ask: I am 37 and underwent a bilateral mastectomy with a diep flap immediate reconstruction. The reconstruction is not complete, and I'm thinking of adding implants because I am very disappointed with the appearance. I am extremely depressed. advice?

Dear Anon

Thanks for your question and welcome to Empowher!

Are you recovering from cancer - is this the reason for the bilateral mastectomy?

When was your surgery? From what I know of breast reconstruction surgery, the results take some time to see. What you look like the first month after surgery is not what you will ultimately look like. It takes several months for the implants to settle.

When did you have the reconstructive surgery? Please give us a little more information but you need to ask your surgeon everything you are asking us now!

I was diagnosed with breast cancer in August. On september 26th, 2007 I had the bil. mastectomy with immediate reconstruction using tissue from my abdomen to make the breast mounds. DIEP flap is deep inferior epigastric perforator, which describes the blood vessels harvested with the fat tissue in the abdomen. It has been about 4 months, and I am going to meet with my doctor this week to talk about adding implants. Does anyone know about this, or have any recommendations about implants. -not happy with reconstruction so far.

Hi Anjie,

Maybe we can help you. There are videos I believe, we have on our site about the procedure you've just had done. Let me see if I can find them. It would be Dr. Jay Harness who's videos we would have on this procedure. He serves on our medical advisory board and is a wonderful human being as well as an amazing breast surgeon out of Orange County at St. Joe's.

Where do you live? If you live here in Az. I can help you with a fabulous doctor. If not, tell me where you live and let's see if we can find someone else for you to see to get a second opinion.

Let me see if I can get Dr. Harness to come on to post and give you some questions to ask your doctor.

Please don't get discouraged. I know it's easy to say and much harder to do, as you're looking at your breasts and not seeing what you thought or hoped you would.

Sounds like you are very disappointed and rightfully so. I just don't know about the recovery time and if things will change over time. Sometimes, swelling will cause things to not look the way they ultimately will look. It can take a while for things to calm down. You've had a lot of trauma to the area. Also, the scar can look much worse then it will when you've had some time to heal. I'm not making excuses or discounting how you feel. I know what you're feeling is real and painful. Please know that.

You've had major surgery and a very traumatic surgery, I might add. You are a very brave woman and clearly have great courage. For you to come to our site to even ask the question and share your disappointment is courageous.
Let's see what we can do to help you.

I'm going to have our Community manager, Tina, help you. As well as our videographer, Todd. They should know what videos we've captured and other women who've had the same procedure. We need to give you women, resources and doctors. That's what we do at EmpowHer. We need to do this for you.

Warmest regards,
Michelle

Hi Anjie:

I just read your post. Hang in there as I'm sure our community, EmpowHer team and experts can provide you with resources which can help.

Thank you for having the courage to reach out for help.

Take Care,

Kelley

Hi Anjie -- I know this must be a hard time for you. A friend of mine recently had her other breast removed and needs to heal properly before reconstruction starts. Unfortunately, she had difficulty in the healing process her incisions are not healing correctly. It is very frustrating for her and she doesn't feel like herself. All I can say is hang in there. Hopefully your plastic surgeon will be able to do more. Please let us know what he/she says.

Hi, Anjie! I'm so glad you've found EmpowHer. I'm sure our wonderful moderators and experts will get you the info and resources you need. I'm so very sorry you're going through this. You've got immediate friends here at EmpowHer -- please know that we're pulling for you and hope that this gets resolved so you're feeling better about the reconstruction. I have a childhood friend who had implants immediately after her mastectomy and she's really happy with the results. I'll try to get in touch with her to see if she has any advice for you.

Hi, Anjie,

I'm so sympathetic to your feelings. And I'm so happy you are here.

You underwent a traumatic diagnoses and a major surgery, and I'm sure recovery was difficult. By now you'd hoped to see much better results, and you haven't. That's so disappointing. But try not to give up -- I think that while it may take some more surgery, you ultimately can be happy with your final results.

Have you been happy with your doctor? And with the plastic surgeon you have for reconstruction? Do you feel that you can confide in one or both of them how you feel? Does each of them have a good bedside manner?

While we're waiting for our experts, I thought it might help you to see some pictures of completed DIEP flap reconstruction. Of course, the missing element here is that we don't know how long after surgery any of these photos were taken. Though I imagine that for doctors to put them up on the web, they are either finished with recovery or well into it. But I thought it might be good to have pictures to refer to when you see your doctor again. This first one (scroll down on the page) is from the University of Texas' MD Anderson Cancer Center (this was a left mastectomy):

http://www.mdanderson.org/diseases/BreastCancer/reconstruction/display.c...

Here is another woman who is clearly not as far along in her healing process (this was bilateral):

http://images.google.com/imgres?imgurl=http://www.breastflap.com/images/...

Here are several, from the website of the doctor who originated the procedure:

http://www.diepflap.com/reconstruction-beforeafter.html

and here are several:

http://www.breastflap.com/breast_reconstruction_photos.htm

this is another before and after gallery:

http://www.prma-enhance.com/index.cfm/ProcedureNameID/19/PageID/1946

and this is a forum with before and after pictures of all types:

http://www.implantforum.com/breast-reconstruction/

What I am noticing from looking at these pictures with you is that while the breasts tend not to be perfectly symmetrical (like all breasts, lol), the reconstruction does tend to create two breasts that are similar in size, placement, coloring and nipple placement; also, that the scars do seem to fade very much with time. It seems like this is what you should be able to expect from your final results.

This is a blog written by a woman who is going through breast cancer and who writes about her diep flap reconstruction. She does not put pictures on the web but she does write about a dissatisfaction with one of her results and when it will be fixed:

http://blog.healthtalk.com/breast-cancer/life-with-breast-cancer/diep-fl...

Take care, Anjie, let us know where you live, and let's see if we can get you some more information.

Anjie,

On your behalf Sunday I reached out to Dr. Jay Harness, the nation's leading oncoplastic breast surgeon, who is not only the former President for the American Society of Breast Surgeons, but a member of EmpowHer's Medical Board.

I told him all about your question, which you posted above, and asked him if he wouldn't mind replying with some guidance.

Dr. Harness asked me to connect with you, so the two of you can have a personal phone call.

Anjie, would you please email me a way to call you? I'll call you back with the number to Dr. Harness' personal assistant, who is expecting to hear from you. She will schedule a conversation where you can ask Dr. Harness every question you'd like.

I'm sure you'll love Dr. Harness. Few doctors care as deeply for their patients.

Thank you posting your health question on EmpowHer.

Todd Hartley
Director
News & Media
EmpowHer.com
todd@empowher.com