Tram flap surgery

I have never written into one of these "chats" before. I am a brand new member that decided to write because I saw your chats about tram flap surgery. I am scheduled for February 7th to have it done. Any advice you can give me would be appreciated. I am very excited not to have to wear the prosthesis anymore, however I am somewhat nervous. It sounds like such an involved surgery. I have talked with someone that has had the same surgery with the same plastic surgeon, so that helped. I would just like some more points of view. Thanks

Hi and welcome.  I am happy to share my experience of Tram Flap surgery.  I had mine in January of this year.  I was off work for 6 1/2 weeks.  It is very painful and for about 3 weeks, you can't stand up straight.  That really bothered my back.  As long as you know that, it is very manageable and worth every ounce of pain (in my opinion).  My surgery took about 7 hours and I was in the hospital for 4 days.  I had 3 drains (always the worst part), one in the breast and 2 in the abdomen.  The breast drain came out in a couple of days, but one of the abdomen drains stayed in almost 2 weeks.  I had virtually no necrosis of the tissue.  My PS said it was the healthiest tram he's seen.  I also spoke with a woman who had the same PS do this surgery and she was very satisfied.  I slept on a wedge for several weeks that kept my upper body at an incline, because you can't lay straight right away.  It helps to also have something under your knees.  With the help of Vicodin and a lot of rest, it was not all that bad.

 

My PS did an amazing job, including the follow up reduction/lift on the other side and nipple reconstruction.  The best thing, I think, is the tummy tuck.  I had quite a belly and it's gone.  My new belly button is so cute!  LOL  I was a D cup before mast and after all the reconstruction surgeries, I'm a C.  The thing I wasn't prepared for, though, was being told I still needed to wear a partial prosthesis when I went to get fitted for a 'regular' bra again.  I refused to believe that.  Not after going through all I did.  After thinking about it and crying a little, I realize I do need a little something, but not a partial prosthesis.  I just need a little filling in at the tip.  I bought 2 pretty bras at Frederick's of Hollywood, believe it or not.  They are full figure, but look nice.  I had to get used to wearing them.  It took a few days. 

 

If you have any other questions, just ask.  I'm here to help in any way I can.  There is another woman (Bernadette) on here who is planning a Tram soon, also.

Thank you for writing in to me. I really appreciate all the information and support that I can get. I had my mastectomy on Nov 17, 2003. I was told that I should wait at least 2 years after my last radiation for reconstruction. I was diagnosed with inflammatory breast cancer on Sept 11, 2003. This wonderful news came after I had returned to work for only a week after having had a stroke on July 24th. (I have recuperated from that with no lasting effects except a bit of pain and numbness in my lower left arm) I found the lump by self examination. It was pretty big and tender and by the shape of it, I thought it was just some infection in a duct. My doc sent me for a mam to double check (thank God) and sure enough, the news was not good. Went back in for another mam, they then took me right in for an ultrasound, then decided to do a biopsy (which was a little risky because I was on coumadin) Had 2 rounds of chemo, my heart started to fail and since my tumor had shrunk considerably with only 2 rounds, they decided that they would do the surgery rather than go ahead with the last dose of A/C chemo. Started back on a different chemo in December. Had a lot of side effects with both kinds of chemo, but with alot of humor, I survived and that is what is important! Finished that in March 2004, then had 6 1/2 weeks of radiation. My last treatment was June 9, 2004. I still have tenderness on my chest wall and armpit area. I too, have given this a lot of thought and decided that the tram (with bonus tummy tuck) and lift on the left side would be the best option for me. She "may" have to take both muscles since I have so much damage and scarring from the surgery and radiation. I sure hope not. The PS that I am going to comes very highly recommended and like I said, I have talked to several of her patients. I didn't even consider implants as I didn't want foreign things in my body. I guess that wouldn't have been an option anyway because of the damage to that area. I considered the DIEP flap but am not really a good candidate for that either as I have a pretty good case of lymphodema in my right arm. I fight that every day. I am kind of nervous but very excited to get on to the next chapter in my life. I live in Boise, Idaho. I am 49 (in a couple of weeks) and single but have a really great support group around me. I am truly blessed in that department.
Thanks for your forum and postings. A lot of information that is very helpful and you all sound so nice, friendly and supportive. It's great to be able to communicate with others that have been to the same party as I have. Even though we wish we hadn't been invited....

Kim

Hi, it's me again. I really don't know where to start with the questions. I guess I'd like to know what anyone else's experience with what to do before the surgery. Like; should I walk alot so that I build up my heart and circulation more? The PS said to "not" lose any weight. Should I continue to eat like I always have? I just want some personal "lay person" perspectives on if I should just kick back and not worry. Go on with my life as before until time for the "boob building bash". I don't want to get all relaxed and think that I am ready if there is some secret thing that "those in the know" feel should be done first. I already have my wedge (as Kathy suggested for sleeping on an incline), I even have a leg wedge for my knees. Got new silky pjs to lounge around in. I have lots of books lined up. Got the insurance all lined up (unfortunately most PS's do not belong to any of the "networks" with the insurances but that is one thing I don't think it would be wise to shop "sales" on -haha) The insurance companies do not realize how involved these surgeries are and don't "allow" much by way of compensation to the PS, so I sure don't blame them. It's just a little more than I had planned on.BUT, I do have the money ready so that I can get on with this. So....I think I'm ready. What do you all think? I keep hearing you all say how painful it is. I have to say that I looked at a website that had actual pictures of the surgery instead of drawings and I had to pause for a second. It really made it real, but I think it was good so that I am prepared for what exactly they will be doing to my body. I can only imagine the pain. I have no doubt that this is what I want to do and it will be great after it heals all up. I'm sorry that I am rambling but once I get started, it just seems to spill. After reading through this I see that I still haven't asked many questions. I just want to share your experiences. My friends are great but can't quite realize the extent of the physical feeling of this experience. Thanks for letting me go on and on.

Kim

My suggestion, as far as how to prepare, is walk to build up your leg muscles.  I found that to be most helpful when getting up (particularly from the toilet).  You need to have strong legs.  You will have to re-learn how to do things (I don't mean to be disgusting, but like wiping!  LOL), because you can't bend and stretch like normal for a while.  My PS keeps telling me that I'm the most educated patient he's had about the procedure I was having.  The more you know about it - the better for you.  I saw the same pictures of the procedure and it was a little scary.  Trust what the PS tells you and definitely follow their advice.  Rest, rest, rest - after the procedure.  It sounds like you are very prepared for that.  Make sure you have someone lined up to take you to follow up appointments.  I wouldn't change how you eat or lose weight, like you said.  Just build up your strength and muscles by walking. 

 

The only complication I had was a small area in the abdominal incision that didn't heal well.  I had a hole that took a while to heal, but I did exactly what the PS told me and it was fine. 

 

If I think of more suggestions, I'll post them.  It sounds like you will do just fine.

Hi, Kim. about the back thing. Yes, the problems I have began with the reconstruction pulling to that side, so it was in the thoracic spine area. I ended up with scoliosis and disc herniations. Because back problems tend to "migrate," the damage later continued into the lumbar/sacral spine. Again, progressive scoliosis and bulging disc problems.

Additionally, you have to remember that the abdominal muscles that they move for a TRAM are the primary support system for the spine. And while my doctors assured me that the obliques would simply take over for the missing muscles, and I guess for some people that is true, it wasn't the case for me.

When I finally found a good spine rehab physical therapist to help me, I learned that when you lose one set of muscles, it's not uncommon for corresponding muscles to shut down as well.

The scoliosis, I will never be able to correct. I think that, had I had the proper physical therapy to begin with, I would have avoided some of these problems.

A friend of mine who had a double TRAM is now going through lower back problems as well from the lack of spinal support.

Again, I don't want you to avoid the surgery, but just talk to you PS and then get the proper follow-up care!

BEV

PS>>>My new nipple started out "at attention," but then flattened out over time, possibly because I prefer sports bras. Even with a "lift" on the other side, they just don't fill bra cups the same way (the "hang" is different).

Biggest benefit of TRAM...I can put on the same old swim suit I wore before cancer and not worry about anything floating out!

Oh, I forgot to address the itching yet numbness issue.  I have that as well.  I'm sure we all have it.  It is very strange, but I don't find it too bad.  It's just weird to itch and not be able to scratch it.  Perfectly  normal.

Bernadette,

It's getting closer to your surgery. How are you feeling about your new PS? I'm getting really excited for my surgery in February but then get scared for a minute or two, then get excited again. You mentioned that you will get the mastectomy and the tram shortly thereafter. Are you still undergoing chemo? If you don't mind me asking, why are they going to do the tram 2 weeks later? I thought that you could have it done at the same time. I was told to wait for my reconstruction because of the radiation. Is there a reason that you have to wait 2 weeks or is that just your choice? Anyway, GOOD LUCK with everything!

That is interesting about not being able to wear a regular bra....I hadn't heard that. Is that because the breast is more "round"? I will have to address that with my PS. But the not wearing a bra at all sounds alot more comfortable anyway.

Kim