If all goes well,
I had my last mammogram today.
Like last - as in forever!
Wahoo!!!!!
I have been having a mammogram or Breast MRI's
ever six months since being diagnosed.
With the mastectomy and reconstruction I will have done soon,
I will no longer need either.
I won't miss them.
Next month I go to Salt Lake to meet and have a consultation with a plastic surgeon.
I have heard a lot of scary things about the type of reconstruction I want,
but I have also seen a lot of amazing results.
It is a very complicated surgery - micro surgery.
Surgery can last anywhere from 4 to 12 hours,
with at least 3 surgeons working simultaneously.
The hospital stay is usually 5 to 7 days, the first few being in the ICU.
Recovery is hard and long too.
Basically they want you moving,
but no cooking, cleaning, bending, lifting, stretching, climbing stairs...for months.
It can not all be done in one surgery so it is done in phases.
Usually 3.
I hope to have all of them done in one year.
That is why I am starting in January.
The procedure is called Deep Inferior Epigastric Perforator or DIEP flap.
Simply - you are cut from hip to hip below the belly button.
They dissect the fat and skin from the muscle and relocate it to the breast.
Since fat needs a blood supply if the vessel in the chest wall are not big enough or ruined from, say radiation,
they will break a rib and tap into the blood supply there.
Then they pull, sew, stitch and glue everything back together.
Here is all the technical stuff:
A DIEP flap is a microsurgical breast reconstruction where skin, fat and the associated blood vessels that keep it alive are transplanted to the chest wall from the abdomen during the Stage 1 Procedure. No muscle or motor nerves are sacrificed in the execution of this form of breast reconstruction. Blood vessels of the flap are connected to either blood vessels in the chest wall or under the arm in the axilla using an operating room microscope. Unilateral and Bilateral DIEP flap breast reconstruction can be performed in a 4-12 hour general anesthetic in the setting of a 5-day hospital stay with a focus on flap monitoring. Blood thinners are administered to prevent deep venous thromboses or pulmonary emboli. Sensory innervation can be supplied by the incorporation of a sensory autograft. Costochondral cartilage or rib resection is uncommon unless you are a very petite woman.
Stage 2 of this reconstructive technique involves the aesthetic shaping of the breast reconstruction flap and the completion of any counterbalancing procedures of the remaining breast (breast reduction, breast lift or breast augmentation). It is typically done 3 months after Stage 1 but can occur later for patient convenience. Excess skin from the flap previously placed for perioperative monitoring will be removed. Revisions to the donor site include liposuction and scar revisions. Nipple reconstruction is completed at this stage. On occasion in the irradiated patient, nipple reconstruction is deferred to a later date allowing for the revised reconstruction to settle, therefore optimizing nipple placement. Stage 2 procedures can be completed in a 2-hour MAC anesthesia in an outpatient setting.
Areolar reconstruction will be completed as a Stage 3 procedure in 2 months in the office.
DIEP flap breast reconstruction has been associated with mild buldging of the abdominal wall but with a significantly decreased rate of abdominal wall weakness or hernia. It has not been associated with post-operative back pain. Common complications are seromas or collections of fluid under the skin that may require needle aspiration.
DIEP total flap failure can be seen in less than 1% of cases.
DIEP total flap failure is diagnosed prior to your release from the hospital. Most patients with a failed DIEP flap undergo a secondary microsurgical flap procedure during the same hospitalization or at a later date, typically at 3 months, in the form of an I-GAP flap.
DIEP partial flap loss is commonly referred to as fat necrosis. Fat necrosis can present as a firm area of the breast reconstruction flap where the blood supply was not adequate enough to keep the tissue soft and viable. It likely represents an anatomic variant of the individual (not unlike a "hole" in your Christmas tree), OR possibly the poor choice of the perforating blood vessels to support the flap reconstruction. To avoid fat necrosis a pre-operative CT or MR angiogram is done so your procedure can be based on the most robust blood vessel of your abdominal wall.
PS In case you were wondering, I do NOT recommend googling a video of this.
PPS The mammogram came back - stable mammographic appearance. No new concerning microcalcifications. Benign Findings
Another Wahoo!!!
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