DIEP vs TRAM flap breast reconstruction??????

hi!

     My name is Karen. I am trying to find out as much about the diep, siep, gap, and the free tram breast reconstructions!  So far I understand the surgical techniques... but I would love to hear from women who have had these new microsurgeries! The plastic surgeon that I am consulting in North Idaho only does the TRAM reconstruction. However, I found a surgeon in Missoula, Montana and he takes Montana breast cancer medicaid patients. Medicaid would not cover such an expensive surgery and the lady I talked to said they do the breast cancer reconstruction just to help the fight against breast cancer!!!!

                                     thanks for any info!!! Karen in north Idaho

Hi, Karen.

I have not yet had reconstruction, but my DSIL is a plastic surgeon. There is a dirty little secret out there that most of us do not know about breast reconstruction. OUR INSURANCES PAY VERY LITTLE FOR BREAST RECONSTRUCTION!!!!!!!! When you start talking about DIEP or SIEP (micro surgeries) VS tram you are talking about major time differences. I am sorry to say that with what plastic surgeons are compensated for these reconstructions, most prefer the tram or even the free flap (not quite micro surgery) verses the longer DIEP or SEIP surgeries. PS's just can't seem to convince insurances to pay more for these better but more costly, time consuming surgeries. If I have one, and I say if because my insurance does not use the plastic surgeon I have chosen, I will have either the tram or the free. To my knowledge, no one in this town does the micros on a regular basis because of this compensation problem. The metro area here is over 1,000,000 people. Most do free or tram.

Judy

Hi, Karen.  I think you made a wise decision to wait for the surgery until you could research and decide what is best for you. 

I had a TRAM -flap many years ago.  Results vary with the surgeon.  One of the best looking TRAM-flaps I've seen was on Desertdreaming.  She had a bilateral a couple of years after her double mastectomy.  She has absolutely great results!  Very natural looking.

Because you are having a bilateral, you won't have to worry about weight gain or loss.  Whatever happens to one side will happen to the other...those of us with just one side reconstructed are the ones who have to worry about that.  I'm surprised your SIL didn't tell you that.

As far as I know, anywhere they take tissue for a reconstruction is going to involve losing muscle somewhere.  I'm not that "up" on the microvascular surgeries, so forgive me if I'm totally wrong about that.  I know when I had the reconstruction, it was the belly, the back, or the butt.  The belly was the most popular because it gave a bonus "tummy tuck." 

Since you're having bilaterals, I would think about plain old implants.  You wouldn't have to worry about losing muscle anywhere, the procedure is much less invasive, and any good plastic surgeon should be able to give you a good result.

And Erin, we did have another friend whom we have since lost who had a bilateral Lat Dorsi with implants.  She, too, had a really nice result.

Good luck in your decision, Kathy.  And good for you for making sure you had time to look at all the options!

Hugs...

BEV 

 

Karen...I've gained about 40 pounds (OMG, that makes me sound like a plain old COW, doesn't it?) due to plain old menopause! I know the bipolar meds can be real tough on weight gain because my hubby is bipolar. He switched to Abilify when it first came out and lost quite a bit of weight when he switched. Really does a good job of keeping him stable as well. That's not all he takes, of course, but was able to get off Depakote and Zyprexa, which are major culprits in the weight gain problem.

Didn't know you had the rads. Hope you have good luck with whatever you choose!

BEV

Dear Karen,

I had simultaneous bilateral GAP reconstruction a year ago after failed implant reconstruction.  I didn't have enough tummy fat for DIEP.  I had to travel out of state to New Orleans, Louisiana for my surgery as there are not many surgeons who perform this procedure.  My Stage I GAP took 8 hours with 2 microsurgeons working on me at the same time. 

Skin, fat and blood vessels (no muscle) were taken from my upper buttocks.  I stayed in ICU for 24 hours so the nurses could monitor the blood flow to my flaps every hour. I was then moved to a regular room and stayed in the hospital a total of 4 nights.  surgery was painful, but I was walking around the French Quarter on day 9 post op.  I went back to work after 6 weeks. 

Stage II revision surgery was performed 12 weeks after Stage I, and my doctor reconstructed my nipples, reshaped the breasts, reshaped the buttocks, and did some body contouring with liposuction for symmetry (liposuction of inner/outer thighs, lower back and tummy).  This was very painful but short lived.  I returned to work 2-1/2 weeks after surgery. 

I am thrilled with the results.  You can view before and after photos of DIEP/GAP at my Docs' website. http://breastcenter.com 

Cricket1954 

Karen,

     I am planning on having the DIEP done in Louisiana at the Center for Restorative Breast Surgery.  Their link is...  http://breastcenter.com/  I have spoken to them, I have researched the surgery and have not found one bad thing so far. 
     The TRAM Flap surgery takes muscle from the stomach, buttocks, or the back.  The Free TRAM Flap is done with very little muscle and the DIEP, GAP are done with just tissue and fat.  The surgeons in Louisiana are doing it on a daily basis.  They work with your insurance and with you. There is a place on their site to contact them and they will send you information or call you. I spoke to them for 1 1/2 hours the other day, and found them to know what they are talking about. There is a surgeon in New York that does it too. His name is Dr. Allen.  He is the pioneer of the surgery here in the USA.  He found it and studied in Japan and brought the procedure here originally, and has had great success with it.  I highly recommend that you contact them to see what information they can give you concerning insurance and answer your questions.

      I am anxious to have it done and to be free of implants for good.  You have to be explanted for 8 weeks prior to the surgery, and a non smoker, so if your like me you have to quit.  It is for our own good anyway to quit.  They help with planning your trip and all.  They are no longer in New Orleans of course, and they also worked with Dr. Allen at one time.  He chose to move north and they stayed south. 

      Good luck in your research and with surgery.

                       Joyshow

Karen

       Your best bet is to contact Dr. Allen in New Orleans or Dr. Scott Sullivan in New Orleans.  Dr. Allen does a newer procedure now called the I-GAP where they take the fatty tissue from the bottom of the buttocks and then the scar is in the crease and there is less showing.  I understand it is one of the best ways to go.  If you want you can email me at [email protected] and I will give you the information that I have available plus put you in touch with a few women who have had the surgery done already and love the results.  Joyce

Hi Karen,

   In talking to a few doctors offices yesterday I was informed that quite a few of the doctors do not want to do the new I-GAP that Dr. Allen pioneered.  They are stating that they have had patients that end up with Sciatic Nerve problems.  I still feel that the DIEP or the S-GAP is the way to go, there is no muscle transfer, no chance of breast cancer, no need for Mamograms anymore.  Plus when they do a Tram Flap they take muscle from the stomach and that is hard on a person who has any type of back issues.  They need all the stomach muscles they have and in tact so that they can hold the back with more support. 

Bernadette....I am praying that all goes well and that you heal well and have a speedy recovery. I will keep you in my thoughts and prayers.  Best Wishes.