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Tuesday, July 27, 2010

Road Trip! The DIEP Flap Reconstruction- San Antonio

Hello everyone!  So last week I finished my last chemo session.  Hurray!  So with radiation quickly approaching in the next few weeks, I had to decide what kind of reconstruction options were available. I traveled to San Antonio on Sunday to stay in a hotel and get up Monday to visit with some doctors who are highly skilled and knowledgable with the DIEP Flap procedure I have been researching. This is not an implant surgery.  With most implant surgeries, the use of expanders are necessary and put in place before radiation.  They are filled every two weeks to stretch the skin, and sometimes skin graphs are necessary.  With this, often comes a great chance of infections & pain.  Also, there is the inconvenience of an extra surgery.  I had been researching a new procedure called the DIEP Flap, Deep Inferior Epigastric Perferator Flap.  This is different than the TRAM flap, where the breast are rebuilt from an abdominal muscle and tissue that is "channeled" under the skin up to the breast.  This often causes complications with sitting up and using the abdominal muscles which have been partially removed. This tissue is still attached to the lower part of the body, but runs like a "tram" under the skin so that it has blood supply.  With the DIEP FLAP procedure, the belly fat and skin along with blood vessels from the groin area are completely detached with incisions across the lower tummy, like a tummy tuck procedure.  The breast shapes are then cut out of the tissue and shaped.  The surgeons work under a microscope using microsurgery techniques and reattach the arteries and veins using suture material barely visible to the naked eye.  The surgery is long and tedious and requires highly skilled surgeons.  Currently there are about 40-45 surgeons in country performing this procedure and 5 of them are at a facility in San Antonio, Texas.  They are the Plastic Reconstructive & Microsurgery Associates.  They perform over 500 a year.  If you google "diep flap San Antonio" their site will come up in the top few.

There are many benefits to this procedure.  First of all, no surgery for expanders.  This procedure uses your own natural living body tissue and because of this, their is little risk of infection or rejection.  The surgeons are moving healthy, non-radiated tissue up to the chest area.  The appearance is more natural looking than implants, and you get a "tummy tuck" with a much flatter, attractive appearance left in the abdominal region.  The abdominal muscles are left in tact and remain strong.  So it was worth the trip to San Antonio to get all this nailed down.  Insurance of course has to be approved, but they don't seem to think it is a problem.  This group of doctors do not "balance bill" what the insurance company won't pay, which is a big plus for me. I have heard that standard reconstruction surgeries can cost in the range of $90,000.  A friend of Kevin's said that is what theirs cost to the insurance company.  His wife had a Tram flap procedure done on one side and an implant procedure on the other due to the burns from radiation on one side.  I am sure this DIEP Flap procedure is well over $100,000.  That is one of those things that you won't know until everything is said and done.  It all depends on the rates negotiated with insurance companies.  Thank God for our insurance.  We found out today that they have paid out over $140,000 to date in medical payments.  We also found out that I have a lifetime maximum benefit of $2,000,000.00.  Two Million Dollars!!!  Time to start praying that there are no recurrences with this cancer and no other major medical problems.  That could add up really fast with scans and tests 2-3 times a year, and I have many years ahead of me that I will need medical coverage (I am thinking positive here). 

There is only one doctor in all of Dallas/Fort Worth that is doing this procedure, but I feel more comfortable with a "team" of doctors who perform hundreds a year and have accountability to each other.  The surgery is quicker with a minimum of two micro surgeons working at a time, so their is less time under general anesthesia.  I was really impressed with the doctors and staff.  Assuming everything is approved with the insurance, I will possibly have the first phase of reconstruction in November, about 8 weeks after radiation is finished.  This is much sooner than we anticipated and it will depend on my healing from radiation.  The second phase of the surgery is nipple reconstruction and any modifications needed.  The last phase is tattooing the nipple color.

To all my blog followers, this is probably too much information.  But to some who are facing these decisions and wondering about their options, I wanted to share this with you.  After all the abuse my body has taken in the last few months, it is good to think about getting "rebuilt" to a new and improved me.  In the meantime, I will be trying to shed about 30-40 pounds in the next 4 months before reconstruction so I can wake up from surgery with a new, healthier, fit me!  Getting off these steroids will be wonderful, and I plan on starting Weight Watchers next week and getting to the pool at least Monday through Thursday.  Being on a low-fat diet and exercising is crucial with survivors of triple negative breast cancer.  It is the number one thing that increases the chances of keeping the cancer at bay after treatments are over.  It is something I can control.  So it is now not only about looking better and feeling better, but about staying alive and extending my years.  Still love getting your comments and please join my blog by clicking "follow" on the right hand side of the page if you have not already.  Until next time my friends...

6 comments:

SingingWarrior said...

I'm moving into a nutrition change myself. needless to say, I'm not making the change without a lot of kicking and screaming. "deprivation" of any kind is a huge trigger, so I've come to realize today.

Anonymous said...

Thanks, Penny, for explaining this procedure. I especially appreciate the illustrations. It is my prayer that your insurance will cover this surgery. It is good that you are looking forward. We'll be looking for you in San Antonio in a few months. We love your daughters and are thrilled now to get to know Presley as we have Landri.. Presley is a sweet and caring young woman and a joy. Thanks for sharing her with us this week. Love, "Aunt" Sharon

Ellie K. Belfiglio said...

Hi My dear Penny,
It is so good to hear that you are looking so to the fututre. That is mt girl. Stay strong and patient. In a few short month, you'll be finished with this evil of disease, and begin your new life. I am glad that you choose DIEP FLAT. Since your last chemp, I read so much about it and I know it is the right way to go. A big huraaa for you my child. Love you
Your mommy Ellie

Yolanda said...

This procedure sounds great. My Mother had the expanders etc. Her radiated skin did not heal well so she ended up having to have skin grafts, and many surgeries. Praying the procedure is approved!

Shanna said...

Hey Penny - was reading your blog today. I'm so glad you are done with chemo! I would love to come and see you sometime. Also, just FYI, I believe Lifetime Maximums on health care go away in 2011 due to healthcare overhaul. Just thought this might ease your mind.
Stay strong!

willow58 said...

It is amazing what technology can do. I wonder if I can donate fat so other women can have breasts!!! I certainly over the years have learned how to make fat tissue!! I hope you are laughing. A merry heart doeth good like a medicine.