If I wanted to remove my current implants and have them replaced with a safer brand, my plastic surgeon shared that she could move them to above my muscle and all that pain would go away. It would be a quick, easy surgery. She compared it to changing from one shoe to another. However, I’d still be stuck with a foreign object in my body and if breast implant illness is a thing for me, none of these symptoms will really go away.
Because of this, I have eliminated any implants (saline or silicone) as viable options for reconstruction option for here forward. Given my high c-reactive protein, my doctor believes that once I have the implants removed, I will be shocked at how good I feel, that my body has gotten so used to running this way that I don’t recognize how run down I truly am.
My options left are reconstruction with tissue transfer or go flat. Tissue transfer means that the plastic surgeon will take tissue, meaning fat, from a donor site around my body and use it to fill the breast pocket that is left when the implant is removed. The donor site is typically called a “flap.” Options include TRAM flap, which takes abdominal fat but also loses one set of abdominal muscles, Latissimus Dorsi Flap which takes back muscle. However, new technology allows doctors to perform microsurgery to actually reconnect the veins and arteries with a couple other donors sites so that you do not need to lose muscle on the process. This includes DIEP flap using abdominal fat and SGAP flap which uses gluteal fat. These options are now what’s considered the gold standard in breast reconstruction. All of these existed seven years ago when I had mastectomy. They were just not on my radar because I wanted the option with the fastest recovery as the girls were so young at the time.
This time, I will be going with a DIEP flap reconstruction. Because of the microsurgery done to reconnect the veins, this is only done in certain hospitals. UW and Froedtert are the only locations in Wisconsin that due this surgery. Two surgeons work as a team to dissect the abdomen separating the skin, muscle, and fat, then work to reattach it to the blood vessels in the chest. The surgery takes anywhere from 8-12 hours depending upon the conditions they find with the blood vessels when they open up. I can expect to have 6 drains for the first few weeks. I will have a new incision hip to hip across my abdomen, but they will be able to reuse the original incisions in my breasts.
I will be traveling to UW Health Hospital in Madison. Dr. Affifi and Dr. Michelotti will perform it. I will be in the hospital 5 days and then will likely be out of work for 4-6 weeks. I hear I might be under the care in the hospital of a friend who works there and will be on that same floor. Hopefully, he can sneak me extra jello or the good socks.
Because I have already had the mastectomy portion, my recovery maybe different--hopefully better! Doctor says plan for 6 weeks, I say that I heal better than most, so I am planning for 4, with maybe going back half days for week 5 and 6.
The major risks with this surgery are the new flap dying after it's place at its new location. This could happen because it doesn’t get enough blood supply or forms a blood clot where it has been reconnected. Infections are always a concern with any surgery and the large incision needs to be allowed to heal safely avoiding infection and the wound re-opening.
Most women who have this type of reconstruction, end up having another minor revision surgery 3-6 months down the road to repair little things that didn't quite settle correctly. My plan is to combine the revision surgery with step 2b, which originally started me thinking about my BRCA this summer. They usually have to do some revision to the abdominal scar and this will be the perfect time to remove my ovaries and do the preventative hysterectomy at the same time.
Thankfully, I have a support of so many around me throughout this! I have one friend who went with DIEP at around the same that I had my initial mastectomy, and another that reconstructed this way just a year ago. I also have a great community of women through a facebook groups who are all BRCA+ or who've had DIEP. I feel like I know what I'm getting myself into and am ready! I'm just waiting on the scheduler to coordinate the surgery date.
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