Bilateral Pedicle Tram vs Silicon Implants
Comments
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I had breast cancer, had dble masectomy due to gene BRC2. Now having reconstruction 1 yr later. I can't have DIEP due to TTP (blood clotting) work with blood vessels a problem. I have been suggested to do bilateral pedicle tram. But, also maybe silicon implants. Surgeon suggests pedicle tram more.
Can anyone tell me what they went through? I also have fibromyalgia. Am due to decide soon so surgery can be this fall.
Thanks
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I didn't have the pedicle TRAM- I had a free TRAM and only unilateral, but my expereince- it is a hell of a surgery with a long recovery.
I didn't want to have implants so I went the tissue flap route. If you are not opposed to implants alone, you might consider that , but I know having TE's is painful and uncomfortable and the fill process hurts from what I've read.whereas with the TRAM, you have surgery and a long recovery.
you might ask your surgeon why he suggests the TRAM over the implants.
I could not walk for a few weeks after the TRAM and I could not do very much with the arm on that side- I remember thinking I could not imagine having both sides done. My mom has fibromyalgia, so I have some idea of what that's like.
18 months after surgery I still have tightness in my abdomen from the TRAM. I often wonder if my PS was overzealous with the tummy tuck. I also developed mild truncal LE from TRAM scar tissue in my armpit.I did have radiation on the TRAM (not reccomended) tho.
I see that you are new to the site, once you have been here a bit, you can request access to another private site that has pictures women have posted of various surgeries. send member Timtam a private message for access. I am not sure how long you have to be a member for access, but to keep looky-loo's out you have to be here a bit.
personally I think better results are possible with the TRAM and you would have the pain all at once , whereas the implant route seems to involve a lower level of pain over a longer period. Having fibromyalgia you might take that into account.
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bcp1975- I would seek a 2nd opinion.
The bilateral pedicled TRAM is a surgery that leaves women with a lot of disability post op. They basically take your whole rectus muscle (the one that forms the "six pack" abdomen) on both sides and tunnel it up through the front of your stomach/chest into your breasts. The upside: you have more natural feeling/looking breasts (as you would with any flap reconstruction.) The downside: you are at extreme risk for hernias, abdominal pain, constant "pregnancy" appearing look with bulging abdomen and back pain from inadequate truncal support in the abdomen. And frankly, with TTP (I am in the medical field), you might run into problems anyway even with a pedicled TRAM (or any surgery.)
Do you have a hematologist at a major academic medical center? I would consult with a hematologist and a second PS. Saline or silicone implants are not a cakewalk I have heard either - there is a 50% failure rate of implant based reconstruction at 10 years and you would have to have multiple fills and then implant exchange.
I would seek the opinion of a 2nd PS at least, if not a 3rd PS as well as a hematologist to really determine what your peri-operative risks are. Do you have an internist or primary care doc who can quarterback some of this for you?
I had a free TRAM done and although I wish I had chosen a more experienced surgeon to start with I am happy with the fact that I did it and I know it will turn out pretty well. But it sure would have been nice to get the DIEP and not have lost any tummy muscle. Just my 2cents though...
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Hi, Thanks for your into. How do I get in touch with the people you mentioned in your reply for their opinion or some pics of these procedures. I am going back to original surgeon in a few weeks (he did original lumpectomy) to go over what surgeon wants to do. I am unsure what to do now (after waiting a year, I thought I was ready and knew what to do) now I don't know what to do. The surgeon is from a major hospital (where I was with my TTP,so my previous records are easy to find on record).
bcp1975
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Alyad: When you said you had free TRAM, did it involve using the tummy muscle, or any part of it? I ask because I am to undergo the DIEP surgery (uses only tissue & fat - no muscle). I really want to know or hear from anyone what their recovery was from the DIEP, whether unilateral or just one side..... thanks girls !
Shelly
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Shelly,
I beleive what I had is considered unilateral immediate muscle sparing Free TRAM- they took a 2 cm square of muscle around the vein and used the alloderm mesh to hold that void together? I wish I had had the DIEP instead but there wasn't anyone locally who did it- now that I know more I wish I had looked into expanding my search outside my immediate area. 19 months after surgery I still have a lot of abdominal tightness but fwiw I can do sit ups and I did go on a long distance backpacking trip this year and I can climb up and down hills no problem as long as I am wearing the backpack with hipbelt which provides abdominal support much like a back support belt. What I can't do is say climb up on a bunk bed or really large steps. It seems like its more a range of motion problem.
Recovery wise- I was very tight and could not stand up straight for a few weeks. i walked hunched over and it killed my lower back cause it was having to hold up my whole torso. I still have issues sitting w/o back support for very long- kills my lower back. After surgery I slept in a recliner for a week or so then moved to the bed with a lot of pillows supporting me. I have tightness more on the surgery side. I can lay on that side, but have to ease into the position more carefully than on the other "good" side.
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