I had a bilateral mastectomy with immediate reconstruction with implants that didn't go well. I ended up eventually having the DIEP flap surgery. I'm going to tell you a little bit about it, in case you are thinking about this as an option for you. Some people confuse the DIEP with the TRAM flap, but they are as different as night and day. With the Diep flap, the entire stomach flap is completely removed and reattached to form a breast...unlike the "tunneling" procedure used in the TRAM.
First, if you have had any previous surgeries on your abdomen c-section/appendectomy then they will probably do a CT scan to make sure that they can use the flap that is affected. In my case, I had an appendectomy scar, it didn't effect their use of the flap.
The size of your breasts will depend on the size of flap they can harvest. In my case, I ended up with D cup breasts, but if you are very slim, you might have an A/B...it varies, according to each individual, but your Dr should be able to give you some idea of what your resulting size will be.
SURGERY: Let's move on to the actual surgery. Mine took about 10 hours. Of course, they were having to fix a lot of things that had been done previously, so it may not take as long for you. My incisions were from hip to hip for the flap harvest. Then each flap was attached with a football shaped incision that went over and under each "breast".
POST-OP: When I came out from the surgery, I was in recovery then transferred to my room. I was given shots of Heparin (blood thinner) so that the newly grafted veins wouldn't develop clots and cut off the blood supply to the new "breasts". My grafts were constantly monitored by machine and my nurse with a Doppler to make sure there was sufficient blood flow.
PAIN: I will say that I had very little chest pain, because my chest was mostly numb from my previous mastectomy and reconstruction attempts...most of my pain was in my very big abdominal incision. Coughing was a nightmare, walking for the first several weeks was very painful (I walked like the hunchback of Notre Dame!). However, things improved on a day to day basis. 8 Months after my reconstruction, I ran a 5k Race for the Cure, so it does get better. Of course, you are giving pain medicine which does help to an extent, just don't over do it..rest and go slow, your body needs time to heal.
RESULTS: My reconstructed breasts look very much like my "old" breasts. I chose to have nipple grafts after about 3 months recovery. With my clothes on, you can't tell that they aren't my natural breasts. With my clothing off...you can still see my scars, but they are very light..it's been about 5 years since my procedure. I am very pleased with my breasts, and if I had to do this whole process over, the only thing I would change, would be that I'd go with the DIEP flap as my first reconstruction and skip implants all together.
COMPLICATIONS: The biggest problem I have had has been a hernia through my abdominal incision. Anytime there is a cut through the abdominal wall, it is a weak point that can allow for a future hernia. I knew this, and wasn't surprised when it happened. It will have to be repaired in the future, but at this time...it doesn't cause me any undue problems.
LOOKING BACK: This surgery made a huge difference in my life...and in my self-esteem. It allowed me to feel like a woman again, to feel "normal" again. I would do it again in a heartbeat.