After FLAP Thoughts-DIEP, TRAM SEIA

1. What kind did you have?   BILAT TRAM, IMMEDIATE 

2.  How long for Initial healing? SURGERY WAS 12/11.  BREAST WOUNDS HEALED IN ABOUT A MONTH, BUT THERE IS SOME FAT NECROSIS.  SOME IS DISIPATING, SOME WILL HAVE TO BE REMOVED STAGE 2.  BECAUSE I WILL HAVE RAD ON CA SIDE, EXTRA SKIN/FAT LEFT THERE BECAUSE OF POSSIBLE DAMAGE. I GET SOME PAIN ON THAT SIDE, BUT MOSTLY BECAUSE ELASTIC FROM BRAS OR CAMIS DIGS IN.

HAD SKIN NECROSIS IN BELLY AND THAT TOOK ALMOST 4 MONTHS TO HEAL COMPLETELY... HAD TO HAVE IT DEBRIDED, HAD WOUND VAC AND THEN WET TO DRY DRESSING CHANGES.    WILL STATE THAT I AM OBESE AND THIS WAS MOST LIKELY REASON FOR THIE PROBLEM.  LACK OF BLOOD FLOW TO WOUND.  BUT CONSIDERING I WAS CUT HIP TO HIP AND CAME OUT OF SURGERY ABOUT 15 LBS LIGHTER, MY NECROSIS WAS ONLY 21cm LONG AT ITS' WORST POINT.

3. Was the Pain More Or Less then Expected? NEVER HAD MAJOR SURGERY BEFORE.  MOST OF MY IMMEDIATE PAIN AFTER SURGERY WAS MY ELBOWS FROM BEING HYPER-EXTENDED DURING 9 HOURS OF SURGERY.  REALLY NO SEVERE PAIN, BUT ACHINESS IN BREASTS AND BELLY WAS PHYSICALLY TIRING..  AXILLA NUMB FROM SB, TINGLING/ITCHING IN BREASTS AND MORE THAN ANYTHING MY BELLY FELT 'SUNBURNT' FOR ABOUT 2 MONTHS... SKIN SURFACE VERY SENSATIVE, BUT AGAIN, NOT TRULY PAINFUL.

4. Any Complications?  SEE ABOVE RE BELLY WOUND What? ONE THING THAT WAS/IS A CONCERN.  BECAUSE PS WAS WORRIED ABOUT MESH INFECTING AND ME HAVING TO HAVE ANOTHER SX IF THAT HAPPENNED, COULD NOT START CHEMO LIKE WE HAD PLANNED.  I'M 16 WEEKS OUT AND WON'T BE STARTING UNTIL NEXT WEEK BECAUSE PS DIDN'T CLEAR ME UNTIL WOULD WAS COMPLETELY CLOSED 2 WEEKS AGO, AND IT TOOK THAT LONGO FOR ONCO TO BE ABLE TO MEET WITH ME.  SO LITTLE WORRIED ABOUT WHAT NASTY LITTLE CELLS MAY HAVE BEEN PARTYING IN MY BODY WHILE I WAS HEALING.

5. Did your Surgeon Estimate your finished Size before surgery?  And are you about that size now?  ASKED FOR A FULL C.  WILL PROABLY BE THAT AFTER 2ND STAGE.  LIKE I SAID, HE LEFT EXTRA IN CASE OF DAMAGE/NECROSIS AND LOSS

6.  Before surgery Size & After surgery size (cup) 42DDD LONG BEFORE/ PROBABLY A D BUT HAVEN'T GOTTEN A REAL BRA ON AND DON'T PLAN TO UNTIL AFTER REVISION.  WEARING CAMI'S AND 'STRETCH LEISURE' BRAS FOR NOW..  

7.  Did you have Nipples done?  What kind?  NOT YET, PLAN TO AFTER CHEMO/RADS/REVION

8.  How did you like your Stomach Before Surgery?  OBESE HAD SOME 'APRON' OVERHANG How did you like it about 6 months after...4 MO POST OP IT'S DEFINATELY SMALLER.  IT WAS FLATTER IMMEDIATELY AFTER SURGERY BUT HARD AS A ROCK. I'M GETTING SOME MOVEMENT BACK NOW AND IT'S SOFTENING, BUT STILL DEFINATELY SMALLER, NO OVERHANG AND STRETCH MARKS ARE GONE.

 How much do you like it now? SEE ABOVE

9.  Did you sleep in your bed, Hospital bed Or Recliner? MY BED WITH WEDGE FOR 2 MONTHS, COULD FINALLY SLEEP ON SIDE AFTER 3.5, BUT STILL CAN'T SLEEP ON STOMACH, BUT I CAN LAY ON IT NOW FOR A LITTLE WHILE

Added Questions: 

10.  How Long Was Your Hospital Stay? 6 DAYS

11. Did you have any Complications? I DID HAVE SOME BLOOD LOSS AND WAS TRANSFUSED DURING SURGERY AND AGAIN 2 DAYS AFTER  What? 

Anything Else you would like to Add?THIS IS A BIG SURGERY, AND I HAPPENDED TO BE THE LARGEST PATIENT MY PS HAS HAD TO THIS POINT.  DESPITE MY COMPLICATIONS I'M GLAD I DID THIS.  I AM HAVING SOME TUMMY SPASM WHEN I DO A LOT OF WALKING BUT FEEL STRONG AND HAVE MOST OF MY RANGE OF MOTION BACK AT THIS POINT.  JUST BE PREPARED TO FEEL LIKE YOU WERE HIT BY A TRUCK THE FIRST MONTH....NEVER HAVING SURGERY BEFORE, I WASN'T PREPARED TO BE AS TIRED/WEAK AS I WAS AT FIRST.   IF YOU WANT MORE INFO, YOU CAN CHECK MY WEBSITE ON MY PROFILE.  IT'S MORE OF MY EMOTIONAL DEALINGS WITH MY CANCER AND PROCEDURES.

Dejaboo, I am paying close attention to this thread, thanks so much for starting it.  I have big decisions to make as well.

Yummy - your plastic surgeon was ok with performing the TRAM even with the knowledge that radiation would be needed later?  Or was that a decision that was made post-surgery? I saw a ps last week who won't do any sort of immediate reconstruction if radiation is going to follow.

M - I am at Dana Farber.  I liked the plastic surgeon I met with last week (affiliated with Brigham and Women's) but I may get a 2nd opinion from a plastic surgeon at BI.  We are lucky to have so many great options nearby.

Did anyone get either a TRAM or DIEP prior to radiation?  That is my big question since I really, really want to have immediate reconstruction.  Thanks!

Dejaboo,

I won't add answers about my DIEP (all went well without complications), but I will say my PS told my husband he had two choices during my 5+ hour surgery:

1.  Sit in waiting room and go nuts, or

2.  Go to mall, or find a bookstore and come back in a few hours.

My husband opted for #2, and was grateful for the suggestion as he fully intended to sit in the waiting room and probably go nuts!  He was back in plenty of time, and I knew nothing about his absence until he told me.  Good for all of us!

Good thread - interesting reading.

Pat

Lorena B....my ps would not reconstruct until after rads.

Pam, There are plenty of implant chicks on this board.  I have to admit that many who helped me (and apparently aren't having any problems) have moved on and don't 'do' the board anymore.  I responded to your lat flap/implant post.  Best wishes

This is a great thread.  Everyone's experiences are so different I find it truly amazing.

Have to say I'm only just over the surgery and nowhere near finished but I'll fill in whatever blanks I can. 

1. What kind did you have?    Unilateral

Delayed Or Immediate?  Well, I had immediate expander last March, then implant in August, but had a free TRAM on March 27 this year because I was not satisfied with the implant.

2.  How long for Initial healing?  How long has it Been total?

3. Was the Pain More Or Less then Expected?

Zero pain in chest or abdomen, not one hit of pain meds, not even Tylenol.

4. Any Complications?   What?  Hematoma that had to be surgically evacuated on hospital day 4.  My flap was in very precarious position and its survival was in doubt so they wanted to do everything they could.  Luckily, it's now been two weeks and all seems healing nicely except the whole foob is very hard.  Color and temp good with good arterial and venous doppler signals.

5. Did your Surgeon Estimate your finished Size before surgery?  And are you about that size now?   My foob is huge, partly because of the swelling and hardness.  Much will have to be remove at stage 2.

6.  Before surgery Size & After surgery size (cup)

7.  Did you have Nipples done?  What kind?  

8.  How did you like your Stomach Before Surgery?   How did you like it about 6 months after...

 How much do you like it now?   My tummy was a bit poochy, not bad.  Just enough for one smallish foob.   Since I have not had any swelling to speak of at the stomach incision site, I LOVE LOVE LOVE my flat belly! 

9.  Did you sleep in your bed, Hospital bed Or Recliner?  I was in the hospital for seven day, what with the two surgeries and the dicey situation, but was sleeping almost flat from day 2.  Very little pulling.  Once I got home, I tried the bed wedge pillow I had bought in preparation but found it uncomfortable and just went to two down pillows under my head the second night home, then down to one pillow.  I sleep on my back with brief turns to my good side.  I'm very comfortable.

Added Questions: 

10.  How Long Was Your Hospital Stay?  7 days for above reasons

11. Did you have any Complications?  What? I did lose a lot of blood but they wanted to avoid transfusing me.  I've been okay and have ordered some of my favorite iron compound preparation, Floradix, to help build myself up.  The Floradix is great because it does NOT CONSTIPATE like iron tabs (Feosol, etc.)

Anything Else you would like to Add?  My surgery was estimated to be about 8 hours but it turned into 11.  I had sent my husband home for the duration and he was getting panicky.  Finally, he got the call. He did drive in to see me in the PAC U, where I spent two nights, but it was a waste as I was not seeing straight, if you know what I mean. LOL  Lovely experience.  Felt nauseated for almost two whole days and could not drink anything except water.  FWIW, make sure you will be able to get drinks that are not sweet because if you are like me, anything sweet on a sick stomach will turn it even more.  I found plain seltzer water to be perfect.

Good luck to all.

Tina

I am having my TRAM in less than two weeks and I am trying to read through everyone's comments. I have a question about number 9 - is the recliner or hospital bed more comfortable once you are home?  Do you need it because the position is easier to sleep in or because it is easier to get out of bed/chair if it reclines up/down?  I have an adjustable type bed - not really a hospital bed - in one of my kid's rooms and I was debating whether to swap beds with her or buy a new recliner since I don't have one. Has the recliner been more comfortable later on in the recovery? 

I recently heard a suggestion to use a chaise lounge - the backyard type - if you don't have a recliner.  Especially the soft kind where the recliner is 'activated' by using your feet and no arms or tummy.  It's cheaper and you can use it this summer to relax in outside.  It's a thought. 

I used a recliner and found it quite comfortable with a fitted sheet on it and all my blankets and stuff.  But it is lever-activated and the lever was on the wrong side so that was a major hassle.  I actually had to learn to climb out and back in with the footrest up.  That was a sight, I'm sure.

I haven't had my surgery yet...4 days to go...Tuesday April 15 bilateral DIEP.

To answer the question concerning loved ones...I told my husband to go to work. This way he can keep busy instead of worrying. I have asked the nurse to call him about 1 hour before he can see me. This will give him time to shower and get to the hospital. No reason to hang out for hours doing nothing but wait and worry. I would much rather he use, what will be holiday days, at home when I will need him most. While in hospital the nurses and my doctor will take good care of me I'm sure.   

As for other loved ones (except my children) I have asked them to come to the hospital no earlier than day 3 (Day 1 surgery, Day 2 recovering, Day 3 come and visit) or just wait till I get home where all can be much more comfortable. I won't charge them exuberant amounts for parking and coffee either.

Hugggs

Dorathy

Hi Dejaboo - I hope you WILL get a second opinion about the Diep, it has to be so hard for you to switch gears and get info on the other procedures!

For what it's worth at this point in time, here's my answers to your original questions:

1. What kind did you have?   

Unilateral Or Bilateral?  Mine was unilateral (right side.)

Delayed Or Immediate? Immediate.

How long of a Delay if delayed?

2.  How long for Initial healing?  Still healing, 6 weeks later. How long has it Been total?  I'm still not totally healed - my surgery took place on March 3, 2008 - my stomach incision is still open and draining, unfortunately.

3. Was the Pain More Or Less then Expected? MUCH more! I had 3 c-sections (last one 15 years ago) and went in thinking that the "tummy-tuck" portion of the Diep would be easier - I was soooo wrong!

4. Any Complications? Yes.  What? Abdominal staph infection and gallbladder attack - then later, my abdominal incision opened. Also, swelling in my Diep breast - and cording up my right arm, preventing full motion.

5. Did your Surgeon Estimate your finished Size before surgery? We discussed it and I told him no later than a B cup. And are you about that size now?  No - it's much larger than I expected - not in the front but on the side under my arm. I'm told it's swelling and it'll go down, but somehow I doubt it. Hopefully by Stage 2, with nipple reconstruction, the PS will be able to remove some of the extra fat.

6.  Before surgery Size & After surgery size (cup) Before - 40B; After - 42 C/D (not sure, can't find a bra to fit comfortably right now.)

7.  Did you have Nipples done?  Not yet.

8.  How did you like your Stomach Before Surgery? It was ok, but too soft and fat, although I never had any stretch marks.  How did you like it about 6 months after...I'm only 6 weeks finished, so I can't comment......my abdominal incision is still open and oozing, very gross to look at! My stomach muscles still spasm and I have a lot of pain if I stand or walk too much.

 How much do you like it now?

9.  Did you sleep in your bed, Hospital bed Or Recliner? 

Added Questions: Recliner for the first two weeks.....my own bed with a lot of pillows after that.

10.  How Long Was Your Hospital Stay? My initial stay was 5 days - readmitted to ER for staph infection, stayed 11 days.

11. Did you have any Complications?  What? Staph infection and gallbladder problems (latter still not resolved.) Also I needed two blood transfusions in the hospital probably due to the antibiotics doing a number on my red blood cell count.

Anything Else you would like to Add? Leave yourself a LOT of time to recuperate from any TRAM flap surgeries......the risk of infection is much higher than other surgeries because of the time under anesthesia (I was in surgery for 7 hours.) You'll need a LOT of help once you get home - you need to keep your hands scrupulously clean while "milking" your drains.......it's recommended to shower two days in a row before your surgery with Dial antibacterial soap (not that it prevented MY staph infection!) Also, discuss with your surgeon how soon after surgery you can start exercising your arms to reduce the risk of scar tissue and cording.  Good luck and God bless!

Wow Abby............you've been through so much! I know how you feel about your tight stomach - mine is that way, and it has muscle spasms, but I'm not exactly a "thin" person, so I'm hoping it'll eventually stretch out. So many ladies have said things really improve after 1 year, so I'll be praying that'll be YOUR story in another 5 months.