Should I Delay TRAM Flap for DIEP Flap

[JenZen12]

Hi All,

I'm scheduled for a delayed pedicled TRAM flap right breast reconstructive surgery on March 7, 2025. Should I consider DELAYING surgery if it means I can have a DIEP flap instead?

Here's the thing: everything is TOTALLY LINED UP for my current schedule TRAM flap for 3/7/25. But if we try for a DIEP flap, we may need to reschedule the surgery to allow for a longer surgery. That could mean a delay of one, two or more months!  Is getting a DIEP flap *worth* screwing up all these details below**? Or is the TRAM flap a similar (sucky?) recovery? Or is it more about a DIEP preserving muscle and therefore one's abdominal strength isn't lost at all?

**Here are My Reasons for Wanting to Keep Current Surgery Date to 3/7/25:

1) It looks like the most amazing anesthesiologist I requested will be available. This guy has been my anesthesiologist for about 3-4 outpatient procedures before and every time I wake up feeling great. NO nausea at all. I spoke with the hospital and they told me there's an excellent chance he'll be assigned to my surgery. But there's no telling if a future date he'll be scheduled.

2) If it ends up being postponed to late March or early April I won't be able to keep me and my 10th grade daughter's annual spring break plans to go visit my sister in DC.

3) Speaking of my sister, she's already planning to come up to help for the first week. She took off the day of my surgery and the day after surgery from work, and will be remote on Wed-Fri. What if she can't get the time off for a future date?

4) Lastly, I am trying to make sure all my revision surgeries fall into this calendar year 2025 in order to hit my out of pocket maximum. If  surgery gets delayed too much, some of the revision surgeries may not fit into 2025. But if a DIEP flap doesn't happen until May or June, all the subsequent outpatient reconstructive and cosmetic revisions like a left breast lift or rebuilding a new right breast areola and nipple may not fit into 2025. If they happen in 2026, I won't be able to afford them.

Thanks so much for input, ladies! It means a lot,

Jennifer

[KindArtist]

Hello JenZen12. I read your post, and let me preface my reply with the fact that I have no knowledge about the different kinds of flaps because I had stage 1 invasive ductal and a lumpectomy. But from reading your post, here are my thoughts which could be helpful towards your decision. Play the long game (focus on the big picture of your future life as a whole) and put your health first over details such as when your sister can get off to help, or missing one event with your daughter in a long string of events to come in your lives. There are many good anesthesiologists out there. You have a valid concern about the cost factor, so first find out what the timeline is for the recovery from the flap, and the soonest you could schedule the follow up procedures. If it were me, I’d base my decision on the pros and cons of the physical procedure itself. Your age and lifestyle also factors into your decision. For example, does your lifestyle or work call for lots of abdominal strength? What’s the difference of in future functionality when comparing the different types of flaps? Ever hear the saying “Put on your own oxygen mask first”? You are faced with a serious health decision right now, and your family should be supportive of you deciding to make the best decision for your own body that you’ll live with for the rest of your life, even if it causes inconvenience, whichever way you decide. Write down the pros and cons of just the physical consequences from either procedure, as minimizing risks to your health and future functionality comes first. Call in more than once to get several opinions on how scheduling could work to fit all in 2025. Consider hiring a home caregiver service temporarily if your sister can’t make it to help on certain dates. (however, I don’t believe these services are covered by insurance). Contact a church and relay your need for help. They have support groups who could help with certain aspects like meals while you recover from surgery. Hope this helps some. Sending hugs. 💕

[JenZen12 in reply to KindArtist]

Good thoughts and considerations. Thanks for taking the time to share this.