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Topic: Trans Flap - Breast Reconstruction

Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.

Posted on: Oct 11, 2007 06:18PM, edited Oct 11, 2007 06:18PM by terrigolf

terrigolf wrote:

I had a mastectomy one and a half years ago.  I had reconstruction done by the trans flap - mostly because I was told that I would get a tummy tuck out of the operation.  Well - I "didn't" get a tummy tuck and my stomach has been messed up ever since.  The reconstructive plastic surgeon has never been too concerned about it.  My stomach is tender to the touch and seems to be bloated - maybe if I go on a diet it won't be bloated but my breast surgeon did a mamogram and said it was not filled with water.  Anyway - has anyone else had this experience with the trans flap procedure - it is so discouraging!!   Thanks.

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Oct 13, 2007 01:22AM 2curvy wrote:

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. 

Dx 3/6/2007, IDC, 1cm, Stage IIIb, Grade 3, 0/7 nodes, ER-/PR-, HER2-
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Oct 13, 2007 02:02AM 2curvy wrote:

It may be called a hernia, but I know nothing about it!

Dx 3/6/2007, IDC, 1cm, Stage IIIb, Grade 3, 0/7 nodes, ER-/PR-, HER2-
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Oct 13, 2007 10:24PM sccruiser wrote:

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

One must still have chaos in oneself to give birth to a dancing star

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May 18, 2008 01:35PM sampson wrote:

Hi, I'm new to the board, and am going to have breast reconstruction surgery again. I had cancer 15 years ago and had a saline implant put in. Had never been happy with it as it was too firm to begin with, but thought I'd get used to it. Well in the last five years it has shifted, and raised up so much I feel like a freak, kind of like a Picasso painting. You have to be very aware of what kind of tops you can wear, so as not to be too lopsided.Well I do not want another implant, and was considering the tram flap, but after reading some of your experiences, I am not so sure. Has anyone had good results with the tram flap surgery? I need to know all of the side effects so I can make an intelligent decision. Thank you in advance

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May 18, 2008 07:32PM Kathy_K wrote:

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 

When a woman tells the truth she is creating the possibility for more truth around her. Adrienne Rich

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May 19, 2008 02:38AM jodi1withi wrote:

Hi Sampson< I am also trying to decide on which procedure to go with> I am having a double mastectomy with immediate reconstruction> my two choices are implants or diep flap> I have read so many negatives about both> now I am totally confused! I am attending a forum class this week> women on the forum answer all your questions and even show their results> any info I learn I will surely pass on:)

ANyone out there with positive results?

THanks< Jodi

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May 19, 2008 02:51AM Kathy_K wrote:

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?

When a woman tells the truth she is creating the possibility for more truth around her. Adrienne Rich

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May 19, 2008 07:47PM TammyLou wrote:

MS Free Trams.

Zero complications.

Tammy Lou

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May 20, 2008 04:20AM moonie wrote:

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

Dxd 12/03, DCIS, Mast, ILC, ooph, unilateral pedicle tram 2004

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May 20, 2008 05:05AM MargaretB wrote:

I had  a free tram with immediate reconstruction a few years ago and have had no problems.  It is a a longer recovery and a long surgery (my surgery was 15 hours) and recovery was 3 weeks before I started feeling better.  PM me if you need any information.  good luck with your decision.

Dx 12/23/04, Bilateral w/tram 3/10/05, DD chemo 5/12/05, finished 6/26/05

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Jul 22, 2008 04:49PM kkh1 wrote:

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

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Jul 25, 2008 11:09PM swimangel72 wrote:

I had a muscle-sparing free tram (started out as a Diep - but my surgeon ended up taking a small piece of muscle to support the perforators). I ended up with an abdominal staph infection and an open abdominal wound requiring packing twice-a-day for over 3 months. It finally healed - but unfortunately I was left with a large abdominal bulge on the right side. A cat scan showed no hernia but my plastic surgeon said it's a muscle wall weakness he can repair during my revision surgery in Stage 2. I too was expecting to look fantastic after the "tummy-tuck" and am very disappointed. Fortunately, my new foob is fine - just too big. My PS said he'll lipo it down to the correct size also during Stage 2 next year. I have never worn a girdle after my surgery - my surgeon never recommended it. I did find out that women who have had prior abdominal surgeries (in my case 3 c-sections) are at a 24% higher risk for these kind of abdominal donor site problems even with a Diep (which STILL has a lower risk of complications than a free-tram or a pedicle-tram.) In any event, it's something I'll have to live with - it has given me more motivation to lose weight because I know I have 30 pounds to lose and all that extra weight is between my internal organs, so it should really help the final aesthetic outcome in the long run AND make me feel better too.

3/3/08 Right-side mastectomy with immediate muscle-sparing free tram; 3/9/08 Developed abdominal MRSA staph infection and hernia;Completed 4 months Navelbine and 1 year Herceptin; Arimidex - 3 more years! Diagnosed at age 53

Dx 2/5/2008, IDC, <1cm, Stage Ib, Grade 1, 0/7 nodes, ER+/PR+, HER2+
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Jul 26, 2008 03:44AM moonie wrote:

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!!!

Dxd 12/03, DCIS, Mast, ILC, ooph, unilateral pedicle tram 2004

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Jul 26, 2008 05:06AM pinoideae wrote:

Sorry Swimangel to hear you are having a tough go of it.  That flippin staph bug causes a lot of people problems, I dont think anyone knows how some people get it and others dont.  I am still healing from pedicle tram, so far so good, but the abdomin can still be an issue at this point.  I am still wearing a girdle, but in my situation, the muscle is cut, so the girdle is a must.  Down the road I will find out if a hernia or an abdominal wall weakness is an issue.  Go back to the ps in 2 months for a consult (to next step in this recon process), and will see then if I will need a repair.  Sounds like the stage 2 does a lot of the fine tuning and correcting which will give a much better outcome for you.

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Jul 27, 2008 03:37AM swimangel72 wrote:

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!

3/3/08 Right-side mastectomy with immediate muscle-sparing free tram; 3/9/08 Developed abdominal MRSA staph infection and hernia;Completed 4 months Navelbine and 1 year Herceptin; Arimidex - 3 more years! Diagnosed at age 53

Dx 2/5/2008, IDC, <1cm, Stage Ib, Grade 1, 0/7 nodes, ER+/PR+, HER2+
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Jul 27, 2008 05:24PM, edited Jul 27, 2008 05:27PM by pinoideae

I agree, it is good to share stories to know we are not alone.  I appreciate the honesty as well, I need to know the good and the bad of it.  Also, there is not one recon fits all.  It is just amazing what ps can do today, at least I am amazed!  Well, so far so good, as I said in another thread (forgot the name of it), I have resigned myself to the fact that I may have to deal with an abdominal bulge albeit a hernia or abdominal weakness (but there ARE ways to fix this).  I saw the ps last Wednesday and he said I am doing remarkably well, but need to stay off work for another couple of weeks.  (Still hurts to cough or sneeze, still do not feel normal muscle strength although there has been a big improvement).  3 weeks before I can do any strenuous exercise, mow grass, vacuum, mop, scrub out bathroom etc.   I had a delayed reconstruction (2 surgeries, started with reduction and then tram flap - pedicle).  What this did for me was remove any evidence of radiation (I had radiation + boost - what a mess in tissue, when I first saw ps for recon he knew the risk of failure was high because of radiation, this was the way to go, at first did not get it, but I certainly get it now).  Because of delayed, I have the half-moon type of incision.  Can only see one across under nipple going across and down in the center, cannot see the one under.  Incisions look so much better than when I first saw them.  They are fading nicely and healing well.  I had one seep fluid in center but healed up quickly on its own.  ps looked and said no worries, so I am not worried.  I am wearing a full support girdle which is not to go above belly button.  I was told to wear it for another month.  You know what, I think I will wear it an extra month.  At the end of Sept scheduled for a consult on implant.  I am going to get a small implant under flap (in pedicles this can be done by going in from the side of foob) and then full...er implant on the left boob.  Both implants will be under the pectoral muscle, and then will look at any lipo to be done, and nipple recon.  I truly am ecstatic.  Would I make this choice again given the option.....hell ya!

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Sep 1, 2008 05:40PM graysee wrote:

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!

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Sep 1, 2008 05:47PM, edited Sep 1, 2008 05:48PM by pinoideae

My muscles are fine so far.  I do not feel weaker, although, I have not tried sit ups yet, but really don't care to .  I am back to doing all the household chores I used to.  My dad had a hernia operations, and my Aunt had two hernia operation and neither one had a tram flap.  You have MAJOR restrictions while healing that you must follow.  My back is fine, no problems there.  Make sure you discuss your back issues with your ps. 

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Aug 19, 2009 03:52PM Jeannine wrote:

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 !!!!

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Jan 5, 2010 09:22PM mowoods wrote:

Hi - I had my reconstruction surgery almost 3 years ago.  After a few weeks discomfort I have recovered really well, and can do everything I did before the surgery.  The big bonus was that I got a tummy tuck.  I have found it to be a really successful way of overcoming a bad situation.  I was off work for six weeks, and am now back to normal.  Please don't be scared - with the right surgeon, it can be a terrifically successful procedure.  Good luck with your decision. 

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Aug 5, 2011 01:27AM lyricaloballad wrote:

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.

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Oct 21, 2011 12:55AM Cherrie wrote:

These post are very scary for someone who is trying to figure out her options in regard to a BMX.  I was doing pretty well until I read this.  Are there any positive results out there?  I have had radiation on the left side and will not be able to get implants.  My BS brought up a trans flap.  It sounds like a longer recovery and more problems than implants. I don't want to take off more than 4 weeks.  Oh this is getting harder and harder to make a decision.  I thought I had one.

Dx 10/4/2002, IDC, 1cm, Stage I, Grade 1, 0/1 nodes, ER+/PR+, HER2-Surgery 10/21/2002 Lumpectomy (Left); Lymph Node Removal: Sentinel Lymph Node Dissection (Left)Radiation Therapy 11/14/2002 ExternalHormonal Therapy 01/10/2003 TamoxifenSurgery 10/11/2011 Lumpectomy (Right)Surgery 11/12/2012 Prophylactic Mastectomy (Both); Reconstruction: DIEP flap (Both)
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Oct 21, 2011 01:21AM, edited Oct 21, 2011 01:27AM by karenmarie1

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.

Karen Marie Orig DX 2/2001,IDC, 5cm, Stage IIb, Grade 2, 0/7 nodes, A/C 6 rounds, CHF Due to Chemo, 7/2005, Recurrence, 1/26/2010, Recurrence 11/2012 Stage IV, Taxol 11/2012, ER+/PR+, HER2-

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Oct 21, 2011 02:06AM Cherrie wrote:

Thanks Karen.  I had similar rads and am 9 yrs out.  Did your recurrence come after your MX on the same side?  I read so many problems in other posts and it has scared me.  I just had a lumpectomy and they found ADH which ups my odd of BC by 5 fold.  1 in 4 I don't lijke those odds so am considering a BMX instead of waiting for my cancer to recur.  So confusing.....I am  a young 57.  At least I think so.  Thanks for your response.

Dx 10/4/2002, IDC, 1cm, Stage I, Grade 1, 0/1 nodes, ER+/PR+, HER2-Surgery 10/21/2002 Lumpectomy (Left); Lymph Node Removal: Sentinel Lymph Node Dissection (Left)Radiation Therapy 11/14/2002 ExternalHormonal Therapy 01/10/2003 TamoxifenSurgery 10/11/2011 Lumpectomy (Right)Surgery 11/12/2012 Prophylactic Mastectomy (Both); Reconstruction: DIEP flap (Both)
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Oct 21, 2011 04:31PM jblcsw10 wrote:

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.

Jane - BMX w/TE 6/28/10

Dx 5/17/2010, IDC, <1cm, Stage I, 0/5 nodes, ER+/PR+, HER2-
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Oct 21, 2011 08:31PM kathylyon wrote:

jbicsw - you are very wise. I agree with you that some people that have had problems with their surgeries go on the threads because they need support.  We all need support in one way or another.  I have  spoken with women that have had the pedicle tram and they have not had a problem.  Everyone is different. 

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Oct 22, 2011 03:57PM Kazzy wrote:

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.

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Oct 23, 2011 02:08PM kathylyon wrote:

Kazzy - Sorry to hear of all your problems.  what type of tram Flap did you have?  A free tram FLap?

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Oct 23, 2011 03:08PM Snobird wrote:

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.

Dx 10/2006, Paget's, <1cm, Stage 0, Grade 3, 0/7 nodes, ER+/PR-, HER2+Surgery 12/20/2006 Lumpectomy (Left)Surgery 02/15/2007 Lumpectomy (Left)Radiation Therapy 03/07/2007 ExternalSurgery 12/06/2010 Mastectomy (Left); Prophylactic Mastectomy (Right); Reconstruction: DIEP flap (Both)Surgery 11/17/2011 Reconstruction: Nipple reconstruction (Both)
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Oct 23, 2011 04:28PM SandyinSoCal wrote:

I agree with Snobird. Avoid TRAM. There is no need to sacrifice your core ab muscle now with the advent of DIEP.  Make sure you find yourself a surgeon who does it day in and day out because it's a very technically-challenging procedure.  With the best surgeons, the success rate is greater than 99.5% and you'll end up with soft warm breasts that will never rupture.  The "NOLA in September" thread is huge, but full of great information and you can ask questions that everyone will be glad to help you with.

I am wonderfully made to do ExtraOrdinary things! (www.girleo.com)

Dx 5/22/2007, IDC, <1cm, Stage I, Grade 3, 0/1 nodes, ER+/PR+, HER2-

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