Gail’s Narrative: Why I Traveled for DIEP Flap
When I was diagnosed with breast cancer in 2023, a mastectomy was recommended by the tumor board based on various factors. I assumed I would have the surgery locally in Oregon—never in a million years did I think I would travel for surgery. That seemed like a luxury reserved for the rich and famous.
I wanted to undergo immediate reconstruction using my tissue, specifically with a DIEP flap (which uses the blood vessels and tissue from my abdomen to rebuild the breast at the same time the breast tissue is removed). I met with my local plastic surgeon, who quoted me a 15-hour surgery, and a week-long hospital stay, and informed me that I would need to have some of my abdominal rectus muscle removed due to my blood vessel anatomy, as seen on my CTA scan.
Determined to find better options, I sought multiple opinions. I soon discovered that I could have mastectomy and DIEP flap surgery in just six hours, retain all of my muscle (thanks to an innovative technique called Apex), and enjoy an easier recovery—if I traveled for the surgery.
Traveling to the Center for Restorative Breast Surgery in New Orleans
After my research, I found my team at the Center for Restorative Breast Surgery (CRBS) in New Orleans. I lived in Oregon, but remote consultations allowed me to set everything up. Mastectomy and breast reconstruction are covered by the Women’s Health and Cancer Rights Act, and some insurance policies, like PPO plans and traditional Medicare, allow you to cross state lines. However, you are still subject to your policy’s limitations, such as in-network/out-of-network rules and out-of-pocket maximums.
Though my insurance was out-of-network, it was worth it to me to keep my muscle intact, as I couldn’t find an in-network provider who would preserve my muscle.
My pre-op appointments were scheduled for the day before surgery. I did blood work and other tests at a local surgery center and sent the results to CRBS a few weeks prior. I flew to New Orleans a few days before the surgery and spent a full day at the Center meeting with anesthesia, physical therapy, my oncologic breast surgeon, and my plastic surgeon. Although I’d already done a CTA scan at home, many patients complete this scan the day before surgery.
It was a full, informative day. I loved meeting my team in person and immediately felt at ease. The spa music playing in the background was a welcome change from the typical “Top 100” hits playing at my local plastic surgeon’s office. I needed a peaceful atmosphere, and CRBS delivered. Dr. Cabiling explained the Apex flap procedure to me and reassured me that he would photograph my abdominal rectus muscle during surgery to show that it stayed intact.
They prescribed anti-anxiety meds for the night before and the morning of surgery (after I signed the consent forms). I had a nice dinner that evening and stayed at an Airbnb near the hospital, where I did my Hibiclens shower and rested before the early morning wake-up call.
DIEP Flap Surgery and Hospital Stay
My skin-sparing double mastectomy, DIEP flap surgery, and sentinel node biopsy took 6.5 hours. The operating room had three surgeons: my oncologic breast surgeon, my plastic surgeon, and a co-surgeon who was also a microsurgeon, along with a physician’s assistant.
After surgery, I was taken to recovery and then to my private hospital room, where I had around-the-clock care, and my flaps were closely monitored with dopplers. The room was beautiful, equipped with a Murphy bed, and by far the nicest hospital room I’ve ever stayed in. CRBS is the only hospital in the world dedicated to women undergoing mastectomy and/or breast reconstruction.
I wasn’t allowed to eat after surgery but was given ice chips.
The day after surgery, my catheter was removed, and the nursing team helped me transfer from the bed to a chair and walk to the bathroom. I also walked three laps around the hospital floor. While some DIEP surgeons don’t allow patients to stand up straight immediately, I was able to because none of my abdominal rectus muscle was compromised, and I didn’t have mesh. Important question to ask your plastic surgeon.
I spent two nights in the hospital. Before I was discharged, the team reviewed my care instructions with my caretaker and taught me how to shower with a shower chair. They also gave me a lot of supplies, including surgical bras, a binder, compression socks, and more (we needed an extra bag for all the supplies!).
Post-Discharge: Staying in Town
CRBS wanted me to stay in New Orleans until my post-op appointment, which was a week after surgery. I stayed at the Hope Lodge, a free facility funded by the American Cancer Society, just a 10-minute drive from the Center. My room was like a hotel room, with two beds and a bathroom, and I had a caretaker with me. Each day, we stripped my drains (I had four: one in each breast and one in each hip), and I worked on walking laps around the Hope Lodge building.
I met other women recovering from surgery at CRBS. While I had a DIEP flap, I met several women who had an SGAP procedure, and I was surprised to learn that even very thin women could reconstruct with their tissue! Women of all ages—from their 30s to their 70s—were undergoing mastectomy and reconstruction, some having immediate reconstruction, others opting for delayed. We all bonded with our caretakers during this shared experience.
The second floor of Hope Lodge has a Day Room sponsored by CRBS, equipped with couches, puzzles, blankets, and a TV. I spent many days recovering there. In the evenings, there were activities like BINGO and even sponsored dinners. One evening, we were even visited by Bryan Bresee, a former Saints football player who lost his sister to cancer.
About six days post-surgery, I returned to the Center for my post-op appointment. I met with Dr. Ordoyne, my oncologic breast surgeon, to discuss my pathology report (my breast tissue was sent to a local pathology lab). I also met with Dr. Cabiling and his PA, who examined my incisions and removed my breast drains (leaving the hip drains in place). They also taught my caretaker, my mom, how to remove the hip drains when they were ready to come out.
Flying Home After Mastectomy and DIEP Flap Surgery
A week after surgery, I flew home. While I was cleared to fly after a week, some women choose to stay in town longer, as some centers around the country have different timelines for when patients are allowed to fly home (two to three weeks).
We added a wheelchair to my airline reservation, and I had two flights home, with a long layover in Seattle. By day 5, I was off strong painkillers and was only taking Tylenol and Advil by day 7. I didn’t experience any pain at the airport, but I wore a mastectomy pillow in the wheelchair to protect my chest. I flew home with two hip drains. At security, I was gently patted down, but I showed the TSA agents my drains and a letter from CRBS explaining my surgery.
We had the morning to pack up and care for my drains before catching my afternoon flight. My first flight was over four hours and uneventful. I read my book, chatted with another passenger, and wore compression socks to prevent blood clots. In Seattle, my wheelchair assistant wheeled me to the family restroom, where I was able to strip my drains and record the output.
If you’re flying after DIEP surgery, remember to bring cash to tip the wheelchair assistants—they work off tips.
The final leg of my flight brought me to a small regional airport in Oregon, where I was wheeled directly to the plane via a ramp. My family was waiting for me when I arrived.
At home, a rented lift chair was waiting for me in the living room, and I had a good night’s rest.
Post-Op Care at Home
My PA called me weekly to check in, and I had a 24/7 contact number for any questions. While I didn’t experience any complications, I knew I could be referred to a local wound clinic if needed.
One potential downside of traveling for surgery is that if something goes wrong with the flap or the flap fails, you may need to return to the original surgery center for treatment, as local surgeons are often hesitant to work on another surgeon’s reconstruction. However, my surgeon had a 99% success rate, and both of my flaps were successful.
Phase 2 DIEP Surgery
Three months after my DIEP flap, I flew back to New Orleans for a revision surgery. Everyone’s Phase 2 is unique, but mine involved extending the incision to harvest more fat from my hips and upper flanks, lowering the incision, and cleaning up “dog ears” (the little corners at the end of the hip incision). I had pre-op appointments the day before, spent one night in the hospital, and flew home a few days later.
Reflecting on the Experience
Though traveling for surgery felt daunting at first, I’m so glad I made the decision. My surgery time was much shorter, I had access to a team specializing in breast reconstruction, my surgeon performed four DIEP flaps per week, and I preserved my abdominal rectus muscle without artificial mesh. For me, it was 100% worth it to travel for surgery, and I am forever grateful for my team at the Center for Restorative Breast Surgery.
 Surgery){kind=link}
No comment