Tram flap surgery

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happyhanna
Regular Member


Date Joined Nov 2006
Total Posts : 38
   Posted 11/24/2006 12:02 PM (GMT -7)   
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. confused Thanks

gma
Veteran Member


Date Joined Jul 2003
Total Posts : 2921
   Posted 11/24/2006 7:09 PM (GMT -7)   
Tram flap surgery is serious surgery. It takes time to recover and you have to really take it easy for awhile, but the end result is usually the best. A tummy tuck if you need one is a great asset of the tram. You end up with natural looking breasts and they grow with you as you get older. Trust me I know that. LOL. Just don't expect to come home and do what you did before surgery for a few months. Many of us have had the surgery, so ask away. I did not like the lopsided feel with the prosthesis myself. Possibly one of us is near you and also had the same surgeon. I am in the Fort Worth, TX area, where are you located? Hugs of welcome, Mary K.


babyseeester
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Date Joined Oct 2004
Total Posts : 826
   Posted 11/25/2006 3:55 PM (GMT -7)   
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.
L & H,
Kathy


Brnadebt
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Date Joined Jul 2005
Total Posts : 688
   Posted 11/26/2006 11:51 AM (GMT -7)   
Hi

Iam planning to have mine next month. I took over a year to make this decision, but I feel it is the right one for me. My breast that I had the lumpectomy on is now alot smaller than the other and is deformed looking. I like the idea of using your own tissue because I did not want to have implants. I will also have a lift on my other breast so that it will match better and be alot more perky!

I have wanted to have a tummy tuck for years and this is my way of getting it free. I have had 2 very large children and my stomach was stretched out. I have also had a hysterectomy and so now I have a ledge for the fat to hang over. I will try to post as much as I can after the surgery.

Good luck

Bernadette
 
 


happyhanna
Regular Member


Date Joined Nov 2006
Total Posts : 38
   Posted 11/27/2006 9:33 AM (GMT -7)   

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

 


MNlady13
Veteran Member


Date Joined Jul 2003
Total Posts : 2044
   Posted 11/27/2006 2:45 PM (GMT -7)   
Kim, I can't help you with your questions -- lumpectomy here -- but I encourage you to continue posting. These are good women with lots of practical information. You can't go wrong listening to their advice. Welcome to the board, but sure sorry you have a need to be in a place like this. Hugs, Lauri
"Go confidently into the direction of your dreams. Live the life you always imagined" Thoreau
 
Life is not measured by the number of breaths we take, but by the moments that take our breath away.


happyhanna
Regular Member


Date Joined Nov 2006
Total Posts : 38
   Posted 11/28/2006 4:27 PM (GMT -7)   
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

barkyboys
Veteran Member


Date Joined Jul 2003
Total Posts : 1564
   Posted 11/28/2006 4:39 PM (GMT -7)   
Have you considered doing a mastectomy on the remaining breast and reconstructing both sides at once? I ask that because I have battled back problems after having both muscles taken to build the right side. I don't think this is the case for most people, but please, if you do this, ask for physical therapy afterward to work on core strength and stability so that you avoid problems. The only "repair" for my back involves entry through the sternum and steel rods. My doctors insisted I didn't need physical therapy at the time. At the time I had the Tram flap reconstruction done, and it was a long surgery and a long recovery, surgery on the remaining breast was not an option for me...but that would have been my first choice. And that is what most women, these days, choose to do, I think, if they do the Tram. Just a thought to consider.

I don't share this information to scare you. Whatever choice you make has physical consequences. Wearing a prosthesis can cause back and shoulder problems, having an implant can result in a rupture or a problems with scar tissue...so I want you to know that I am not telling you that this to discourage you from the procedure...just want you to remain as healthy as possible afterwards!!!

After all you have been through, I can't believe that you are ready to undergo an elective surgery! You must be a trooper, my dear! Good luck with the surgery, Kim.

Hope you'll let us know how it goes!

Hugs...
BEV

babyseeester
Veteran Member


Date Joined Oct 2004
Total Posts : 826
   Posted 11/28/2006 7:54 PM (GMT -7)   
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.
L & H,
Kathy


happyhanna
Regular Member


Date Joined Nov 2006
Total Posts : 38
   Posted 11/29/2006 8:39 AM (GMT -7)   

Thanks for all the replies. Bev, I had asked to have a double mastectomy when I had my original surgery. The surgeon and oncologist agreed that that would not be the best option for some reason. I already have problems with my lower back because of small cracks in the bone that goes across the top of my butt. Osteoperosis. So I hope this won't make it worse. I will be getting a lift on the left side. But I will talk to the PS and ask what her thoughts are on that. Is it the "balance" that would make you have back problems now? The way that the muscle "pulls" to that side?

Thanks Kathy for your suggestions and sharing of your experience. I have read several of your posts and find them very interesting and informative. I appreciate the candid answers. We all have to deal with those "bodily functions" so why not address them? :-) My dogs will love your suggestion on walking more. They really love their daily walks around the neighborhood. On your nipple reconstruction, where did they take the skin from to make the areola? Also, did you have them make a nipple that was "at attention" or how does that work? Did you get tatooing too?

Can anyone tell me about the tummy tuck part of it? I had heard that if you have had a hysterectomy (which I have) that you will still have that "ledge". Is that true? I forgot to ask the PS. When is Bernadette supposed to have her surgery? I will be thinking of her and hoping for the best outcome. I also had 2 very large children so have quite a bit of stretched skin to work with along with the ledge. I actually had planned on having a tummy tuck in 1986 but chickened out. Good thing or else I wouldn't be able to do this surgery now when I need it. 

One more question. Does anyone have any suggestions for cording and puckering at the end of the scar in the armpit area? It also itches but is numb so I can't get any relief. It just drives me crazy. Does that even make sense?

Kim


barkyboys
Veteran Member


Date Joined Jul 2003
Total Posts : 1564
   Posted 11/30/2006 4:51 PM (GMT -7)   
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!

babyseeester
Veteran Member


Date Joined Oct 2004
Total Posts : 826
   Posted 11/30/2006 9:42 PM (GMT -7)   
Kim,
 
Yes, the nipple is 'at attention'.  I think that's the only way it can be done.  There is no sensation at all on the entire breast.  I haven't done the tattooing yet.  The PS used the existing skin (the part taken from my tummy).  The PS uses a special technique involving cutting and twisting.  Your question made me look at it again in a different light.  There is a circle incision around the nipple and I'm really not sure why he did that.  I never thought about asking him before now.  The area within that circle would be equivalent to the areola.  As for the tummy area and hysterectomy, I've heard some about previous abdominal surgeries, but not really sure.  I imagine it depends on the location and direction of the previous incision.
 
Bev, I agree about sports bras and not filling out a regular bra the same.  I went bra shopping a few weeks back for the first time and was quite upset when the lady told me I would still need to wear a partial prosthesis!  No way - not after going through what I did.  I actually cried when I left her store.  I finally managed to find a somewhat comfy bra at Frederick's of Hollywood, of all places.  It's pretty, too.  It will take some getting used to.  Now, I think I'll just where it for special occasions.  I actually got the nerve to go to work today without a bra at all!  OMG!!!  It wasn't bad and is soooooooooooooo comfortable.  Good thing it's cold and I have to wear a sweater or coat.  Plus, I work in a small room with 3 other women, so who cares. 
 
 
L & H,
Kathy


babyseeester
Veteran Member


Date Joined Oct 2004
Total Posts : 826
   Posted 11/30/2006 10:33 PM (GMT -7)   
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.
L & H,
Kathy


Brnadebt
Veteran Member


Date Joined Jul 2005
Total Posts : 688
   Posted 12/3/2006 2:23 PM (GMT -7)   
Kim

My surgery has been moved to January because I went to a new PS, the first one I went to I did not like. I will have the mast and then 2 weeks later I will have the tram. My new PS wants to get an approval frommy oncologist before going any further. I know she will be all for itbutI will have to have another mamogram and possibly another CT to make sure that all is well. Im excited to have this done and will keep you posted.

L&H
Bernadette
 
 


happyhanna
Regular Member


Date Joined Nov 2006
Total Posts : 38
   Posted 12/20/2006 1:33 PM (GMT -7)   
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. tongue
Kim

babyseeester
Veteran Member


Date Joined Oct 2004
Total Posts : 826
   Posted 12/20/2006 9:16 PM (GMT -7)   
I can only speak for myself, but the reconstructed breast is wider, I guess is the best way to describe it.  And, it's not as moldable.  It is to a degree, but not like the original.  I started going braless a couple of weeks ago.  I bought some camisoles that are form fitting and wear them under my shirts, just to keep the nipple irritation down.  I have to say, it is extremely comfortable.  I no longer constantly think about my breasts, because they are so comfortable.  So what if they aren't exactly the same.  I don't wear tight fitting clothes anyway.  When I want a little cleavage or to wear something a little sexy, then I'll wear a bra.
L & H,
Kathy

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