ps wont do tram till I lose weight

ksher4ty4

Hi  I have been glued to the comp. ever since I got dx in April. I have been dx with multifocal dcis. my breast surgeon did not explain much at all. She would answer if we asked but we ( my husband and I) found her hard to follow.  I  was thinking mastectomy since it is multifocal and read up on the diep flap.   There is not a surgeon in our local area that does this so we headed to University hospital.  We seen the plastic surgeon first ( sorta backwards ) first bs then ps. usually.    He told me he would not do a tram till I lost 20lbs...he suggested delayed reconstruction.  I really wanted it all done in one shot, especially since this hospital is 2 hours from our home. he refered us to theUniversity breast cancer care center, We are waiting for their call..    SO Confused and tired of waiting.....

ksher4ty4

Im wondering now if I should just accept implants. any ideas?  

roseg

Do you have problems that might make surgery risky -high blood pressure/diabetes? A TRAM or DIEP does tend to be a long surgery and if you have risk factors they'll come to light.

How overweight are you? Somehow I suspect that losing 20 pounds will not get you into a normal weight zone, but it could reduce your immediate risks from surgery.

 DCIS is not an emergency. If being able to consolidate surgeries (and co-pays) would be something that would help motivate you to lose 20 pounds then I think I'd consider waiting and get on a diet.

Generally gals are happier with reconstructions that are self-tissue, particularly if they are big chested. I think it might be better to get with a weight loss program.

CandDsMom

I would seek out a 2nd opinion with another PS.  Is this for a free TRAM or a pedicle TRAM?  It is true that being overweight does increase your risk of complications like flap loss, skin necrosis, etc, there are excellent surgeons out there who do these type of procedures day in and out and the rate of complications declines with the number of cases a surgeon does.  Have you thought more about getting a DIEP instead?  This is like a TRAM except they don't use any muscle.  I would avoid a pedicle TRAM at all costs - this is old school and really causes a lot of disability from what I have heard since they take the whole rectus muscle.

I also had multifocal DCIS and had a bilateral skin sparing mastectomy with immediate free TRAM reconstruction in April of this year.  I am also overweight (was size 16/18 at time of surgery) but otherwise healthy at 35 years old.  I wish that I would have had the DIEP versus the TRAM as the loss of those abdominal muscles does make a difference but my local PS told me (falsely) that I was not a candidate.  As it turned out, I did get pretty extensive skin necrosis probably due to my surgery being so long (14 hrs) and also I lost a lot of blood (blood count 15.1 -> 6.8 which is severe anemia).  I think both of these issues were related to the skill of the plastic surgeon I used locally as I have heard about other PS doing these procedures much more quickly.

Anyway, I am finally healing up (now 10 weeks post surgery) and have switched to a new PS to help me.  Although I have had these complications, I am happy to have gotten a self-tissue reconstruction as it does have the jiggle and cleavage that I had before and it feels like the breasts I had at 21 (firmer and less saggy!).  You should check out the breast reconstruction thread - specifically there is one thread called "NOLA in September" where the women are very up to date in the latest and greatest plastic surgeons in the country - they do talk alot about the Center for Restorative Breast Surgery www.breastcenter.com (full disclosure: Dr. DellaCroce is my new plastic surgeon who has his work cut out for him to put me back together from the first guy's mistakes) but I remember reading a post somewhere in there that talked about other plastic surgeons in the country (another one I heard about is Dr. Marga Massey who travels thru the country - her website is www.drmarga.com).  Anyway, take your time, and make sure you feel comfortable with the person who does your breast and plastic surgery - there are lots of options out there.  Don't undertake this and feel like you have to settle.  take care.

ksher4ty4

 Thanks. This truly is a wonderful site... I have been crying and near tears . I wear size 16 pants. sometimes 14. The PS said if I carried my weight more in my legs and butt it would be different . I have a thick tummy . ( silly me I was thinking that would be good for a diep or free flap)... I do not have diabetes and I actually have Low blood pressure.....  I talked to the breast team at the university and they sounded great.   They are going to get my records and then call me for an appt.  This is my last stop at doc. and I am going to put my life in their hands. tired and I still havent had surgery....  It is sad but my first bs just would flip through my folder as she was entering the room.  like no big deal.... next.....  and her office would say it is only DCIS stage 0. but low and behold , I may lose my breast, have radiation so IT IS A BIG DEAL !!!

nmi

That's just crazy you should not be treated like that!! You will be fine.  Sent PM

CandDsMom

I know - it is really upsetting.  My original PS also was of the opinion that this was "precancer"  I just wanted to scream at him if it was so not a big deal and "nothing" then why was I losing my breasts to it? 

It is really frustrating - hang in there.  I have found this website to be a lifesaver too.  Feel free to PM me anytime.

ksher4ty4

Thanks 2tzus.... you made me laugh with the 3 1/2ft tall thing..... I needed to laugh.

       Iam going to go over to the reconsturction forum.... Im thinking after we go to the university for the 2nd breast evaluation and explaination...(which Iam sure will be more detailed and informative then my first).  I read my records and at one point they say.... no signs of invasive cancer in the left breast.... I had 2 biopsies showing dcis and 2 differnet shape markers put in the right breast. So does that mean they are not sure about invasive cancer in the right breast?????>  I just feel like Im in the dark and Iam so looking forward  seeing  the team at  this breast cancer center at U of M.  michigan...and getting answers....  This site is a wonderful wonderful supportive and uplifting friend through all this...

Glo53

Hi everyone,  my PS also wants me to lose weight and the reason is that there's less chance of infection or complications like hernias. He doesn't expect me to get to a normal weight but get to a safe weight. He also said that if I don't lose the weight I can always just do the implants its up to me. I just thought this might help.