Trans Flap - Breast Reconstruction

Hi Terriegolf:  I think you mean a tram flap procedure.  There is a side effect which causes the stomach to be "lumpy", but I can't remember the name of it (chemopause!) and I can't find my information.  When I do find it I will post it, but I know other ladies will know about it. 

Yes, I had a TRAMflap recon. My stomach is tender to the touch, and bloated at times. Water exercise helps relieve the swelling. Mine has been diagnosed as truncal LE. I have it in my reconstructed breast also.



You might investigate the possibility of Lymphedema. There's a site here with lots of info.



Perhaps ask for a referral to a certified Lymphedema specialist to rule out the Lymphedema.



I had my surgery in Mar 2005. diagnosed w/LE a month later. Was previously diagnosed with breast LE in Nov 2004--6 months after lumpectomy, radiation & SNB.



Don't be afraid to ask for the referral. There's much that can be done if it is LE, and if it isn't then you can explore other reasons. I think PS don't worry to much about the bloating because it often takes care of itself. I think PS look at what they can do to correct the surgery with more surgery. If it is LE, more surgery won't fix the problem. And I don't think a diet is the answer either.



I wish you luck, and please check our the LE thread on this board.



grace

If you are going for a muscle-sparing free tram or DIEP, you should be very happy in the end.  These surgeries have surpassed the old trans flap where the entire muscle is moved up to the breast.  Have you checked out breastreconstruction.org ?  There is a lot of information on there that might help you.

I had a MS Free Tram last January and really like the look of that breast.  Are you doing bilateral this time?

There is a longer recovery time with the flap surgeries as they involve micro surgery under the arm.  My doctor said 6-8 weeks.  You might feel pretty good after 3 weeks or so but there are serious lifting restrictions for the first month to two months.  Like nothing over 5-8 lbs.  The host area will also have to be dealt with - the incision, etc.  You will have drains in both areas for at least 1 week and probably more like 2 weeks.  There is more scarring to the body with flap surgeries and that is a down side.  Mine are fading slowly but I can see the future and it might not be too bad. 

Good luck with your research.  I don't think you can do too much.  Eventually, your gut will take over and you will just know what is right for you.

Kathy 

I had one side done with a ms free tram and the other side was an implant using the one-step procedure.  I must say, the one-step implant was a piece of cake to recover from - only about 3 weeks.  The tram was a good 6 weeks.  The flap side is softer looking, however, without clothing.  In clothing you can't tell which is which.

Where is this class you are going to, Jodi?

I bumped up a thread of positive tram results for those of you asking...

Hi I had my left breast removed from cancer a year ago, this last January I had a trans flap done.

I have had no problem with the breast, however, my stomach is sore to touch and sticks out.  They think that I have a hernia and I am going to have a test on Monday.  If I wear the girdle that they gave me when I had the operation I am more comfortable, but if I take it off I feel like holding my stomach and then I have uncomfortable pain.  The big problem is the buldge.  I thought I was getting a tummy tuck and I am very thin but I look like I am 4 or 5 month preg around the incision and a little above

Hi Swim -

Sorry to hear all that you have been thru.  When are you having your Stage 2 surgery?

 My original recon left me with one breast larger and lower than the other, but the Stage 2 resulted in much better symmetry.  In fact, what my ps did was a lift to my tram side.  I don't know if you have the elliptecal shaped flap? They used to leave that to tell if the flap was surviving--i have heard that that is not necessarily always true anymore.  Anyway, he said by stage 2, we no longer needed it, so he lifted my breast and basically closed up that flap!! My end result was that people are amazed that it isn't original!

I was surprised to hear the stats about c-sections....I had 2 and noone mentioned that as being a risk factor.  Maybe it depends on how long prior it was?  My most recent c was 13 years prior.

Hang in there!!! Do the Stage 2!!!! It can REALLY make a world of difference and the pain is NO BIG DEAL compared to what you have been thru!!!

Thanks Moonie and Summer.........it was good to hear from both of you, you gave me a lift today! Moonie.......the study that discovered the 24% increase in abdominal donor site complications can be found at this link (it doesn't mention how long ago the surgeries took place; my last c-section was 15 years ago):

http://www.ncbi.nlm.nih.gov/pubmed/18453974

Moonie - my flap does appear to be an elliptical shape - much of it is under my arm. My Stage 2 surgery must wait until next summer because my PS wants me to be finished with the Herceptin. So I live with a lopsided body - my right foob and right abdomen are both too big, but the appearance doesn't bother me as much as the pain I experience now and then - on the abdominal side, there's pain if I walk too far - and on my foob, I feel pain because the weight of the foob is more than I'm accustomed, and if I don't wear a heavy support sports bra, it feels "dragged down". So I'm really looking forward to next summer. In the meantime, it's back to Weight Watchers for me ASAP - and back to swimming a mile 4x a week as soon as my PS gives me the OK (I'm hoping he'll say yes this coming Monday!)

My PS said he'll do lipo on the foob to reduce it's size and he'll also put in a mesh in my stomach to reduce the bulge. I don't know if he can totally eliminate the fat underneath my arm though - I'm not sure where he attached the perforators. I had a skin-sparing mastectomy followed by a muscle-sparing free tram (it started out as a Diep but somewhere along the way, it didn't end up that way.) So I have a "circle" where my nipple/areola used to be and an incision under my arm from the SLN dissection - that's it for the foob scars. I'm not sure what plan of attack my PS will use to reshape the breast - right now it's a bit flat in front where the circle is - and too big under my arm. Also it needs a lift - it's much lower than my other side. I'll be talking to him more about what he'll be doing - and asking him to show me photos of good outcomes. If I don't like the results he shows me, I may end up switching to a different PS but I hope it doesn't come to that because I do like my PS - he's been very honest and kind to me since the very beginning.

Summer I hope you won't need any abdominal repairs.........how are you feeling? How is your new foob healing? Even though I was so unhappy with my abdomen, it DID heal and I never had one problem with the foob healing, so that's a blessing! So many of us have been through so many difficulties..........it's good to share stories to know we aren't alone on this long scary journey!

I am scheduled for a tran flap 9/10/08.  I had lumpectomy in 95 rad. and chemo. I am scared an would like some feed back as to how the abd. feels when they take some 20% of my muscle. Is the other side strong to hold up our spine as we get older?  I do not have a great back!

Funny you should mention considering a transflap because I am soooo disapointed in mine that I wish I had asked for inplants instead. I have hugh lumps and pain.DOn't do it !!!!

I just wanted to let people know my sisters experience with this surgery.  DO NOT, I repeat DO NOT have this surgery if you have diabetes or anything that would prevent you from healing right.  My sister had this surgery after the Dr. was told that she had severe diabetes and he said that everything would be ok.  And being concerned she asked again and again he said everything would be fine.  So she went thru this surgery and now is deformed in her tummy area and breast area (one being bigger than the other).  I even saw a news report for our area of 2 women who had the same procedure and had even worse scarring than my sister.  My sister was put into icu.  We are lucky we still have her.  The Dr still has his job.  The sleezy bastard.  When my sister came home we had to doctor her wound which was a gaping hole in her gut.  It was like she had surgery and they didn't sew her back together because of her diabetes which meant the wound had to heal from the inside out.  I just couldn't believe they sent her home that way.  Luckily we take care of our family .... doctoring her everyday and she healed best as she could considering.

I had a left side skin sparing mastectomy in 3/01, I had 33 radiation treatments on that side as well. My PS had me wait one year before she would do the reconstructive surgery. In 7/02 I had a Tram Flap with no complications and was back at work in 5 wks. I spent one wk in the hospital and the rest of the time at home. My new boob looks pretty good naked and great in a good bra & clothing. The down side has been back pain from the removal of part of my abdominal muscle for the new boob. The back pain did not start until a couple of years after surgery. I think the tram is a good option for some women. (((Hugs))) Karen  PS I was age 42 when I had the surgery and age 52 now.

Hi Cherrie, I had DCIS and had lumpectomy w/rads in 2001. Recurrence in 2010 so had BMX with expanders. The radiated side eventually failed and now I am also researching my options. My PS is telling me my best chance of positive outcome is a pedicled TRAM flap which many people advise against. So I understand where you're at...I have been going back through all these threads (looks like you have too) and what I have discovered is all procedures have some chance of problems. I have decided the key in my decision is to make sure I have a good PS who I trust, do my research, and then go for it. I agree these threads can scare the H out of you but a lot of times it is people who have had problems that are here looking for support, I know when things were going good for me I was not here posting, I was out living my life! Good luck in your decision. PS - I'm 57 too.

A lot of wonderful women showed me their reconstructions. As a result I wanted to remove the other breast (after L breast mastectomy and nose removal in 2003) and have implants. Nearly all the women who I saw who had done this looked great, felt great and did not feel anxious about recurrence. The best looking was a french saline implant, but the woman was the most upset because she had metal ports (!) and one of the impants leaked. However I never saw a tram flap.  I was compleetly freaked out from losing a breast and kept seeking reconstruction two years afyer mastectomy, but was told I had TO WAIT.  This completely did my head in. I never knew you could insist on reconstruction at the same time as the mastectomy. I also never knew how long you had to wait before reconstruction if you didnt insist.  I went to plastic surgeon by myself (not referred) because I couldnt stand it any longer to be without a breast...well as you will all know its just to awful for words and as for the prosthetics....  Anyway I let the plastic surgeon persuade me to have a tram flap. This was HUGE mistake. It completely altered my body shape. None of my clothes fit and I dont know how to dress for this body shape.  I am always bloated. I have lost feeling over a very large part of my torso (almost the entire left side). I have lymphadoema as a result of the surgery. I have to wear size 20 tops to fit my L arm in (I am not that big, the other arm fits into a 12/ 14) I hate the way I look. If I gain or lose weight the reconstructed breast gets fat or thin (its NEVER the same size as the other one). I have problems with the net they put in place for gthe stomach muscles they removed for the flap. Apparently I am lucky - I know a couple fo women who have had to go into hospital due to problems with gthe net.  My advice is .. if you can have impants and have it all done at once.

If you can avoid the TRAMflap and have the DIEP instead you would be avoiding the possible complication of developing a hernia in the future. DIEPflap uses the same tummy fat as the TRAMflap without using part of the six pack muscle. TRAMflap is "old school" surgical technique still being used today but DIEP, SGAP and other methods are considered the "gold standard" check out DIEPFLAP 2011 and NOLA threads for info from stories of women who have been through those newer procedures.