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deciding on Tram flap after mastectomy

howlifechanges's picture
howlifechanges
Posts: 1
Joined: Nov 2002

Hi everyone. I am considering a mastectomy after a lumpectomy and I am thinking about the Tram Flap. I am not sure if this is a good idea and would like feed back on your surgeries. Is it worth it? Would you do it again or do you think implants are better for reconstruction. I have read a lot of negative things from women who have had bad experiences with this type of reconstruction. I worry about recurrence so that is why I am considering a mastectomy and reconstruction. Can't wait to hear from you.

carolh's picture
carolh
Posts: 19
Joined: Jul 2000

I had a double TRAM flap March 2001. After a single mastectomy in September 1999 I decided to get the other breast removed and go for double reconstruction. I have no regrets and am very pleased with the results. It is major surgery and recovery takes several weeks but I think it was well worth it. Apart from rather nice, non sagging, new boobs, I also gained a tummy tuck. This gave me the impetus to lose some weight and I managed to lose nearly 50 lbs.

Go for it!

Best wishes,

Carol (Vancouver, BC)

iris48's picture
iris48
Posts: 92
Joined: May 2002

Hello,
I did a lot of research and soul searching trying to decide on which reconstruction surgery would be best for me and my lifestyle. You don't mention whether you have kids and are active with them, or what kind of work you normally do. That plays into some of the decision making, because I am active and physical on the job. To do the Tram Flap is using your abdominal muscle which also supports your back. The actual OR time in estimated at 10 1/2 hours on a surgical table for the double. If you do only one, then the natural one will sag in time and require a lift at the least to match the other side. The recoup time is different for everyone, but my research and several surgeons indicated that 7 to 8 months is about what you need. You need to be waited on because you cannot lift anything, that includes yourself from in and out the the bed, putting on clothes, etc. If you still choose this procedure, do yourself a big favor and point blank ask how many the surgeon has performed in the last three years, can you speak to some former patients and have dialogue with them, can you see pre and post surgical pictures that you know the surgeon has. If they don't readily give you answers here, run don't walk and find another surgeon. That is what I wound up doing. The orig. surgeon estimated 6 1/2 hrs on OR table for the Lastissimus Dorsi or Back Flap surgery for both sides. I later found out through professional friends in the field, he actually took 10 1/2 hours for this surgery, and the woman was in tremendous pain and discomforts for weeks and weeks. Some of these surgeons need assistance during the procedure and ego prevents them from choosing. You as the patient should request another surgeon be there. Better there and no problem than to have problem and no support.
For me, I finally opted for two saline implants which was done 10/17/02. I am feeling so much better, and today went for a job interview and got the job and start in a month. I am a Licensed Massage Therapist. My swelling is mostly down and the "Girls" are looking more natural with gentle cleavage (I had a natural separation prior so this is new experience). The nipples will be done the end of November. This new surgeon specializes in this reconstruction surgery, so the implants (two sides) took 1/2 the time the other surgeon would have taken for a total of 1/1/2 hrs. The nipples take 12 - 15 min each in her office and i can drive myself (45 min) home. I feel like I've gotten my life back. The other concern was replacement. This surgeon said all the work is in place, should one leak or rupture for whatever reason it can be replaced in the office within 35 min. under just local anesthesia (you are awake but do not feel the procedure). She answered all the questions that had me feeling scared and gave very reasonable answers. The complicated procedures require micro vascular surgery and you need someone that does this all the time. Good luck on you choice.
Hugs, Iris

martyzl's picture
martyzl
Posts: 196
Joined: Jun 2002

Hello!
Not sure if you have already contacted me, you've left us no name... just in case it wasn't you... *grin*

It's a personal & individual decision to make. I know happy and unhappy people with trams and implants.
I chose the Tram as I was uncomfortable w/the possibility of rupture, w/having to potentially have them replaced in 10 or so years (according to my plastic man)- though now I read Iris' post and see that's not such a big deal.. I just didn't want to be cut into any more than necessary after this initial surgery! I was hesitant to use silicone (as the fluid or as the "packet" itself) because my immune system was already compromised in college after a bout of Chronic fatigue/Epstein-Barr. I also worried about having a foreign body in me and it's potential effect on my immune system.
Oh! one of the deciding factors for me was the fact that the Tram gains and loses weight with you. It's your fat in there. Seeing as I was weighing more than I wanted to before surgery, I didn't want to end up with my natural breast losing weight with me and a turbo-boob that it would never catch up with.
My remaining breast was well-loved & well-used thru' breast feeding and I knew if I had an implant, I'd be very lopsided (I am a "b" cup, rolled up!) and again, I didn't really want an implant in the remaining breast to even them out...
So.. TramFlap it was.
I had a single mastectomy immediately followed by a Tram on July 22, '02 (this summer) The whole thing, including installing a port, took 6.5 hrs. The first 2 wks out of the surgery I was a very unhappy person. I hated being waited on, being needy, being disabled. I wasn't mentally prepared for that. I wasn't prepared for the stretch marks (they are fading beautifully). I wasn't prepared for temporarily losing feeling down my midline! I wasn't prepared for being a patient. I am a caregiver by nature! Silly me.

It's been nearly 3.5 months now. "Babette", my Tram, is doing well. There are odd things, she's a wee bit bigger/fuller than the original. After chemo is done, I'll have a bit of fat taken out. I had a spot of fat which died (necrosis) which will be removed at the same time. I know, I know.. more cutting which I was trying to avoid.. *rolls eyes* Life goes on! I am comfortable with the tram now, we are great friends, we go everywhere together, she listens to all my deepest fears and such... It's natural to the touch, it moves like my other breast and in all, it's nice to have a very flat stomach... I am glad that I chose it!

Go with what you feel most comfortable with... I had trouble deciding until I had all the information I could get my hands on. As others have and will say again- be comfortable, ask questions, go with the surgeon you trust! Research them!! A good plastic man/woman is worth their weight in gold!

Feel free to contact me- zenhound@cac.net ...

Be well, take care, have fun!
Marty in Michigan

mmontgomery's picture
mmontgomery
Posts: 1
Joined: Nov 2002

I had a mastectomy also after a lumpectomy in July 2001. I researched all the possibilites for reconsturction. The only option for me was the Tram Flap. I'm very active and very independent and those first few weeks after surgery was nasty, but a year and half later I have results that I can live with for the rest of my life. It is very natural looking. The scars took a while to get used to and so did the numbness, but for me it was the right choice.

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