived. I jokingly requested that he put on his surgical hat since I had to wear mine. He cooperated with a grin on his face. He looked at the poster quizzically and said, “What’s this all about?” I asked him if he remembered saying the words on the poster during our initial consult. His answer was, “This doesn’t sound like something I’d ever say to a patient.”
In fact, it wasn’t something he ever said to me or to a patient. During my consult and after finishing the medical and serious part of the exam we turned to a lighter conversation. Dr C is surrounded in his personal life by women, his lovely wife and two beautiful daughters. Perhaps this has a great deal to do with his seemingly endless compassion. I was one of three girls but have been surrounded by men all of my married life; my forever complex and interesting husband and my two sons who are my life blood. We candidly talked about the difference between having boys and girls. Dr. C made the statement that his daughters like to have lengthy discussions about topics that are in need of a resolution. I explained to him that it’s far different in my house. The guys in my life get straight to the point with little or no discussion. He then said with a very broad grin on his face, “Yea, you know, I just look at them after they’ve been discussing away and say to them, can we just get on with it?”
And so, Dr. C, your patient has in fact, “just got on with it.” A year has gone by. I can now confidently tell women that there are qualified plastic surgeons across the country that can successfully perform their DIEP flap surgeries. I can tell them there are those surgeons who will make them a part of the important shared decision making process. I can tell them that I have zero regrets about my decision but it’s because I did my homework to find a qualified plastic surgeon. I recently had a discussion with my youngest son and asked him if he had many fears of me going through this surgery. He made a very brief and clear point. He told me that he really didn’t have any fear because he knew I did a lot of research before I chose my surgeon and knew I felt quite comfortable with him.
I just want to see my grandchildren.
I spoke with my oldest son today also. It was while I was writing this blog. There was a day in April of 2014 that I was told I was stage IV metastatic when spinal lesions were spotted on a scan that was ordered by my medical team before my mastectomy. That diagnosis was sadly made before that medical team had knowledge of prior records of lesions that were visible on a scan seven years previously. They later assessed that those lesions were actually stable. The stage IV metastatic diagnosis was retracted but that was a day I remember well. I was sitting in my breast surgeon’s office with tears streaming down my face and I looked up at her and said, “I just want to see my grandchildren.” I did not have grandchildren at the time but knew that my oldest son and daughter-in-law had those plans in their future.
I spoke to my oldest son today. I spoke to him on the day prior to the one year anniversary of having my DIEP flap surgery. It was a long distance conversation but I spoke to him today and congratulated him on the birth of his first child, our first grandchild. Next week I will travel to see him and hold him in my arms and kiss his tiny face.
Another boy, Dr. C! It’s time to get on with it!