abdominal bulge after tram flap
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MsTori, how do they fix it? My PS says I do not have a bulge, however, my tummy sure sticks out. But...I am overweight. I feel like I would need to lose the weight to know for sure.
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Beckers. I don't know your anatomy. But when the lower abdomen is removed the upper abs will look bigger in comparison and so weight loss would improve the overall look. Remember that even lipo can't remove fat that is embedded in your organs. They can only remove superficial fat.
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Thanks bdavis. I thought my tummy would be further ahead by now but I'm sure the fat with is what's going. Someday it will be gone.
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Hi Beckers,
Even those with DIEP can develop a bulge. As they do go in and move the muscle around to get to the artery and vein to tease it out and them reattach it up at the breast. They also disturb the fascia, which is very strong and works together with the muscle to hold the abdominal contents in. So, it is possible that it is not fat, but a weakening and bulge. The surgeons I have gone to have repaired bulges and hernias on DIEP flap patients, although not as common as free Trams or pediculed trams. I am leaving out a lot, but what they basically do, is remove any mesh from prior surgery, if there is any. They use a medium weight mesh, and secure this to bony landmarks in the pelvic region and the inguinal ligaments, as well as bringing the external lateral obliques forward slightly and secure the mesh to those as well. They are well over 5 years out on performing this technique. A gastroenterologist and a plastic surgeon work together to do this. They came up with this technique after having an influx of tram patients with hernias and lower abdominal attenuations (bulges), and a need to help them. Their patients that have had the repair are well over 5 years out, and doing great. After speaking to a patient, she had nothing but praises. I'm not sure what your experiencing. But there is only one way to find out. I believe that they could do an upright MRI. I'm not sure if an upright X-ray would necessarily show anything since its more for bones. I had a abdominal CT, laying down, but Dr. Denoto did physical exam and diagnosed with hernia's. I think dDr. Denoto, being a gastroenterologist is the way to go. My primary said everything looked great on the CT, but I didn't feel great or look great. I just didn't know what was going on. . But I didn't know what was wrong before seeing my NY surgeons. It could be determined if in fact there is an attenuation or the start of an hernia. This is just my opinion and my experience. And for the full article and exact technique used you could google Dr. Ron Israeli and contact Him, or add. Denoto.Hope this helps. I'm almost 2 weeks post op and feeling so much better.0 -
Wow, Ms Tori. I'm in Calif and on a surgery break til next spring or so (by choice). I did end up having free TRAM. He took about a finger's width of muscle on each side. I had necrosis and my incision which is very low bikini cut (on top of csection scars) was reopened about 4-6 in at stage 2 and I feel like it's worse since then. I also do patient care so there is lifting at work. My tummy is not even at all from my view looking down. I am still a good 50 lbs overweight though too. Where is the surgeon? NY?
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Tori,
I am so happy I found your posts. I have a very large abdominal hernia/ bulge from tram flap surgery Aug. 2012. I have consulted with specialist in DC. They discouraged repair. I saw your posts about Dr. Israeli and have scheduled a consultation with him and Dr. Denoto. I know it's a "long shot" but my daily pain level warrants continuing a search for relief. I tried to return to teaching, but the pain from the bulge is just too much in my abdomen and back.
How are you doing with your repair? Thank you so much for posting your experience.
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My PS says he can go in and re-mesh everything. What have you all been told about this?
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Hi all,
Beckers- remeshing is not the solution. It will be a temporary fix. It's taking out the old mesh, as much as possible, and then laying new mesh. But, it's not just laying the new mesh, the technique is what keeps it from happening again. I highly recommend contacting Dr. Denot and Dr, Israeli (in NY), and requesting their repair technique article. It outlines how the repair is done and why it's done specifically that way, to prevent further complications. I'm a little over 6 weeks out, and can really feel a difference. They have patients over 5 years out from the repair, and it's still holding. If you google their names, you could contact them. I would contact Eva at Dr. Israelis office and ask if she could talk to you about your issues and poss.repair. And if anything, take that to your surgeons and ask if they do that repair. Dr. Denoto is trying to go around and teach other surgeons the repair, because they are kept very busy with these repairs. Best wishes, and I hope this helps.0 -
Tori, thank you so much. I will do that. I don't think going to east coast for surgery will be an option for me so hopefully my PS will look into it. I think he will. I have some lbs to lose too before it's even worth trying. I'm glad you had success.
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I had TRAM Flap surgery in August of 2012. By late September, I had developed a huge abdominal bulge. Many doctors told me it was so large it couldn't be fixed. Luckily, I found Dr. Ron Israeli & Dr. George DeNoto who have developed a technique for repairing abdominal bulges and complications from TRAM Flap.
Edited by Mods to remove member's personal information, for her own privacy and security.0 -
I had TRAM Flap surgery in August of 2012. By late September, I had developed a huge abdominal bulge. Many doctors told me it was so large it couldn't be fixed. Luckily, I found Dr. Ron Israeli & Dr. George DeNoto who have developed a technique for repairing abdominal bulges and complications from TRAM Flap. I can give you their contact information if you contact me by email, cameron5@exede.net . They are the only ones in the states who perform this technique.0 -
I had TRAM Flap surgery in August of 2012. By late September, I had developed a huge abdominal bulge. Many doctors told me it was so large it couldn't be fixed. Luckily, I found Dr. Ron Israeli & Dr. George DeNoto who have developed a technique for repairing abdominal bulges and complications from TRAM Flap. I can give you their contact information if you contact me by email, cameron5@exede.net . They are the only ones in the states who perform this technique.0 -
Hi..I had a BMX w/DIEP reconstruction in 6/13. My flap on one side failed due to poor venous return on day 2 after first surgery, Day 3, they took a piece of saphenous vein (from my lower leg) & used that one to replace the non-functioning one. That one failed the next day. On day 4, back to the OR where they took the latissmus dorsi (muscle from back) & brought it around front & put a TE in. I had 2 SN removed..no CA, so no chemo, or radiation. One flap (CA side) "took", the other (w/no CA) required 3 surgeries. I just had the TE replaced w/implant 2 mos. ago...still feels strange!
While trying to recover from 3 surgeries in 4 days, my abdomen was sore, of course, as expected. Problem is, it hasn't gotten much better. I have lots of scar tissue on one breast & I rub all incisions (both breasts, abdomen, back) 2x/day w/Palmer's cocoa butter & Vit. E. My abdomen has been hard, bloated, hurts when I sneeze or cough & in general, soooo uncomfortable. The bloating gets worse t/o the day from the incision & above. My abdomen looks like I'm 3-4 mos. pregnant & I also developed a bulge (about 1" or so) right on the incision line next to midline. It doesn't hurt, but PS says the incision line has become "lax" & they could fix it, but I'm not sure about anymore surgery. As for the abdominal discomfort...I finally found a PT who's certified in lymphedma & went today. Between the two PTs there, they feel I def. have lymphedema in my abdomen & are going to use lymphatic drainage, massage & "tape" (like the athletes use). They've had a lot of success w/it (provides compression/redirection of lymph fluid). I'll be so relieved if this works b/c the PS just kept saying: it will take time, they stitched me up really tightly & I didn't have a lot of abd. fat to begin with, but .....it's been 6 mos. & swelling is getting worse, I think. I will let you know if it works. I read an article that w/TRAM & DIEP flaps, you can have lymphedema in the trunk, even tho your arm isn't affected. Interesting!0 -
sfin... After my DIEP for a long time, I felt bloated... and looked pregnant IMO. When I had my revisions, and i have had three, it really really helped the abdomen. The second and third revision really had little to do with my abs, but the first revision was awesome. In addition, unrelated, I get lymphatic massage (she does my abs and lat area and lower back... I had DIEP and GAP. She has also used the kinisthology (sp) tape on me. Everything is great now...0 -
from what I've learned about tamoxifen, it enhances, (makes worse) all the peri menopausal and menopause changes. I now consider myself hormonally challenged, lol gotta get thru it somehow. Yes have had stiff and sore joints, side effect, and comes with extra exertion, hot flashes are increased, but it all depends on ur makeup, how long do you have to take it? I was told tamx creates a protective shield around cells, each cell, all good or bad, to guard against any bad cells, that want to damage and multiply. Hence causing extra fluid and weight gain. You learn to read what ur body is saying. This is my first post. Wish you all the best. Glad I came to this. I am coming on 2yrs cf and been on tax for about six months. Suppose to take 10mg 2x also I believe certain foods, herbs, vitamins, interact with the med.
Safe Journey, cw
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Thanks so much for sharing, contemplating trans flap, for left mx, and reduction to rs. Having already had unfortunate extensive complicated abdominal surgery, already have frog belly, (realizing)this has been soo informative. Chemo and radiation a breeze compare to this ongoing occurrence. Not interested in taking such risks. Looking forward to going forward, and reading on about these great Dr's in NY. I'm sure we'll se them soon in the limelight of some TV show. Wish you all God Speed. Cw
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On Jan. 15 I had the surgery (as described by MsTori) and am so so glad that I made the trip to NY. My doctors in Michigan had tried to fix the bulge, twice, without success. I'm one month out and the bulge continues to be gone. I am very confident that it will stay this way - as are the doctors. I would highly recommend that anyone that is experiencing the bulge-following-tram to speak with these doctors in order to be informed on this option. There may be doctors closer to your home that have learned their procedures - Dr.'s DeNoto and Israeli would have that information. Best wishes to all of you, and I hope that you don't give up looking for what you need!
(Sending a big thank you to BreastCancer.Org and also to MsTori for her support throughout this - I couldn't have done it without you!!!)
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Cameron53 -- would appreciate if you could share who the specialist is (and facility) that you saw in DC (ref your July 1, 2013 post). I'm being referred to what I'm told is an abdominal wall specialist at a DC area hospital.
Had my bilat MX-reconstruction in August 2013 with what was supposed to have been a DIEP reconstruction. Due to complications during surgery, my reconstruction ended up being TE on the left and flap on the right. (sfin -- your story sounds very familiar.) Got ahold of my surgical reports 2 weeks ago and discovered he had done a free TRAM, not DIEP...never knew that. The TE was replaced with permanent implant in Dec 2013.
Crushing tightness around entirety of my body (abdomen and back) and a bulge started in late Oct/early Nov. It's not a hernia, and not constipation, and not menstrual water retention, and not lymphedema, etc. etc. It's literally pulling the lumbar area of my back thru the core of my body -- very painful. Abdominal bulge -- very distinct -- has gotten worse, primarily on the left side of my abdomen. Have raised issue to to PS several times to no avail. Finally got him to agree to a CT, but that obviously has to be done laying down. You can't see the bulge when I'm laying down.....
MsTori -- thank you for all your info re Drs Israeli and DeNoto.
All thoughts and words are most welcome. I'm going backwards. Functionality continues to decrease from the pain, crushing tightness, and mind-numbing discomfort. Used to be a She-Warrior winning the battle...mojo is just about gone.
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hi all!
It's been awhile since I've posted on here. I'm now almost 10 months out from my repair from the tram flap, by Dr. Denoto and Dr. Israeli. And it's holding, looks great and I feel so much better. No more pain, no more bulge, and no more hernias! When I went in for surgery, they knew I had 2 hernias, but they found a third umbilical one. Your right, a CT won't show hernias because your lying down. It's by examination that mine were diagnosed, by Dr. Denoto. I just wanted to pop on here, and say, if your considering a tram, please really think long and hard about that. And do your research. My personal opinion now...I would love to see tram flaps not done anymore. They are not necessary with the other options available. When they say you don't need those muscles, meh! You really do! That's what hold you intestines in. That said, if you are having issues such as pain, bulging, distortion of the abdomen, please check I to these two surgeons. They are great! They are very busy, so don't be thrown off by that. It may take more on your part to get the ball rolling, but, I was convinced after my consultation, that I wanted them to repair me. So, I was relentless in calling with follow up questions, and then scheduling my surgery, and follow up appointments. As a bonus, their bedside manner is great!
Hope this helps, and if anyone has any questions, inbox me.
MsTori
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Hi MsTori
I want to thank you for sharing your experience with us. I had a tram flap 17 years ago, and have lived with bulging and squeezing discomfort for about 13 years. Up until I read your post, I had only seen evidence of other tram flap patients complaining of similar symptoms. It was such a joyous moment to finally read about someone who actually had success in treating these symptoms. As luck would have it, I am going to be in NYC in may. I have just scheduled a consultation with Dr Isreal. For the first time in a very long while I am feeling hopeful. Thank you so much
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I was so excited to read your post..I have had a bulge for 11 years and never thought anyone would have answers but you have found them!!! A few questions...prior to your surgery did you get "charlie horse" pain if you moved the wring way or did the muscle crsmp up on you? Did you live in ny for the surgery and recovery time. I live in nc and wonder how I would do the surgery? Thanks again for sharing your success and so happy for you and less pain...
Tracy
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I have also had a bulge since my bilateral pedicled tram flap in 2005. Sometimes it feels like there is a tight knot in my stomach. I have recently had a new primary that grew into my reconstructed tram flap and have had to have another mastectomy to completely remove the tram reconstruction. Had tissue expanders put in to replace the tram, then chemo and radiation, and am scheduled to get implants in the late spring/early summer. Now, because of my 95% estrogen positive BC, my gynocologist recently told me that she wants to take out my uterus and ovaries (and I want that too). I am considering consulting with Dr. DeNotta and Dr. Israel in NY if my plastic surgeon cannot do this repair tecnique. I have had two unsuccessful revision surgeries to the bulge using a lifecell biological type mesh and then a porcine mesh. I guess my next step is to check with Dr. DeNotta and Israel's staff to see if they might be able to perform the hysterectomy/ooph. at the same time as the bulge repair...so much to think about.
Karen
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I had tram flap surgery after my mastectomy in July 2013. I am still swollen around the incision area at my abdomen and nothing fits. I know I had been eating more for a while but I really am eating fairly normally for me, yet this area is still swollen. Is there something I should be doing to reduce this swelling? From what I've read this can be normal but somehow I thought it wouldn't be this long before I started feeling normal again. As it is I still have trouble with bending over to pick things up, sitting for more than a half hour with out feeling hunched over when I stand up, and feeling numb along the incision area. Any suggestions would be appreciated. Thanks!
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2 years later and my stomach is still hard. I'm questioning lymphadema. Definitely have two large bulges. My questions are same as above, did insurance cover surgery? Where did you stay and when were you able to fly home afterward?
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It's been awhile since I've posted here, but want those of you who are researching getting your TRAM bulge fixed, that there could be an answer. As I wrote previously, I had my bulge fixed in January 2014 by Dr. Israeli and Dr. Denoto in Long Island, NY. The bulge has not reappeared, I feel good, am active (a few limitations still), and am so so so glad that I took the chance with these doctors. Prior to this surgery my emotions were all over the place…they are settling down now so that I can get on with being cancer complication free!
Beckers-you had mentioned earlier that your Pt may restitch the area with mesh. Did that get done? My surgeons at U. of Michigan tried, twice, to do that - both times the bulge came back. The way that the NY doctors do it, is bone to bone from all directions, and the mesh is tough. Yes, my insurance company is covering a portion of this procedure. It has been well worth expenses incurred - emotionally, I was a mess. I was able to drive from Michigan. We stayed about a few weeks after the surgery. They want their patients to stay until the tubes are out. The entire experience was a lot easier on me than any other surgery I have had done. Not sure why, but it was. We stayed in an extended stay Mariott. Dinners provided several nights out of the week, breakfast everyday, small kitchen, two rooms - it was ideal. Malls nearby, restaurants nearby, a movie theatre across the street. If I had been home, I would probably have been tempted to clean, or do laundry or cook or something….Staying there made me rest.
bdd1101: I hope you're finding answers to your discomfort. Keep researching. If what your describing is a bulge from the TRAM, the doctors I mentioned above may be able to help.
Hope this helps. Feel free to contact me, personally, if any other questions.
Sue
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In February 2013 I had Tram flap surgery. After 3 mounts my tommy became bloat and bigness. I have a sharp stabbing pain when I sneeze or bend over. In August 2013 I had abdominal wall tightening surgery with placement of mesh, but it did not help. My abdominal is just getting worse and bigger. The plastic surgeon told me the next surgery will not help and told me to visit him after 2 years. My reconstruction breast is huge difference in size in compare with the healthy breast. My belly button died. I cry a lot and lost all hope. But now I am lucky to find this forum and hope to find a right doctor to fix my problem. I will be happy to talk with every body who has same symptoms.
I would like to contact Ms. Tori and Michlady who had a good result with Dr. Denoto.
Thank you for any information.
10/12/2012, DCIS, 1,4 sm, Stage 1, Grade 2, 0/2 nodes, ER+/PR+, HER2- Mastectomy (left) surgery with reconstruction: TRAM FLAP (left), Hormone therapy: 4/1/13 Anastrozole
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Emma, So sorry that you're going through all of that. It's so difficult, I know. Yes, Tori and I have both visited the doctors in NY and have both had good results. Since you sent your email address, I'll send the info on the doctors to you with that address. Sure hope that you find some answers - so frustrating when our local doctors give up trying fix this problem…
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Sue, thank you very much for your replay. I sent to you my right email just now). Sorry, the first time my email was incorrect.
Thank you again.
Nina.
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Hi to everyone. Been awhile since I've been on here and just want to offer encouragement. Michlady and I both had repairs from Dr. Denoto and Dr. Israeli in NY. I live in Florida. So, I drove up, and was fortunate enough to stay with friends for recovery. I have made other trips since then just for more fat grafting surgery from Dr. Israeli since he's the only PS now, that I trust. My surgery was in May 2013 and everything is holding up great! No more bulge. Turned out, the mesh had given way after my original tram surgery. My original surgeon didn't use the right weight mesh and didn't anchor it properly, hence my 3 hernias that developed during chemo, about 3 months after my original surgery. I'm so grateful for these 2 NY surgeons. They are the best and have a 10 year and counting success rate. Before my repair, my abdomen was distended, hard and painful. It looked like I was 4 months pregnant.
This repair works. I'm able to do most things, although I'll never be able to lift anything real heavy again. There are still restrictions after the repair. Turns out you really do need those 6 pack abdominal muscles. :-/ They hold everything in, and so much more. But, I am back to life, just in a new way. And no more pain, distention or pregnant look. I hope this helps and encourages you. In box me or michlady.
Oh, this is important. It was out of network for my insurance and most likely will be for most, but they will work with you on the financial aspects. Just talk to them about it, and their billing person. And it may seem that you are calling them, more than them calling you. They are busy. Best advice is to be persistent. Call, then call again, and push for your surgery date. They have great bedside manner and really attentive in aftercare. They came into my hospital room every morning to check on me after my surgery, and even called in the evenings at times, to check on me.
Hugs to you all, and hope your able to get repaired and back to life.
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Can you please call me. I saw your post on breastcancer.org for tram flap pain.. I am 1 1/2 years out from having my tram flap & I live in daily pain from my surgery. You had gone to NY please tell me what I can expect. My PS keeps telling me it's all in my head. I look as pregnant as my daughter who is 8 mths pregnant, and I used to have a flat stomach. Please could you call me. 313-792-9191 or I can call you back I have free nationwide calling.
Thank you so much for helping me deal with this pain. I am from Dearborn, MI
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