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Tram Flap surgery

jphilpo
Posts: 175
Joined: Mar 2010

I am considering trans flap surgery in the summer when I have recovered from radiation. I can't have implants due to radiation issues. I had a left breast mastectomy and I want to have the other breast removed. Anyone had trans flap surgery? I am really scared about t.

cruf
Posts: 931
Joined: Oct 2000

Hi jphilpo! I had Tram Flap surgery on my Rt breast 10 years ago. If I had to have it on the Lt side(which I can't cause theres not enough muscle left) I wouldn't think twice about it! It feels like the other side. It is a long recovery with a few surgeries but I did very well.I was back on the tennis courts and back to work in 7 weeks. I would be very willing to answer any specific questions for you . You can e-mail me here on this site. HUGS!!! Cathy

Balentine's picture
Balentine
Posts: 393
Joined: Feb 2010

Hi Cruf,
I am also considering reconstruction and have heard some bad stories about the tram flap. Like infections and skin not taking, etc. not to mention to recovery time. I don't know how well I would deal with going through incision in bikini area and breast and all those drains again. What were the determining factors for you that caused you to decide on the tram flap other than it feeling more natural than silicone. Were there other factors?
Lorrie

jnl's picture
jnl
Posts: 3873
Joined: May 2009

I had a lumpectomy but want to wish you good luck!

Leeza

cruf
Posts: 931
Joined: Oct 2000

Hi Lorrie! To be honest with you, I was so scared, I never questioned anything. I was told by my Plastic Surgeon and Oncological Surgeon that this is what I was going to have! I never even questioned them. Looking back, I quess I should have had other options but I was scared and I trusted the doctors so that is what I had! I guess I was lucky that everything went well and I had very little trouble. I have to say that I am aware of the stomach surgery all the time. I still feel tightness in the abdomen. I did gain some wt back(I lost 20 lbs prior to surgery just from fear!)so it's probably causing some extra stretching. As I said, I'm very happy with the results! Please feel free to ask me any questions and I will try to help you out. Good luck in your decision. HUGS!!! Cathy

Sue Yelton
Posts: 4
Joined: Aug 2012

I had a horrible experience with my tram flap reconstruction. I wouldn't wish it on my worst enemy. I broke open on my abdomen about 1 inch deep, 1 inch up and down, and 3 inches across. I broke open around both breast and had large holes in the openings also. I couldn't heal with the saline soaked gauze the surgeon was having me use. I went to my primary care physician. She wanted me to sunbathe nude (I live in town) so I ended up buying a heat lamp and attaching it to the back of a dining room chair and laid on the floor under it so I wouldn't burn. I soon could see I was going to heal. I have no tummy muscles (they used mesh) so I roll out of bed. I have no definition between my breasts and my stomach. I am round like a barrel. I have no waist and my navel is not where it used to be and excuse me but my public area is huge now! If I wear clothes that fit my butt, then they cut me in half. If I wear clothes that fit my waist, then I have baggy butt. I have large fatty areas under my arms and have nothing above my breasts; I am concave. It is hard to find tops that look nice. I am 13 yrs. past my surgery. I have an appt. with a different plastic surgeon and am wondering if with the new strides they have made in implants if that is a way for me to go. I do not want to be any larger. I am fine with that. To use an implant does the Dr. have to make me larger or does he take out tissue to make me the same? Can the area that is concave be fixed? Am I in for a lot of pain? If I get an implant, can I lie on my stomach? Can I take hits/blows to the chest without them breaking? Any suggestions would be helpful. I would like to add that I am on Weight Watchers now and want to lost about 50 lbs. Is that another problem?

Sue Yelton
Posts: 4
Joined: Aug 2012

If I had it to do over again. I would go the silicone route, but I haven't experienced it either. I got tired of the prosthesis; so hot and heavy, lots of care and only 1 set every 2 yrs. and 2 bras once a year. I have explained by tram flap experience. Just one word here: terrible.

sparky72156
Posts: 61
Joined: Dec 2009

I had the TRAM flap surgery this past January, and it went very well. I had a bilateral mastectomy even though I was only showing DCIS on the right side. I wanted to be very aggressive. Oncologist said it was the right choice. I'd do it again. I was back to work part time in 5 weeks, full time in 7 weeks.

jphilpo
Posts: 175
Joined: Mar 2010

Hi Sparky,

I am curious. How long was your hospital stay? What was your recovery at home like?

cruf
Posts: 931
Joined: Oct 2000

I had my mastectomy and reconstruction on Mon. PM and left the hospital on Fri. AM. The MD wanted me to go on Thurs. but my husband was on a 1 day business trip to Fla. so I couldn't go till the next day! Once home, I relaxed as much as possible. I sat up most of the time. I used a wedge cushion on my bed to put me in a semi lying down position. If you have a recliner, that would work very well. The most difficult and uncomfortable thing was to lie down and get up. You don't have the stomach muscles to pull yourself up or slowly let yourself down. It is uncomfortable but totally doable. My husband went back to work the following week and I was home alone.After about 2 weeks, I started to drive. Then, at 7 weeks, returned to work(I'm a Physical Therapist in a nursing home and do lifting etc...) and returned to the tennis Court. I did go to PT for massage and strengthening ex. I truely suggest everybody do that. It does make a big difference. I hope this helps. HUGS!!! Cathy

sparky72156
Posts: 61
Joined: Dec 2009

I went into the hospital on Tuesday and got out Saturday. I would have gotten out on Friday but I had a complication related to a different health issue (a chronic platelet disorder that I have had for 25 years). The recovery at home was ok because I had my sister-in-law help me. She stayed with me for a week and a half after I got home. She helped me get showered and dressed. She did all the cooking and cleaning, and I slept a lot. I don't know what I would have done without her. After she left, I still had lifting restrictions (no more than 5 pounds for two months post surgery, then no more than 10 pounds for the month after that), so girlfriends helped me shop and carry groceries into the house. I had many casseroles in the freezer before my surgery, and friends brought me food twice a week, so I was all set. I have stairs in my house but that was ok because the doctor said that the exercise would be good for me. He wanted me to walk around six times a day and going down the stairs and then up again counted as one "walking" time. I live alone so I only had to care for myself. It would have been rougher if I'd had little kids around.

Balentine's picture
Balentine
Posts: 393
Joined: Feb 2010

I am afraid of the whole thing....pain....recovery time...drains....whether skin will reject....whether blood vessels will work....all of it. My plastic surgeon said I am a better candidate for the tram flap because of the way my existing breast is shaped...more fat and wide than long and narrow. I am going to talk to another plastic surgeon on 5/6 when my chemo will be close to being over (5/17). I am praying about it and considering it but not sure yet what to do. I hated the one drain I had with the mastectomy so I am not too keen on having 3 of them with the tram flap. Come on and persuade me now. :)
Lorrie

Sue Yelton
Posts: 4
Joined: Aug 2012

I had my bilateral surgery in 1993 and my tram flap in 1999. Lots of pain, had blood clot because they kept me from walking too long. See my earlier post.

Noel's picture
Noel
Posts: 3101
Joined: Apr 2009

Bumping up for classicpat. It might help to read some of these posts.

eterrel
Posts: 1
Joined: Jul 2009

I had a tram flap October 2008. It was the best way for me to go. There is a lot of pain incurred with the operation but the results have been worth it. I would do it again in an heartbeat. WHat are your concerns?

jphilpo
Posts: 175
Joined: Mar 2010

My concerns are the pain and the recovery. I guess it's just the fact of another surgery, but I am glad to hear some positive stories like yours. I am a teacher & would like to schedule the surgery for the summer when I can be off work. I will be 6 months out of radiation & will have my right breast taken. I have bi-lateral cancer. I know it's a long surgery too.

sparky72156
Posts: 61
Joined: Dec 2009

I was only on pain meds for 2 days. You have to know how to move with the abdominal surgery.....you roll over instead of sitting upright. But once you get that down, you'll be fine. I would do it again in a heartbeat.

jphilpo
Posts: 175
Joined: Mar 2010

I was told it would be more painful because I am having another mastectomy on my remaining breast. A friend told me this, so I don't know. She thought I would just do the reconstruction on my left side & lift the right breast. I want the other one gone too & my onc. thinks it's a good idea. That is why this is so helpful. I am getting the info from those who have actually done it.

Ritzy's picture
Ritzy
Posts: 4384
Joined: Aug 2009

Wishing you the best of luck with your surgery jphilpo.

Sue :)

jk1952's picture
jk1952
Posts: 613
Joined: May 2009

I'm responding a bit late to this post, but I wanted to give you my experience. I had a bilateral mastectomy with immediate free flap/DIEP reconstruction in April 2009. This may be the surgery that you are talking about: the abdominal tissue is removed and the blood supply reconnected in your breast area. (TRAM flap can also mean the tunneling of the tissue up to your breast area: that is not what I had done).

This was my second breast cancer treatment: I had a lumpectomy and radiation in 2000 for a small amount of invasive cancer. In early 2009, DCIS was discovered in the same breast, and since I had had many tests and biopsies on the 'good' breast, I decided that I should have both removed. Because of the previous radiation, I was not given the option of implants.

The surgery and recovery were long, and the doctor did have a few problems with the blood supply because of radiation damage, but I am very happy with the results and very glad that I had the surgery done. I would highly recommend it, but caution that you need to have a plastic surgeon who is well-trained in the technique and has a lot of experience. I was only on the 'good' painkillers for 2 days, using only Motrin or Advil after that, and I was fine. I know that this is all very personal and not everyone reacts like I did.

For me, it was more a quality of life issue, in that I didn't want to have to deal with prosetheses for the rest of my life, if I could avoid it. There are differences between my real breasts and these new breasts, but no one would know the difference under clothes and they are soft like breasts and should sag like real breasts, as I age. Not many women look forward to their breasts sagging, but for me it is so much better than the alternatives. There are times when I have some discomfort in my abdomen, when I twist or stretch, and there is no feeling in my breasts, but I was on an active sailing vacation last week, and I could do everything that I could do before the mastectomy.

I would encourage everyone to consider all alternatives. When I finally decided what I wanted done, I had a tremendous amount of peace that it was the right treatment for me.

Joyce

Balentine's picture
Balentine
Posts: 393
Joined: Feb 2010

Hi Joyce, Please my post from Apr 4 several posts up. I am struggling with the idea of implants or the tram flap surgery. How many drains did you have, How long were you off work and recovering? Were there any issues with infection? It just seems so invasive. Also did you have nipples made or tattooed on? I hear they have some nice 3D nipples now but you have to go to the righ person. I plan to take my time with this one and may not do anything for another year so that I am sure I am also at peace with whatever I decide. I will be finished with chemo on 5/17 and then I am done. I did not have to have radiation since I had a mastectomy and none of my lymph nodes were positive.

Lorrie Balentine

mariam_11_09's picture
mariam_11_09
Posts: 693
Joined: Nov 2009

I had DIEP flap reconstruction on 1/5/10. I am really beginning to like my new boob. I had only a left mastectomy. I was also reluctant to have a huge scar across my belly but then I never go out in a bikini. For me I would rather have the scar than have a foreign object in my body. My PS also said DIEP flap or tram flap was more of a long term solution than implants. And I really like the natural look and feel.

I had 4 drains, two in stomach, two by my left breast. They were removed about 10 days after the surgery.

I took 2 1/2 weeks off of work but I did work from home for 2 weeks before going into the office. At about 3 weeks I was driving again.

I had my mother come and help me as I have a 10 year daughter. Having help even without a kid for a week or two after surgery is a big help. It is major abdominal surgery to you are limited to lifting etc.

I did have an infection in the stomach incision. Once they got the right anti-biotic it cleared up very quickly.

I had no problems with the blood vessels. They took just fine. In the hospital, they make sure you keep warm to keep the blood flowing. If you restrict your caffeine intake for a few weeks it will help keep the blood flow going.

My stomach on the surface is still numb. It is apparently that way for about 6 months afterwards.

I put oil on my scars and they are doing very well.

I will be honest, at first I was rather indifferent about the results. My PS was very proud of his work. Now, 4 months later I am really starting to appreciate the results and am looking forward to the follow up surgery, ie lift on the right to match the left and the nipple.

I think it is a good idea to take your time and really feel it out. Also you can ask your PS to show you before and after photos of implants and flap reconstruction. Mine showed my plenty of all the procedures as well as the scarring so I had a pretty good idea of what it might look like.

Good luck.

jk1952's picture
jk1952
Posts: 613
Joined: May 2009

Mariam (below) has given you a lot of good information about the surgery and recovery. Since I had the bilateral mastectomy and reconstruction all done at the same time, I may have had a longer recovery period than you would have. I was out of work for eight weeks. I was doing a few things at home after about three weeks, but it was when I felt like working. I did start driving 2-1/2 weeks after the surgery, and was able to do that quickly because I wasn't taking the narcotics.

For my surgery, I had six drains: two for each breast and two in the abdomen. I would pin them to my loose clothes or sweats and they weren't horrible: when I'd shower, I attached them to a lanyard around my neck. I did have to have my last drain taken out early because it was plugged, so I did have to have fluid aspirated a couple times from my abdomen. It's definitely best if you can keep the drains for as long as they are needed. I was on an antibiotic to help heal my belly button, but I didn't have any major infection.

I was very anxious about having artificial/foreign body parts, so this surgery was better for me. I did give blood for myself that was used for a transfusion: that was a great relief for me.

I did have nipples made (at the same time that I had one breast reduced to match the other one), but they were done by making slits in the skin and then gathering the skin together. There was no grafting done. The nipples are not very prominent, but I actually like them better this way. I was told that they could try again, but I think that they are fine the way they are. I haven't had the tattooing done: the nipples were done recently and I want to wait until the fall since you can't swim for a while after the tattoos are done.

Please take your time and make sure you do what's right for you. If I hadn't had immediate reconstruction, it would have been very hard for me to make the final decision about reconstruction. I wish you well.

Joyce

Balentine's picture
Balentine
Posts: 393
Joined: Feb 2010

Joyce,
Sounds like alot of pain to me. I may wait awhile. 4 drains is alot and I hated the drain after the mastectomy more than anything else. How do you sleep at all with 4 drains in? I don't think I could sleep on my back all night for 2 weeks. I am a baby when it comes to pain. And then the infection too?? It makes me wonder, do I really need 2 boobs? Mmmm...I think I am wanting to do it more for my husband than anything but I am also getting tired of the prosthesis and breast forms. It is a difficult decision to make so I will take my time. I will get the plastic surgeon to show me some pictures though when I go back to visit him on 5/6. Thanks for your advice and sharing your experience. God bless.
Lorrie Balentine

jk1952's picture
jk1952
Posts: 613
Joined: May 2009

Lorrie, I have to admit that I'm not sure what I would have done if I didn't have the immediate reconstruction. I think that I would have dragged my feet with the reconstruction, and I'm just so thankful that I could have it done all at one time. Before the surgery, I always slept on my side, so the sleeping on my back was new to me, also. I used several pillows: two under my head, one under my knees and one on each side. I slept alone during recovery, and didn't start sleeping on my side until about six weeks after surgery.

I know you'll make the decision that's best for you.

Joyce

Sue Yelton
Posts: 4
Joined: Aug 2012

I had no drains on this, but it was very painful. I was a teacher and had it done in June fortunately because it did take a long time to recover. My husband has been a real trooper through all of this. You will need a caregiver. The mastectomies were a breeze compared to the tram flap. I chose not to have the nipple; there won't be any feeling anyway and who wants an erect nipple all the time??

jayjune
Posts: 6
Joined: Apr 2010

i have had billateral mastectomies i am 24 my major concern about the DIEP is stomach hernias and can i carry a pregnancy without complications? as i would love to have little ones in the future. all answers will be greatly appreciated especially those that have done it and later had to be pregnant and also PS answers would be great too

athena81
Posts: 2
Joined: Jul 2010

Jayjune, I have the same question! I am 28 and will be having surgery when I am done with Chemo and I want to preserve my ability to carry children if at all possible and I'm hoping that with the DIEP I can still do so. Does anyone have any info?

wirak
Posts: 22
Joined: Jul 2012

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