Breast re construction!

rustylocks

Hi All
Today I went to see my PSabout my options. He gave me two ops to consider.
1) To have reduction on one and use the tissue to rebuild the other.
2) To go for full recon by using the muscle from my back.
My hubby and I have talked about them both.The first one is a lesser op and less time to heal .
The second he said can have some complications with it, it can fail and the scar goes from my back under arm to front.
I was wondering if anyone had had this done or the other op and what they could tell me about. Also I would like to hear what others think about these ops.
Thanks in advance.
Rusty xxx

wildangel

Hi Rusty,
Where would he get the tissue from to rebuild? I have heard that they can use excess butt fat to make a breast. I like that idea because you get lipo and a new boob all in one shot!

A friend had the back dorsi flap done and she has a HUGE scar on her back. See if your doc will let you see pictures of the work he has done. That should help you make up your mind right then and there!

Good luck!
Angela

seeknpeace

Hi,

This past Feb I had a bilateral mastectomy and tram flap reconstruction. It is hard to make these decisions so fast but, a must in many cases.

Myself, if I could do this over, I would have had the diep which is the same as the tram but, it saves your ab muscles. I hate that part. At first the tummy tuck is all good but, my lower abdomen is starting to round out and I have NO control or way to fix that and the bundled muscles under my reconstructed breasts is awful and I hate it. I hate that he made them so big too. I asked for a b and got a d. Who wants to sag?

I know that you are looking at the dorsal flap, but, with the reduction on the non cancerous side, how will they move the blood vessels? Was there an option for the diep or are you a candidate? With that surgery, in case you have not had time to research, they give you a total tummy tuck, removed tisse from the lower abdomen, and do microsurgery to connect a blood supply to the moved tissue. With mine, they tunneled the tisse still connected to the lower ab muscle, up through my upper ab skin and located them in the newly reconstructed area. But, they cross them, the left goes to the right and vice versa. So, the muscle is laying crossed right beneath your breasts and it is large. I hate it. A lot. Do ask for pictures of his work. That is VERY important too. Good luck honey. Keep us in the know and if you need more answers, just ask.

Jan

newboobs

Hi Rusty-- I had a reduction and lift on my non-cancer side and a mastectomy and saline implant on cancer side. It took a while to get "comfortable", but I love it now. The healing wasn't bad at all.

Good luck to you

littlelindalu

newboobs said:

Hi Rusty-- I had a reduction and lift on my non-cancer side and a mastectomy and saline implant on cancer side. It took a while to get "comfortable", but I love it now. The healing wasn't bad at all.

Good luck to you

I also would try to avoid cutting into any muscles for reconstruction. I had reconstruction that cut all my chest muscles and have suffered with arm/shoulder problems ever since. I am researching the DIEP -- which still cuts your ab muscles (although it does not remove part of them like the TRAM) -- and have seen that some women suffer with ab problems after that surgery also.

If you can be satisfied that this surgeon has done a lot of reconstructions SUCCESSFULLY (ask for pix and women already done a few yrs ago that you can talk to about how they are doing now) using the tissue from your other breast -- that sounds like a much better way to do it.

seeknpeace

Hmmmm...now I am confused...cut and pasted below is a description of tram vs diep..I had the tram. I wish that someone here did the diep. I understand that with the microsurgery, it is an even longer surgery and docs just do not want to do it...

DIEP flap breast reconstruction results in the creation of a "natural" breast without muscle removal.
One in nine women develops breast cancer with some requiring mastectomy for treatment.

Psychological and emotional benefits associated with breast reconstruction are huge.

Implant reconstruction superficially appears simple, however, the body's reactions to an implant and consequences thereof frequently require further surgery. Additionally, the safety of breast implants is controversial.

With TRAM or free TRAM surgery, skin and fat of the lower abdomen are used to form the breast. Sacrifice of a portion or the entire rectus muscle is necessary because the blood vessels lie within the muscle. The muscle doesn't contribute to the size or shape of the breast. Even a small amount of muscle removal can lead to an abdominal hernia.





With the Deep Inferior Epigastric Perforator no muscle is removed. The perforating vessels with the overlying flesh are removed and the muscle is left in place. Patients recover quickly with usually only a three-day hospital stay. The abdominal scar is placed low on the abdomen because no muscle is removed. The perforator blood vessel dissection increases operating time but the body tolerates superficial surgery well.

There are very few surgeons who are capable of performing this reconstruction and Dr. Keller is proud to be one of the pioneers in this new technique.

littlelindalu

seeknpeace said:

Hmmmm...now I am confused...cut and pasted below is a description of tram vs diep..I had the tram. I wish that someone here did the diep. I understand that with the microsurgery, it is an even longer surgery and docs just do not want to do it...

DIEP flap breast reconstruction results in the creation of a "natural" breast without muscle removal.
One in nine women develops breast cancer with some requiring mastectomy for treatment.

Psychological and emotional benefits associated with breast reconstruction are huge.

Implant reconstruction superficially appears simple, however, the body's reactions to an implant and consequences thereof frequently require further surgery. Additionally, the safety of breast implants is controversial.

With TRAM or free TRAM surgery, skin and fat of the lower abdomen are used to form the breast. Sacrifice of a portion or the entire rectus muscle is necessary because the blood vessels lie within the muscle. The muscle doesn't contribute to the size or shape of the breast. Even a small amount of muscle removal can lead to an abdominal hernia.





With the Deep Inferior Epigastric Perforator no muscle is removed. The perforating vessels with the overlying flesh are removed and the muscle is left in place. Patients recover quickly with usually only a three-day hospital stay. The abdominal scar is placed low on the abdomen because no muscle is removed. The perforator blood vessel dissection increases operating time but the body tolerates superficial surgery well.

There are very few surgeons who are capable of performing this reconstruction and Dr. Keller is proud to be one of the pioneers in this new technique.

The only one of these methods that does not involve any cutting into the muscle is the SIEA (with removal only of ab tissue -- only possible if the blood supply in the tissue is sufficient) -- with the DIEP the tissue is taken and the ab muscle is cut to get to the wider part of the blood vessel that is there. With the TRAM, part of the ab muscle is indeed transplanted along with the tissue. If reconstruction is possible using only existing breast tissue, it would be preferable/easier to recover from altogether.

seeknpeace

I have not read anywhere that the muscle is cut. The vessels are dealt with, but, the muscle is left intact, is my understanding and what I have read everywhere that I have researched. With the tram, not the free, but, the regular, ALL of the muscle is used to provide a blood supply to the moved abdomenal tissue. The tissue and the muscle are moved intact and tunneled under the upper abdomenal skin to be placed in the breast area, then a flap is sewn in. With the DIEP, you not only keep your muscle totally, you have much less scarring, numbness, etc. You also recover much much faster. I was 8 weeks out of commission, and longer til I was "me" again. I regret the tram and wish that I would have had time to find a local doctor to do the diep. It would be my choice of surgery. I was not comfortable with implants, I was concerned with removing a bad thing and possibly replacing it with a bad thing, and it would be my luck to have all the bad responses to the implants.

Anyway, I would like to know where to read about the muscle being cut. I do not know of that to be the case with the DIEP.

littlelindalu

seeknpeace said:

I have not read anywhere that the muscle is cut. The vessels are dealt with, but, the muscle is left intact, is my understanding and what I have read everywhere that I have researched. With the tram, not the free, but, the regular, ALL of the muscle is used to provide a blood supply to the moved abdomenal tissue. The tissue and the muscle are moved intact and tunneled under the upper abdomenal skin to be placed in the breast area, then a flap is sewn in. With the DIEP, you not only keep your muscle totally, you have much less scarring, numbness, etc. You also recover much much faster. I was 8 weeks out of commission, and longer til I was "me" again. I regret the tram and wish that I would have had time to find a local doctor to do the diep. It would be my choice of surgery. I was not comfortable with implants, I was concerned with removing a bad thing and possibly replacing it with a bad thing, and it would be my luck to have all the bad responses to the implants.

Anyway, I would like to know where to read about the muscle being cut. I do not know of that to be the case with the DIEP.

To see the differences explained in more detail go to websites like microsurgeon.org/breast_reconstruction.htm OR
emedicine.com/plastic/topic140.htm

You will see that they explain in these (& other sites) that during the DIEP the ab muscle is cut to remove the thicker part of the blood vessel along with the ab area tissue. The SIEA is the only ab area fatty tissue transfer that is done without cutting the ab muscle at all -- and it is only possible for those who have sufficiently thick/robust blood vessels in that fatty tissue. That is why I am concerned about the DIEP myself -- I have read and heard that some women still have ab tightness with the DIEP -- not as bad as with the TRAM -- but trouble still.

I have heard that some drs also call the DIEP a free-Tram, by the way -- so the free-Tram must be similar.

seeknpeace

littlelindalu said:

To see the differences explained in more detail go to websites like microsurgeon.org/breast_reconstruction.htm OR
emedicine.com/plastic/topic140.htm

You will see that they explain in these (& other sites) that during the DIEP the ab muscle is cut to remove the thicker part of the blood vessel along with the ab area tissue. The SIEA is the only ab area fatty tissue transfer that is done without cutting the ab muscle at all -- and it is only possible for those who have sufficiently thick/robust blood vessels in that fatty tissue. That is why I am concerned about the DIEP myself -- I have read and heard that some women still have ab tightness with the DIEP -- not as bad as with the TRAM -- but trouble still.

I have heard that some drs also call the DIEP a free-Tram, by the way -- so the free-Tram must be similar.

Hi Linda

From personal experience, abdomenal tightness is not a problem with the tram. The first month or so, you feel tight, but, that all goes away. Even if they were to cut that muscle to get to a blood supply, they do not leave it cut. It is a functioning part of your body still, unlike the tram where the entire thing is moved to the chest area with tissue intact, by route of tunneling through the upper abdomenal area. It is horrible. The diep takes that aspect out and when you are looking at a three day stay in the hosp vs an 8 day, as I did, that tells you a lot. I am not familiar with the other and look forward to reading about it. I do not believe that the free tram and the diep are the same. I am gonna find out and get back to you about that.

Thanks for the links. Jan

seeknpeace

seeknpeace said:

Hi Linda

From personal experience, abdomenal tightness is not a problem with the tram. The first month or so, you feel tight, but, that all goes away. Even if they were to cut that muscle to get to a blood supply, they do not leave it cut. It is a functioning part of your body still, unlike the tram where the entire thing is moved to the chest area with tissue intact, by route of tunneling through the upper abdomenal area. It is horrible. The diep takes that aspect out and when you are looking at a three day stay in the hosp vs an 8 day, as I did, that tells you a lot. I am not familiar with the other and look forward to reading about it. I do not believe that the free tram and the diep are the same. I am gonna find out and get back to you about that.

Thanks for the links. Jan

Ahh..I read about all and I do remember looking into the siea now. It is not always one that can be done, only a certain percentage of ppl can have that one.

littlelindalu

seeknpeace said:

Ahh..I read about all and I do remember looking into the siea now. It is not always one that can be done, only a certain percentage of ppl can have that one.

Dear Jan -

Per the studies I have read and some women I talk to, ab tightness or ab muscle weakness can be a problem with either of the two TRAMs or the DIEP. The less the muscle is cut, with the DIEP and some of the newer Free-TRAMs, there is less trouble than with the original TRAMs as the incision in the ab muscle is much smaller. I am aware that there are some women who would not be candidates for the SIEA -- which would be my choice or the one I would hope could be done on me. I have also become aware that some drs are doing Free-TRAMs or free flaps that are variations of the SIEA (with no ab muscle incision at all). I find it confusing that these drs call these free-TRAMs as I thought a free-TRAM meant taking a small piece of the ab muscle along with the tissue and blood supply -- as long as the dr gets the surgery done correctly, I guess they can call the procedure whatever they want. Again, my preference would be NOT to cut the muscle at all. I have already had muscles cut and know from painful experience that muscles do not always heal well from being cut. I also hear that some of the GAPs and even LATs are done without taking/cutting those muscles -- will take another look at them shortly.

I am happy for you that you have not had any ab tightness problems.

seeknpeace

littlelindalu said:

Dear Jan -

Per the studies I have read and some women I talk to, ab tightness or ab muscle weakness can be a problem with either of the two TRAMs or the DIEP. The less the muscle is cut, with the DIEP and some of the newer Free-TRAMs, there is less trouble than with the original TRAMs as the incision in the ab muscle is much smaller. I am aware that there are some women who would not be candidates for the SIEA -- which would be my choice or the one I would hope could be done on me. I have also become aware that some drs are doing Free-TRAMs or free flaps that are variations of the SIEA (with no ab muscle incision at all). I find it confusing that these drs call these free-TRAMs as I thought a free-TRAM meant taking a small piece of the ab muscle along with the tissue and blood supply -- as long as the dr gets the surgery done correctly, I guess they can call the procedure whatever they want. Again, my preference would be NOT to cut the muscle at all. I have already had muscles cut and know from painful experience that muscles do not always heal well from being cut. I also hear that some of the GAPs and even LATs are done without taking/cutting those muscles -- will take another look at them shortly.

I am happy for you that you have not had any ab tightness problems.

God, me too Linda. The biggest thing for me is that I really am not happy with the bulge created by the ab muscles crossing under your breasts and also that the lower abdomen is rounding out, naturally from the pressure of my innards. I have not gained weight, and now I am afraid if I lost I would look like a freak with that crap under the boobs and then the bulge below...sheesh. I would recommend that ppl really explore their option. When I went to see the plastic surgeon, I knew what I wanted and he did not do it, and knew of no one in our area who did. For me it was the diep. But, given the option of implants vs tram, I preferred the tram. I just wish that the results were better. You can see the scars on either side of my breasts in just about any bathing suit that I wear. My breast mounds are far enough apart that there is no cleavage, I feel like Tori Spelling. (she has the WORST boob job). My actual breasts are symetrical and look natural and I have gotten a lot of compliments from industry ppl, but, still and yet, I wish that I could have found someone to do the diep. The plastic surgeon is a long time aquaintance and friend so I had a comfort level with him and he is the chief of plastic surgery at two hospitals. He is good, but, I just wanted the other.

I do know one lady who had double meshing in her lower abdomen, where I have only a single mesh.

Jan

littlelindalu

seeknpeace said:

God, me too Linda. The biggest thing for me is that I really am not happy with the bulge created by the ab muscles crossing under your breasts and also that the lower abdomen is rounding out, naturally from the pressure of my innards. I have not gained weight, and now I am afraid if I lost I would look like a freak with that crap under the boobs and then the bulge below...sheesh. I would recommend that ppl really explore their option. When I went to see the plastic surgeon, I knew what I wanted and he did not do it, and knew of no one in our area who did. For me it was the diep. But, given the option of implants vs tram, I preferred the tram. I just wish that the results were better. You can see the scars on either side of my breasts in just about any bathing suit that I wear. My breast mounds are far enough apart that there is no cleavage, I feel like Tori Spelling. (she has the WORST boob job). My actual breasts are symetrical and look natural and I have gotten a lot of compliments from industry ppl, but, still and yet, I wish that I could have found someone to do the diep. The plastic surgeon is a long time aquaintance and friend so I had a comfort level with him and he is the chief of plastic surgery at two hospitals. He is good, but, I just wanted the other.

I do know one lady who had double meshing in her lower abdomen, where I have only a single mesh.

Jan

I know a woman who had a free-TRAM which did not involve any incision in/removal of her ab muscle about a year ago. She also had arm problems from the pockets made for her implants -- and gives me hope that I can get some of my arm/shoulder mobility back once my implants are removed. She is very pleased with her recovery and tells me that I will be absolutely thrilled to be able to sleep on my stomach again.

littlelindalu

Dear Rusty -

I hope that our messages here have helped you with your decision. Feel free to email me if you have any other questions -- I have been researching these flap procedures for a number of months and would be happy to share what I have learned about their advantages and downsides.

Regards and best of luck to you!