Abd swelling after TRAM Flap

When the PS took out my two abdominal drains last Thursday, he told me to expect some swelling as the drains wouldn't be there to remove the excessive drainage.  I noticed that my abdominal area is slightly swelled.  The binder leaves a weave pattern on my stomach & didn't have that with the drains.  If I were in your position, I would call the PS.  Hopefully you'll be okay until you can call Monday.  If you feel there is more than just normal swelling, please don't hesitate to call your dr. over the weekend.  I was told I should wear my binder for 3 months and just had my surgery 4/13.

It can take up to a year or more, so unfortunately, patience is what you'll need.  Avoiding salty foods helps keep the swelling to a minimum.   I was told that wearing a binder for too long may cause your core muscles to become weak from lack of use. 

Hi Sandy,

You can start to do mini-crunches too, but sit-ups aren't the best or only way to build your abdominal strength.  The "girdle" muscles that hold your tummy in encircle your abdomen, and there are a couple of really good exercises for those muscles.  One is planking, where you get on the floor and support your body on your toes and elbows, keeping your body straight and off the floor for as long as you can.  The other is to lay on your back,  put both feet straight up in the air, and keeping your legs straight and toes together, slowly lower them to the floor.  The further down you can go with straight legs, the strong your obliques are, and the trimmer your abdomen will appear.  Too many sit-ups can actually give you a rounder belly.

I still swell if I eat chips, or if I do any sort of work that entails bending over forward, such as working in the yard, scrubbing the floor or washing my car.  Walking and swimming do not seem to cause it.

Massaging helps move the lymph fluid and swelling out, and feels so good!  I used to have lymphatic drainage massages twice a week, and my tummy was noticeably softer immediately after the massage.   The next day, it would feel tight again, but I think that very gradually, the massages really helped.

You can massage your scars with circular movements and rolling, to keep them soft and prevent them from binding.

I seen the PS this morning.  He told me the reason to wear the binder was to keep down the swelling.  He said if I stopped wearing it, I would swell up. 

Just to add to the confusion........I had DIEP in Nov and my PS doesn't have his patients wear a binder at all! After almost 6 months, I still have a very little bit of swelling sometimes but it doesn't get in the way of wearing whatever clothes I want.

Hi Sonya,

Did you see your PS this week yet?  What does he think about with the open wound?  I kept my newly reconstructed breast covered with a thin layer of gauze and then the surgical bra.  I wore it to bed every night, during the day I also wore it.  It was the most comfortable.  I had a 2nd one, but it was a size smaller.

My incisions on my breast were held together with "glue" not stitches.   These held on till my occupational therapist massaged them away a couple weeks ago.   My surgery was 2/25, right after you.

Sandy

Hi Sonya,

I was put off we my PS as well.   I had a DIEP that turned into a Ped. Tram and left the hospital on the 4th day.  My husband helped me more than some of the nurses.

Anyways, after I got home 6 days passed and he never called to see how I was doing.  Even my vet calls and checks on our dog!    On the 6th day I was scheduled to see him and had 3 drains removed, 5 days later he checked me again and removed the 4th and final drain.

After this, it has been 3 week visits (3 - 3/10, 3/31, and 4/20), now I'm seeing him after a 4 1/2 weeks coming up on 5/19).   I don't get much from him, just that I should be patient.  I have swelling issues as well as some tissue firmness with the new breast.  He never suggested an occupational therapist.   I did because I couldn't move my left arm much.   I have a wonderful occupational therapist, I've learned so much from her.   She specializes in lymphedemia(sp?) as well.  So she is familiar with Ped Trams, reconstruction etc.

A surgical bra is one they gave me in the hospital (after my surgery I woke up wearing it), they gave me 2 (one to take home too) as well as 2 surgical binders.   A wonderful nurse did this.  It has velcros in the front.  I couldn't wear a camisole bra or sport bra, too snug even with a size 42 +.   I'm typically a 34B.   I needed to be comfortable and let everything "form" with my new breast.   I think I will still need another surgery.  The nipple area and around is still inverted in and there is still incision work too probably.  Also, possible a lift on the other side.  I had a left max. only.  I was told for every hour you're under anethesia it's a month recovery (I'm not sure how true this is, but it seems like forever to feel myself).

Get a 2nd opinion from the other PS who referred you, more knowledge the better.  Are you dry-packing" the wound?   I am amazed how long it taking for healing, I am seeing good changes especially since I'm seeing this Occ. Therapist.  She is massaging (gently) my new breast.   There is an open window she told me that she could start this, so the tissue is softening.   

You're not over- reacting!  Don't let someone make you feel that way - you need to be your own advocate/vigilante!   I would take care of the wound and get good answers so you're not worried. Your immunion system will be comprised with chemo.   Please take care, good luck, you can PM me any time.

Sandy

It took three months for my incision to heal after my failed TRAM. As for the swelling...it's been a year and a half and my stomach still swells sideways. Yep, that's right. Instead of an "all over" bloat, it's along the top of my stomach. I've been to see another PS to have scar revisions and she said that it's because of the way the previous PS shaped my lower abdomen and stretched the surrounding tissue. Luckily, there's no hernia. I've lost 24 pounds, hoping the bloating would go away, but it hasn't helped...

Linda

Sassie - I ended up with an abdominal hernia as a direct result of the free-tram - it became infected with mrsa in the hospital - the mrsa destroyed my abdominal muscle (which had already been compromised by the removal of a 1 cm "cuff" of muscle when they removed the perforators) - and this is why I have a large bulge. It is not "swelling".........swelling implies a temporary situation. My hernia is permanent - and can only be repaired with opened abdominal surgery to place mrsa-resistant mesh. To answer your question - this problem could occur during ANY abdominal surgery, including Diep......but it is more common with free-trams and pedicle trams. My surgery was 7 hours long and my immune system was already compromised - I had been on antibiotics for 3 days prior to surgery to fight off bronchitis. I showed up in the hospital with a 100.6 fever but the anesthesiologist said "she's good to go" - thus started my down-hill spiral. I blame the anesthesiologist for his cavelier attitude about my overall health........and I blame my surgeons for not speaking up to post-pone this surgery, but I've been told by two malpractice lawyers that my case will never win so I've given up thinking about a law-suit. I went into this surgery with so much confidence - in my doctors - in my own health and ability to heal - and with optimism that I too would get the "added benefit of a tummy tuck". How I wish I could turn back the clock to last year.......to change my attitude........to stop and think how serious this surgery really is........that it is much more involved than a regular cosmetic tummy tuck.........and how I wish I had gone to a more experienced plastic surgeon. Since I can't go back in time..........I use my experience as a warning to other women about to undergo reconstruction to research your surgeons and hospital thoroughly........and to learn more about preventing hospital acquired infections. Check out this web site to educate yourself on the dangers of mrsa and c-diff:

www.hospitalinfection.org