sguenther@bellsouth.net unilateral
reconstruction for Poland's syndrome (congenital under development of the
breast) please refer to either DIEP or Stephanie in the subject line.
The following patient comments
on DIEP flap breast reconstruction are unedited and extremely important.
Patient comments and feedback have challenged Dr. Alex Keller to constantly
improve the DIEP flap breast reconstruction. This translates directly into
increased patient confidence and well-being.
I've come full circle; today was my first routine
mammogram since the diagnosis of breast
cancer last year. Any anxiety over this event was far overshadowed by the
reaction of the techs to my DIEP flap reconstruction. Mine/yours is the
best breast reconstruction they have seen. They were astounded at how good it
looks, and astounded that the possibility exists of coming out of a mastectomy
with such a beautiful breast and with all abdominal muscles intact. I knew
already that your work for me is amazing. But I have no personal basis for
comparison. To watch experienced professionals - who have seen lots and lots of
breast cancer patients' breasts and reconstructions - with their jaws agape in
awe, really sent the message home to me. Just thought you would like to
know!
I met Dr. Keller almost by accident and it was
one of the luckiest days for me.I
was diagnosed with breast cancer on January 29, 2001.I went to see my breast surgeon who was a participating member in my HMO.My diagnosis was fairly straightforward – I had a malignancy and,
because of the size and location of my tumor, and my small breast size,
lumpectomy was not an option.My
mastectomy and reconstruction were done on February 14th.
My breast surgeon thought that I might be a good
candidate for DIEP Flap reconstruction and referred me to Dr. Keller.This all happened very quickly and I was not even aware of the various
reconstruction options.I knew almost from the start that I would prefer not to have
a saline implant.I never would
have opted for implants cosmetically and was very concerned about the
possibility of it breaking, hardening and not looking very natural.After Dr. Keller explained the Tram, Tram Flap and DIEP Flap
procedures to my husband and me, I immediately knew that the DIEP Flap was the
way I wanted to go.My husband has
been very supportive and agreed that this was the best procedure.I am a 42 year old, relatively active woman and did not want to have my
stomach muscles cut which ruled out the Tram and Tram Flap.(Why would you want to cut your muscles if you have another option?!)The surgery was long (10 hours) and the recovery was not pain-free, but
was certainly worth the result.I
stayed home for about six weeks and each week felt stronger and healthier.My breast feels great and looks terrific – I have become a bit of an
exhibitionist showing it to friends and family who want to see it!All agree that it looks great.
I would like to mention that I went for a second
opinion regarding my diagnosis and mastectomy at a world-renowned hospital in
New York City.The surgeon I met
with immediately concurred with the diagnosis and the decision to do a
mastectomy, but had reservations about the reconstruction, which were related to
the duration of the surgery and the difficulty of recuperation.This particular hospital recommended a saline implant, which I had
already ruled out.I have
absolutely no regrets about opting for the DIEP Flap reconstruction and
wholeheartedly believe it is the best alternative for women who are good
candidates.
I had no lymph node involvement, but had to have
chemotherapy due to the size of my tumor.I
have completed six of eight chemotherapy treatments and feel remarkably good.I will schedule the nipple reconstruction for October or November.
Dr. Keller and his staff have been wonderful.They helped me battle my insurance company (successfully) regarding
payment for this procedure and offer monthly support group meetings which are
invaluable in helping us realize that we are not alone in this battle.We all know that cancer is an insidious disease and so hard to deal with
on many levels.I at least feel
fortunate that I was referred to Dr. Keller and received such good care and
support from him and his staff during such a difficult time in my life.
Hi, Dr.K
Just wanted you to know, I have a new
problem. It is learning to handle with tact the women who have undergone
recent TRAM flaps. I met one today who had a TRAM a year ago after a
failed expander implant, and even though she had a decent (not great, but not
bad) result, my incisions and the shape and symmetry of my reconstruction
already look better than hers. She couldn't believe it was only 3.5 weeks since
my surgery; she said she couldn't stand up straight for 2 months! I just told
her she was looking and doing great, and wished her continued better health. I
hope she will be happy with her situation.
If I had had a TRAM, and then learned of your
DIEP, I would have been inconsolable.
In the local support group last week, I was
fortunately succinct and not too boastful of your work, as the two women who
spoke right after me had recent TRAMs, and again, at this point both were moving
almost as well as I am, but after months, not weeks. Again, I wish to be an
advocate for DIEP, but not at the expense of the feelings of those for whom it
is too late...
It is an amazing thing, when the possible
depression from a mastectomy is replaced or superceded by positive feelings due
to a well-done immediate reconstruction.
I wish somebody had an equivalent silver bullet
for the ravages of chemo...
Thanks again.
I keep saying, "Thank God for Dr. Keller and
the miracle surgery." Seven months ago
in a routine mammogram a suspicious cluster of calcifications was noticed. I was
assured that statistics were on my side, but sure enough, after a needle biopsy,
I was told that I had DCIS and a re-excision would be needed to get the rest of
it. Meanwhile the radiologist told me that with all the calcifications I had, I
should just get a mastectomy, something I dreaded
to hear and decided to ignore. To make a long story short, just before my
radiation treatment was to have begun they discovered more possible DCIS in a
mammogram and told me that if they took that out, there would not be much of a
breast left anyway; mastectomy was the only answer. Since I already had every
cancer book that the local public library owned, I quickly began studying them
for information about reconstruction and this is where I first saw the term DIEP
flap. On to the internet where I found Dr. Keller's website, then to my pcp who,
by coincidence, had just heard of the DIEP from a family friend who had just had
it. My doctor immediately offered to write a letter of medical necessity to my
insurance company to get this surgery for me because
I have suffered from fibromyalgia for 1 1/2 years
and have only kept it under control by daily exercise. The tram flap that is
normally offered removes abdominal muscle, requires a long recovery time, and
won't even allow you to stand up straight for a long time, not to mention the
pain that I heard about over and over again when I emailed or spoke with women
who had had it so that was not for me. My insurance company in Massachusetts
denied my doctor's request because a prominent plastic surgeon here told them
that the DIEP flap would make fibromyalgia worse. I scoured the internet for
information to back up this claim but could find nothing. I then paid an office
visit as recommended by the insurance company, to this same doctor, who, not
realizing that I was the same person, turned around and recommended the DIEP
flap as being the ideal surgery for a person with fibromyalgia!!!!! He even said
that he could do it!!!!
The insurance company denied me again, the new
reason being that the surgery was available locally. The doctor then told me
that he could not really do it, but he had a doctor who could. I called that
doctor and he told me that he could not!!!
My fibromyalgia doctor wrote the next letter for
me - she was furious that I would even need to have a letter for a procedure
that was obviously so appropriate for my needs. She was the original person who
set up my physical therapy and got me to the point where I was in control of the
fibromyalgia so she didn't want to see me slide back from the effects of a tram
flap. Implants, by the way, were never an option for me because as part of the
fibromyalgia syndrome, I have multiple allergies and I know that my body would
have rejected any foreign object placed inside it.
Immediately this letter, too, was denied by the
insurance company because they still told me that there was a local doctor who
could do it. Apparently they called that doctor and pressured him to say that he
"could" do it although he had never tried it! I then saw a team of
cancer doctors at a very large Boston hospital who agreed that I needed a
masectomy and when I told them about my fibromyalgia and explained the DIEP
flap, they all agreed to write letters for me. By this time I was so furious
that I sent off a nasty letter to the insurance company telling them that more
letters were on the way, that if they cared about their patients they would
listen to what my doctors were recommending for me, and that I would never give
up.
I also threatened to call a local tv station and
go public with this outrage. This letter resulted in another immediate denial of
benefits with the usual insulting letter designed to discourage and demoralize
me.
So I went public!!!!! I had been in contact with
the tv station right along and this time, mad as a hornet, I gave them my
permission to call the insurance company. That very afternoon the phone rang and
my most-hated-person told me that "there has been a reversal of the
decision."
How I cried and thanked God, it was a miracle and
I was so grateful. Because the second hospital had found problems with the other
breast, I quickly decided on a bilateral mastectomy to relieve my worries and
because I might not ever get this lucky again with the insurance company.
Finally, two weeks ago, I received the surgery. The first three days in the
hospital were very uncomfortable but not painful and I spent the rest of the
week in a motel with a visiting nurse coming in, not in the best of spirits but
there were little victories every day. One week to the day of the surgery, I
actually walked around in a little park with the spring flowers bursting into
bloom and it seemed like they were blooming for me. No, the surgery did not make
the fibromyalgia worse, and now I feel like a whole person again, not a maimed
cancer victim. I am 57 years old and feel like I have a new lease on life.
This was the bad news: Diagnosis - breast cancer
- 1979.
This is the good news: Twenty-year survivor as of
today.
When I first was diagnosed with breast cancer, I
had the surgery that was available at the time - a modified radical mastectomy.
In 1981, following radiation and chemotherapy, I
had a saline breast implant. In 1982, I had a second procedure to construct a
nipple and areola on my reconstructed breast and a breast reduction of my
remaining breast.
In 1997, 18 years after my original surgery,
following some changes in my remaining breast, I had a second mastectomy
followed by a bilateral DIEP flap reconstruction performed by Dr. Keller. In
March of 1998 Dr. Keller performed bilateral nipple and areola reconstruction.
My conclusion from my heart: Dr. Keller’s DIEP
flap surgery and nipple and areola reconstruction is so far superior to the
other surgeries that for me there is no comparison.
1. The DIEP surgery resulted in my immediate
feeling that I was still a woman with two breasts.
2. I know that there is a 20-year gap between
my surgeries and the medical community knows much more now than they did then,
but my reconstructed breasts done by Dr. Keller look and feel like my breasts.
They have been described by my friends as fantastic, great, perfect, wonderful
(and I agree).
3. In the past I had difficulty wearing clothes
because I was not symmetrical. I had not worn a bathing suit in over five
years. I had difficulty wearing a dress. I had to wear extra layers to cover
up the difference in size. Now, I am completely symmetrical. I can wear a
bathing suit with comfort. I actually have cleavage, should I wish to wear a
low cut dress.
4. It’s been over two years since the DIEP
surgery with Dr. Keller. I felt completely healthy following the initial DIEP
surgery and I was playing tennis three weeks after the surgery. I still feel
healthy, but this time I feel healthy emotionally as well. I am cancer free
and happy.
5. I have always felt completely taken care of
by Dr. Keller and his staff who allowed me the time to ask so many questions
and always give me the answers. I know of no other doctor (and I have been to
many) who open up their office, provide staff members for a support group
meeting for their patients as Dr. Keller does. It’s just incredible how he
takes care of his patient’s physical needs and emotional needs.
My cancer diagnosis was in another lifetime.
Treatment was somewhat different. If I had a choice, certainly I would not have
picked this road to travel. Since I didn’t have that choice, at least I had
and will have Dr. Keller by my side to give me back my life.
I was diagnosed with breast cancer in November
1998. Since my cancer had spread to the lymph nodes, a modified radical
mastectomy was suggested along with six months of chemotherapy. At the time I
did not consider reconstructive surgery since I was in shock and decisions
needed to be made quickly.
After my chemo treatments were over, I began
looking into reconstructive surgery. I had a 15 minute consultation with a
plastic surgeon who told me I was not a candidate for breast reconstruction -
his reasons are still not clear to me. I left his office depressed, however, I
did not stop there..... I logged onto my computer and began searching for
plastic surgeons. In my search I came across Dr. Keller's web site and was
impressed. I proceeded to make an appointment with Dr. Keller and after my first
consultation, I was convinced that he was the surgeon for me.
Dr. Keller performed the DIEP surgery and I have
never regretted it. It was a ten hour procedure; however, I honestly can say
that recovery was quick and pain free. Even though I was apprehensive about the
pain and the long hours under anesthesia, I must say it all went very smoothly.
There was some discomfort because of the drains, which are needed, but again,
the discomfort was minor. The result of the DIEP is a very natural looking
breast, which I am very pleased with. Dr. Keller's knowledge of this procedure
along with his compassionate and professional manner has me recommending the
DIEP to anyone facing this decision.
Dear
Dr Keller, and Wonderful Staff People:
Please
find the enclosed check for the D.I.E.P. that was performed on Sandra (patient
name changed).
Doctor,
when we first came in and you showed us the photos of the DIEPS that you had
performed on other patients I asked where are the photos of the PERFECT
procedures. Your response was " I don't put them in the album."In my humble opinion the work you did on Sandra we both think you
should put in the book as a "perfect” job. Thank you so much for making
what could be a very difficult way of life turn into an every day appearance.
To
Cheryl, and all of the great and profession staff. The manner in which you
have handled my bride I will be forever gracious. Keep up the excellent work.
I'm very happy that I had the Diep Flap
reconstructive surgery. As you know, I waited five years before having it done.
I had always worn a prosthesis. I would be most concerned when wearing a bathing
suit, for fear that the prosthesis would come out in the water. But now I don't
have to worry about that anymore. It's over a year now since my surgery and the
reconstructed breast has healed very well. I found that by using Vitamin E oil
it has helped to diminish the scar.
Whenever I go for my follow-up examinations with
various doctors, they always comment on how natural my breast looks and what a
work of art it is. And that I could probably go topless on the beach, and no one
would ever know that I had a mastectomy! I have had only very positive feedback
from other professionals in the medical field.
I am a volunteer on the NY Statewide Breast
Cancer Hotline and Support Program and speak to many women statewide with
questions and concerns about breast reconstruction. I usually recommend the
procedure and discuss it in very positive terms as an option to be considered
after mastectomy. I usually mention that the Diep Flap procedure also requires
less hospital time and usually has a faster recuperation.
The reconstructive surgery has given me more
confidence in how I look and feel and has helped me to put my breast cancer
ordeal behind me, for the most part.
I
’d like to thank you so much for the
DIEP you performed on me last March. Having breast cancer and the thought of a
mastectomy with an implant were devastating.
With the DIEP, my breasts are symmetrical. The
reconstructed breast looks and feels like my natural breast. This was very
important to my general well being.
When I hold my new granddaughter close to my
chest, I know she’s comfortable against my warm, soft, natural breasts.
The outcome of this type of reconstructive
surgery has also helped me heal from the psychological impact of this disease.
Thanks once again.
In 1996, at the age of 33, 1 was diagnosed with
breast cancer and had no choice but to have a modified radical mastectomy. In
terms of reconstruction, I was fortunate that my breast surgeon knew about the
DIEP Flap and referred me to Dr. Alex Keller. At the time, I was Dr. Keller's
25th patient to receive the DIEP Flap. At the time of diagnosis, I was
devastated and my thoughts centered on survival, so the breast reconstruction
seemed secondary at the time. However, I did realize on some level that my
emotional recovery would depend in part on the success of the reconstruction -
reconstructing meant I was committing not only to surviving, but to healing. I
am happy to say that now, four years after my diagnosis, surgery and
reconstruction, that I feel wonderful. The scars on my reconstructed breast
have faded so much that when I recently went for my mammogram, the technician
mistook the DIEP Flap breast for a real breast.
Perhaps the best testament to the success of my
DIEP Flap reconstruction is that I barely give a thought to my reconstructed
breast. Aesthetically, it looks great. I don’t have to think twice about
wearing a bathing suit or dress or shirt that is cut lower than my other
clothes. Fortunately, as time goes on, my experience with cancer with its
fears and emotions is starting to take its place further back in my mind. I
can never forget that I had cancer, however, my emotional and physical
recovery has been greatly enhanced by the DIEP Flap. All women facing breast
cancer and reconstruction should have this option and I hope that those of us
who have had the DIEP Flap can help spread the word.
Dear
Dr. Keller:
This letter is overdue and I am finally having time to take a few
minutes to write down a couple of lines regarding the DIEP flap
reconstruction. The following is a short version as how I remember it.
I can remember, as if it were yesterday, the fear of being diagnosed
with breast cancer. The first surgeon I went to suggested a mastectomy and in
six months another surgery for implants. He said that was the best way. I knew
that I did not want implants because of the risks involved. Many women have to
undergo several operations for whatever reason. I was so overcome by the
diagnosis that I almost went for it (without the implants). It took a phone
call from my boss to wake me up. The fear was so overwhelming that it
interfered with any rational decisions to be made. Thank God for this woman,
Nanette, who through her friend, Card, told me about Dr. Keller. I don't know
how many surgeries I might have had by now it weren't for her. She definitely
was the angel watching over me.
My visit with Dr. Keller was what I needed. After discussing the
surgery, I knew this was the way to go. This is what I truly wanted. My
wonderful husband, who was by my side at the time of this visit, and has been
with me throughout with his support, thought also that this was the best way
to go - reconstruction immediately following the mastectomy. Dr. Keller was
very sensitive to my fears, understanding and reassuring me that I'd be okay.
A very kind and gentle doctor, in my eyes -- the best, He explained the
incisions, connecting the blood vessels, fat from the tummy to the breast,
grafting of skin and, yes, the blood transfusions. The fact that I would have
my own breast instead of an implant or just a mastectomy made me go with the
DIEP flap. I knew I was in the best hands. How could I go wrong with God and
Dr. Keller?
Yes, the surgery was long but I did not have to go back for several
surgeries (implants or the possibility of rejection). It's all mine. After the
operation, when I was brought back to my room, I took a peek at what was now
my breast, I could not believe my eyes. Through the tears of happiness, I saw
my new breast - no massive incision on my breast, no flat chest but instead a
new, healthy, cancer free breast, just like the other one. I was so ecstatic I
wanted to show everyone.
My hospital stay was short. I was discharged in three days. I will
admit it's a little hard moving around after surgery. The abdominal incision
takes a little time to heal, just as it would with any other kind of surgery.
After a couple of weeks of rest you are able to gradually get back to normal I
returned to work 5 weeks after the surgery and continued with chemotherapy for
5 months and was able to work throughout. Keeping busy is a key to healing.
No one, unless you have been through this yourself can ever know or
understand what this means to a woman. You feel at one point you can be
stripped of your womanhood. With this surgery, you come out feeling whole and
healthy. It's amazing, Dr. Keller also has a support group for anyone who
feels they would like to share their concerns with other breast cancer
patients. I am now approaching my 5th year of being cancer free. Am I sorry I
went through such extensive surgery? Of course not. I made the best decision
in my life. I only hope and pray that women who are diagnosed with this
terrible disease will somehow, someway find this wonderful doctor.
THANK
YOU, DR KELLER!
The following letter was
received from a lady whom I have never met. It stresses the importance
of keeping the abdominal muscles.
Dear
Dr. Keller,
I found your web site about tram flaps very
interesting.Using the new
technique you have developed will be wonderful.I can say that because five years ago I had a tram flap. Leaving the
stomach muscle intact would be so much better.I had waited ten years to have reconstruction after my mastectomy then
decided to go and have my one breast reduced, iam not a small person.
So I was told about a wonderful procedure
called tram flap. A real looking, feeling breast. Also insurance would pay for
it. Well, a week in the hospital in pain and hunched over I returned home to
recoup for weeks. Not being able to stand without being bent over and not
being able to get up using my missing muscle side. Also the depression of all
this pain and such cause me to gain weight.
Yup then a hernia arrived, which I still have
to this day, five years later. So
instead of worrying about my breasts being even, I have a lopsided stomach
which has no support on one side.
So please if you can persuade woman to not have
there stomach muscle removed, explain that you really do need your stomach
muscles to exercise, lift, run ect., its much worse than having one breast to
be in pain and uncomfortable all the time.
My Doctor never told me about the down sides of
a tram flap operation, that being overweight I was not a good candidate and I
best never gain any weight, along with a number of other problems.
I don’t blame him, its my body and I willing
went in for the operation.I do
remember the disgust in his voice that I had gained weight and ruined all his
work.This doctor works out of a
medical university and is well known so he had done many tram flaps.
I just want to thank you for validating my
feelings about not having a stomach muscle one side or both.I am sure my doctor is a fine doctor for most patients. Keep up the
good work.
I hope in some way I have given you a little
insight to the human factor of how one feels having this done to them.I was 32 when I had a mastectomy.
