UNIV. OF PENNA. - RECONSTRUCTION ANYONE?

I had my bilateral mastectomy and immediate reconstruction at the University of Penn.  Dr. Liza Wu there is my ps and she is great.  Are you going there and who is doing your surgery?

The MS Free Tram (Muscle-Sparing Free Tram, or MS2) is an abdominal flap (or flaps) that is supported (vascularly) by a small cuff of muscle.

Muscle tends to be more active than fat, so it tends to have a robust blood supply.

In the procedure, the microsurgeon takes a credit card sized sliver of muscle off of the rectus abdominis.  Then, the flap is reconnected to the blood supply in your chest.  (It's kind of like the process you'd have to go through to connect your foot to your forehead.)

The way it "works" is similar to the way that amputated limbs can be "saved."  The vessels are reattached and circulated.

If you need two flaps, the surgeon cuts your abdominal skin and tissue in half.  If you need one flap, the other half is discarded.

There is a small risk of hernia, so sometimes surgeons insert a little mesh to support the abdominal wall.

The typical recovery from this surgery is 6 weeks.

Immediately following the surgery, it will be difficult for you to get out of bed by yourself.  The nurses will show you how to lever yourself up.

I had MS Free Trams in October 2007.

I am very pleased with my results.

A very good website:

http://www.breastreconstruction.org/

In the personal stories section, there are pictures of each type of procedure.

Tammy Lou

Tammy Lou,  thanks for posting that link.   I can't believe my body experienced that!  Wow!

Nancy,

I was in the hospital for four days. I went home with five of the six drains that I had.  But I was lucky in that four got removed after one week.  And the last one in two weeks.  My recovery so far is going pretty well.  I have my six week visit with the PS next Monday. I'm hopingto have the nipples done next month, but it may have to get pushed back because some of the skin was affected by the dye they injected for the SNB and it hasn't heal completely.  I was suppose to see Dr. Borsas initiately but she was booked so I went with the other breast surgeon. I had diep in one breast a tram flap in the other.  She had to take a very small amount of the muscle out.  Both were skin sparing.  My stomach is really tight right now. I'm hoping that looses up in time.  It's such a strange feeling.  The pain wasn't too pain.  I took the pain meds for a couple of weeks.  The worst part for me was trying to sleep.  I had to sleep in a chair a few nights.  I didn't have a reclinder, but one of my friends brought other their glidder rocking chair and I was so thankful to get it.   Dr. Wu was wonderful.  She's a great PS.  Wonderful bedside manner.

Nancy, the Breastreconstruction.org site has a section that describes the different types of recon. the free flap showes the DIEP surgery.

Sheila

Hi Nancy,

As Felix mentioned I as had Dr. Wu for my surgery and she had to take a small amount of muscle for the right breast.  When I read my discharge papers it stated diep was done on left and tram flap on right.  I guess that is because she had to use some ab muscle on the right breast.  And just like Felix my left breast is a little larger than the right but she is going to fix that during the second surgery.  I won't be having that until the end of May.  I have children but they are all grown up now.  My youngest is attending college at Drexel and was able to come home and help me during the first week of recovery.  If it wasn't for her and my best girlfriend I couldn't have made it through.  It was really tough but I believe it's worth it already.  I know after the second surgery things will look better. 

Hey I have a question for Felix.  Did you have the nipples and areola done the same day.  Dr. Wu mentioned she would be doing the origami technique.  Is this what you had?  Where the aerola's tattoed. I forgot to ask her about that. 

Does anyone know the recovery time for the nipple and areola reconstuction? (i.e... out of work a day.. a week or?? Thanks!!

Marie,

My rt mast was done Nov 07 and my exchange 5/08.  I had my nipple done in Oct 08 as part of other revisions.  So I was actually under general anesthesia.  Went in on Friday, took Monday off from work (have a desk job) and returned on Tuesday.  I don't even think there was a name for the procedure...she just took the existing skin on the breast, twisted it and stitched.  The worst was the goofy bandage to protect it.  And it was absolutely huge!   My tattoo was done in her office, took about 45 minutes... a lot of the time spent trying to get the perfect shade to match my existing side.  Then drove myself home and was at work the next day. The nip and tattoo was by far the easiest part of my reconstruction...and turned out great.  Really draws the eye away from the scars.There are some women on this site that had 3D tattoos done.  I would have considered that but I was trying to match my exisiting side.  Phyllis

Nancyluvspink...

I can understand your apprehension... I have not set up my appt as yet... The idea of it being awake.. hmmm I can relate... but as I do not have any feeling in that breast, I suspect I will not feel a thing.. Wishing you all the best.

I am scheduled to have a diep flap on may 21 with Dr. Wu. How long was your recovery and hospital stay. Also how did she do you nipple reconstruction and areola?

Good morning Sohardbnme - I had me stage 2 in early February at Penn (SrugiCenter/Perelman).  It was a piece of cake compared to first go round!  Mine was scheduled for 7am, so I was at the center by 6.  I was home by noon and ready to eat lunch.  The recovery was easy.  My PS (Dr Kovach) does this procedure on Fridays. I was back to work (teaching) on Monday.  I had my nipples done and dog ears fixed.  Dr Kovach also did some light lipo around the dog ear site.  I came home with a surgical bra and bandaged nipples, both of which had to remain in place for 48 hours.  I also had a binder that I had to wear until my followup appointment.  The binder was removed for showering etc.  I will probably finish with tattoos later this summer.  HUP has a person who does tatooing in the plastic surgery department.

I found the overall experience to be very doable.  I was back doing normal things, other than lifting, in a day or so. The Perelman Center Surgicenter is very comfortable and the staff were wonderful.  I particularly enjoyed the receptionist that checked me in.  She is quite a character.

Pm me if you have specific questions.  I leave for work soon, but will respond later this evening.

Good luck!  Let me know how everything goes!

My dog ears were more annoying than large.  They stuck out funny!  Not very nice looking.  Dr Kovack removed the extra flesh and lipoed around the revision area and around my hips.  I don't notice a great difference just a subtle improvement.  There was a lot of bruising afterwards which tylenol took care of. The scars are about 5 inches on both sides.

The nipples are origami nipples.  They look good but I was warned that they will flatten over time.  I'm not too worried as I didn't want permanent 'high beams' anyway.  I will get tattooed this summer.

I've heard great things about Dr Wu!  You are in good hands.  Hopefully you will be home by dinner.  Do you have off for the rest of the week?  You might be sore for a few days.

Well, I'll be thinking of you.  Good luck!

Janet

The dog ears are totally gone, so that's not a concern anymore.  I have a lot of weight to loose (30-40lbs), so I'm not ready for form fitting yet.  However, the lipo gave me some shape, which is good.  The rest of the fat I have to loose through diet and exercise.  I guess what I was trying to imply is that even after going through liposuction, I still have a layer of fat around my hips and stomach that I have to put some effort into loosing. I'm afraid that loosing weight will shrink my flaps, so I've avoided the whole diet thing. I'm sort of caught in this catch 22, I need to loose weight, but loosing weight might shrink my flaps.

Try to relax.  This procedure is easy compared to the DIEP procedure.  There is minimal, limited pain afterwards and you will be surprised how nice the nipple looks once finished.  Hopefully you won't have to wait long once you get to Penn and before you know it, it will be over!