TRAM Flap or DIEP Flap Reconstruction question

TiffanyLeigh

Hello fellow breast cancer fighters.  I had a BMX this past October and a lttle over 6 weeks of rads which ended in January.  I met with my surgeon today and we discussed reconstruction, she informed me that implants are not an option for me...Any of you in or were in the same situation?  What was the outcome?  I would imagine if a thin woman had the TRAM or DIEP, the reconstructed breasts would be farely small.  I'm wondering if it's even worth it; I'm in my early 30's and I can't imagine going the rest of my life without breasts (yes I know many women do it).  Any advice would be helpful.  Thank you!

besa

  There are other tissue options in addition to DIEP but you need to go to a very experienced plastic surgeon who specializes in these procedures.  sGAP and lumbar (hip) flaps are among the options for thin women. Some plastic surgeons can even combine flaps "stacking" different types of flaps together (for example combining DIEP and GAP flaps).  There are a number of women who have had these combination flaps done on the "NOLA in September" thread.  Despite being thin they end up with nice sized reconstructions.  I traveled to NOLA to have an sGAP reconstruction done.  For me it was worth it.

char123

Hello Tiffany: 

 I had DIEP Surgery done in 2010, I am thin and I think it turned out great and it was worth it, you would be surprised how much fat is really there.  Ask the surgeon, you may be pleasantly surprised.. good luck!

ckmoss

I am trying to decide between the flap or inplants.  My plastic surgeon is one of the best in our town and want to stick with him, but he is all for the flap (his specialty). I'm kinda leaning towards the inplants as easier surgery, but all is so much to take in.  May I ask why your surgeon didn't think you were a good candidate for inplants? I actually didn't know that there were reasons you couldnt have them. This is all happening so quick for me and I definately want to have reconstruction done at time of mas. surgery.

TiffanyLeigh

Thank you for all of the information, it sounds like I will have a lot of options to discuss with the surgeon.



I was told before I even had surgery that implants most likely wouldn't be a possibility because of the damage radiation would cause to my skin and tissue. It's been almost 5 months since I completed radiation and I'm still really tight; so I can see how my skin wouldn't stretch for the implants. However, I still have not met with the plastic surgeon, so he may say something different.



Thanks again for all the information and good luck to you all! xo

Nissi

Hi Tiffany, I am a newbie on this site and this is my first post.

I had lumpectomy and radiation in 2006 then my DCIS came back in same breast in 2011 and I was told I should have a mastectomy.  I went through a grieving process at the thought of losing my breast.  My Plastic surgeon and Breast surgeon were an excellent team at Brigham and Women's in Boston.  I was also told that I was not a candidate for the implants because of the radiation had damaged the elasticity of my skin.  I am about 40 pounds overweight, and I was a good candidate for the TRam flap proceure (pedicled).  It was major surgery requiring both surgeons and about 5-6 hours.  It was a few difficult weeks after surgery but I had a great family and friend support and help team!  It has been 20 months now and I am very happy with the look of my new reconstructed breast.  It is numb and my stomache area is still partially numb and uncomfortable when I am full from a meal. One thing I wished I had known is that I am not a candidate now for tubal ligation surgery because of the major abdonminal surgery.  I am 46 and do not want to have any more children.  I probably would have had my tubes tied before if that was at all possible. So make sure you ask your surgeon all of the things that will affect you in the future.

Everyone needs to make the decision that is right for them.  I knew I could not bare to see myself void of a breast. If you have any specific questions about my tram flap reconstruction surgery, feel free to ask.

Blessings

Nissi

Nissi

Hello ckmoss,

I also wanted to have the reconstruction at the time of surgery and I was very glad I did.

I also was not a candidate for implants because of my radiation. 

Just put all your choices on paper with pros and cons of each. 

Blessings

Nissi

deb1973

Hi,

I am nearly two weeks out from a Bmx & DIEP recon. I weigh 135 & am 5"71/2 at time of surgery although I had the benefit of some tummy fat from my pregnancy. Recovery the first week & a half is hard but doable. since I got the surgical drains out yesterday, I am feeling much better. The recon breasts are small, but closely match the size, shape, contour, etc., of the originals. I am sure it is case by case, but it's def worth looking into if you're interested. Hope this helps!

Beebop

Nissi,

So glad to read your post. I am contemplating a Tram (free)flap, but am terrified. Trying to find people who have had good outcomes. My original reconstruction with expanders failed due to infection, then I had radiation, so implants are no longer an option. Thanks!

Nissi

Becky, so sorry your first reconstruction did not go well   Don't be terrified, I will be praying for you!  Keep us posted, let me know when you see your doctor next so I can be praying specifically for you to have strength and wisdom for the right choice that is perfect for your situation!

You can do it!

Deb1973- you have made it through the toughest 2 weeks!  Those drains were not fun.

The worst part for me was trying to not get nauseous from the pain meds because vomitting after that abdominal surgery was horrible.  Before surgery they gave me a patch behind my ear to stop any naseau, but I didn't know that and  I thought it was something they forgot to take off after the surgery so I removed it )  My advice to anyone who gets naseous from pain meds-ask for the patch and leave it there!  

deb1973

Thanks so much, Nissi:-) The nausea sounds awful- good advice about the patch. My worst issue was back pain b/c I was on mandatory bedrest until day four. Apparently, that's the trend in the area where I was treated so the doctors can protect the flaps better. So glad to be home & healing:-)

nandia

Hi Tiffany, I had a double mast last August with free tram reconstruction after surgery. I can tell you that the first 2 weeks are kind of tough bc of trying to heal. I was out of work for 5wks after surgery. The reconstruction left my breast smaller than what I had prior to surgery which is not a prob per say. The most difficult part not being able to wear a regular bra. I have sports bras and stretchy bras that seem to rise as I do not have a groove underneath my breast where we most women have that help with having our breast in our bra cups. I am do to go back to see my PS in about 6 mos after my radiation that ended in march of this yr. my only concerns today are whether I am able to carry a child if I were to be pregnant. At the time of surgery I never considered having anymore children as I have 2 already.....but being in love and finding my best friend has made me think otherwise and considering having more children. I would do more research as I believe there are several types of tram surgeries out there and it all depends on the surgeon as well. I've seen a well known and recognized plastic surgeon at Fox chase cancer in Phila, Pa. which I felt was very supportive and knowledgable of the surgeries available for women with breast cancer. I will pray that you find peace and the knowledge to make a sound decision. I know it can be difficult to decide but know that you have someone here (me!) if you have any more questions

Anonymous

Hi, ladies. So glad I found this thread. I am scheduled for Masectomy, SNB, and immediate reconstruction (pedicled TRAM) on 06/13/13.

I'm scared. And frankly, it feels good to admit it.

There is lots of good advice on this tread. I'll try to remember: nausea patch, don't take it off; IV tylenol or pump morphine, if they offer it.

Nandia: I have some questions for you. If any are too personal, you can (of course) decline to answer or PM me if you want your answers kept off the board. My biggest question has to do with being off work for 5 weeks. My doctor has said 3. What kind of work do you do? Are you over or under weight? what was your overall health prior to surgery? How long were you in the hospital? How long were your drains in?  Are there any particular circumstances that contributed to your being off for five weeks, or was that always the plan?

Galsal

Wow, I was off for eight weeks for what was to be a Diep but became a Free-Form Tram.  Then four weeks working part-time as I built back up to full-time.  The NP of my PS team was surprised when I'd thought I'd be off for about six weeks - told me usually about twelve weeks.  So we compromised ultimately. 

This was a Veterans Hospital and they're not known for dragging things out in terms of surgery and recovery time.

Jennt28

Steph01 - the pedicled TRAM is reasonably outdated by the free TRAM and DIEP, and can leave the abdominal strength very impaired. Is there a reason why your surgeon is doing the pedicle version other than because that is what they've "always done"?



Jenn

Anonymous

Free flap TRAM and DIEP flap are not covered by my insurance. My PS suggested the DIEP flap, and was very surprised that insurance won't cover one of the other procedures. It's true, I'm a little nervous about the pedicled tram, but I can only do what I can afford: which is what my insurance will pay. The pedicled tram may be a little "outdated" but I have faith that it will be the right solution for me.

Jennt28

Steph01 - The pedicled TRAM has been performed on many women so if that is what insurance will cover then that's it. Was just wondering...



It's always interesting to learn how the coverage works differently all over the place. My recon is only minimally covered here in Australia. So far hubby and I are just on $20,000 out of pocket paying the additional fees that Medicare and insurance don't cover. And, we have TOP level private health insurance... :-/



Jenn

35_smiling

repost

I had my mastectomy with immediate reconstruction surgery (by using my belly fat to create my new right breast) was last week on Friday May 24, 2013. I was scheduled to be at Beth Israel Hospital by 9:30am. Got there on time and they gave me a buzzer and when it goes off that was time for prep. We (my hubby and I) sat in the waiting area until this thing buzzed...then I started crying and they told my husband they will let him in later.

They got me all ready for surgery and my husband was allowed to come in. We said some prayers and I made him do a before photo with all the marker markings made from the plastic surgeon. I was still very scared and nervous. The doctor came in again and spoke to my husband and answered all his last minute questions. I was glad for that. We kissed and I was wheeled into surgery which six hours later it turned out. I woke up and my husband was the first I saw. I was super happy and very scared to look under the covers now.

I have a follow up appointment with the plastic surgeon tomorrow so, I hope me and hubby are doing things okay. The drainage's are a bit discomforting to do but we get it done. I am still very sore but once things heal it would look better....I hope anyway. I find it hard to look at myself right now.  its really not a pretty sight to see...I thought looking at other women will help me but seeing it first hand on my own body is just a shock for me.

I am super excited that my insurance paid 100% and I am doing good and coming along well.

Chilly1nPhilly

Three weeks to return to work after a tram flap procedure?!!!  That has to be a mistake. I went back (without consulting the doc) after 4 weeks, but the advice was to return after 8 weeks. In retrospect, I can see why they advise to wait for 8 weeks. I'm lucky I didn't get fired, because you are just in no condition to work, no matter what the work is.

Don't worry, it will end up OK but it's heavy going for the first couple of weeks.

Jennt28

I was back at work after 3 weeks... I would have liked longer off, but couldn't take a longer break.



Jenn

Nissi

I was prepared to be out of work for 5 weeks after my tram flap, but by the end of the 3rd week (no longer on paid meds) I went back to my office job about 3 hours for that 1st day then worked up to 5 hours.  If felt good to get out of the house and accomplish something.  Everyone is different. You know your body when you are ready.  I followed all the doctors order to the T.  God really helped me and I had a lot of help at home those first 2-3 weeks.

Nissi

Anonymous

I am using all of my sick time to be off for three weeks. I don't know what I'll do if I need to work part time, if I have to have radiation treatments, or have to have chemo. At this point, I am praying for the best and dealing with changes if/when they happen.

Lisa5amonth

Hi all,

Just wanted to add a positive story regarding a pedicle tram flap.  I was scheduled for a free tram flap which was changed to the pedicle during the surgery due to small veins/arteries in my chest.  My surgery was 1 year and 1 week ago today.  It was an extremely slow recovery which I took 3 months off of work (I am a massage therapist so require the use of my upper body) and began back to work slowly.  Today, I look great and feel great.  i do not have any negative outcomes from the surgery.  In fact, i love the look of my body... my flat stomach is wonderful!  I do not have any issues with my abdominal muscles and  can do everything I did prior to the surgery.  I truly believe you need lots of time to heal, both emotionaly and physically.  although it has been very tough financially, the benefit of a slow recovery has been invaluable!

Anonymous

Thank you, Lisa. I am a little over three weeks from surgery, and oi also had the pedicale tram flap. I think I am doing really well, although I still tire easily. It's really good to know that you don't have abdominal issues!

GreenGirl1

Hello Lovely Ladies,

It is a pleasure and comfort to read through your posts. I am a 4 year survivor who was diagnosed originally in 2009. I had a lumpectomy and then two subsequent re-excision surgeries for clear margins. I turned down chemo and radiation and did an overhaul to my lifestyle. I lost 40 pounds and feel great. I have been diligent about my lifestyle since my initial diagnosis. And have had all of the recommended follow up screenings. Recently I was diagnosed with DCIS in the same breast as my initial cancer. A couple of opinions later, and it is pretty clear that this recent diagnosis is a result of leftover remnants from my initial surgery. To me, this is good news. With a Grade 3, stage 1 cancer, I truly believe that the exceptional care I take of myself has kept the cancer contained. This could have been a lot worse news! The issue now is that a mastectomy has been recommended. And, after agonizing for a couple of weeks over what reconstruction choice to make, I have just decided on the DIEP flap. I am afraid that an implant in my body would drive me crazy and be "uncomfortable" if that makes sense. I like the idea of having my own tissue placed in my breast even though the initial surgery is more complicated. Has anyone undergone the DIEP and been unhappy with the results? And, why? Does anyone love the results? Has anyone had implants and been miserable and then opted for the DIEP? Any experiences you can share will be so appreciated and helpful! Thanks so much. Be well.

Anonymous

Green, I had the pedical tram flap done, which is similar to the DIEP, but involves stomach muscle and fat, not just fat. I am only three and a half weeks from surgery, but am feeling great. I admit to being a "fast healer",but am very pleased with the results thus far.

GreenGirl1

Steph,

Thank you so much for your response. I am glad to hear that you are recovering so well. Are you having a lot of pain? What is the estimate for your recovery in terms of going back to work and returning to exercise? I had two c-sections when my daughters were born, so I am thinking that the recovery time should be less than with c-section since they are not cutting through the muscle in my case.

Anonymous

I was told here weeks off for work, but I still have one drain. I've been working about 10 hours a week since week two. Haven't really felt like exercising yet, so I haven't asked. I still tire easily, and my body moves a lot, (ie, I'm not a "sitter"), so I'm not really ready for more yet.

GreenGirl1

Wow. That is encouraging. I am sort of dreading telling my boss that I need 4 weeks out of work. I am hoping I can make it back after more like 3 or if I feel up to it, doing work from home after the first couple of weeks. I am not really a sitter either. I start to go stir crazy! But it all depends on my recovery. I am strong and healthy so I expect things to go relatively well.

GreenGirl1

Morning Steph, hope this morning brings you super healing and strength. Do you mind if I ask how old you are? I am about to turn 50 this month and while I do consider myself strong and healthy, if I were 20 years younger, my healing would probably be a faster process. Also, when you say you went back to work after 2 weeks, did you go back to the office or open a laptop at home? Hope you don't mind the questions! I'm just trying to prepare myself for all of this. I do have to say that last night, after making the final decision to do the DIEP, I slept well and feel completely at ease with my decision. I was a wreck for a couple of weeks agonizing over implants .

Anonymous

Green, I am 46. I went back to work on Sunday, June 30, which was 17 days after surgery. I was allowed to work 10 hours, but did have to push my PS a bit to get that. Today is 26 days post-op, and my PS said I could go back full time. I'm really not ready, so he agreed to write my "doctor's note" for 20 hours in the office and additional at home. (I had worked 5 hours yesterday, and it totally did me in. I can't imagine working 8 hours just yet.) I should also mention that I'm about 40-50 pounds overweight. If your weight is closer to ideal, I'm sure you'll do great. If you are more overweight than I am, you'll probably have a harder time.



I'm glad you are at peace with your decision. I think you'll be very happy with the results. Rest well and keep me updated.