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Topic: abdominal bulge after tram flap

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

Posted on: Jul 14, 2008 08:10PM

bebe wrote:

I am 5 years out (YAY!) from unilateral mastectomy & my tram flap reconstruction surgery.The bulge on the right side of my abdomen is very uncomfortable & I am very self conscious about it. Onc says it is not a hernia,,,Anyone else have this problem? Has anyone had surgery to correct it?

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Apr 7, 2012 09:20AM maryanne64 wrote:

Hi girls,

I had a double masectomy with immediate reconstruction with a TRAM flap. I had 3 lymph nodes removed on my right side which turned out negative, thank God, so I did not require chemo or radiation. My breasts turned out well. My stomach is another story. Immediately after my surgery, my stomach was flat as a board. My friends were all gushing that at least there was one positive thing that came out of this whole cancer episode in my life. This was short lived however. A few weeks after my surgery, I noticed that my stomach was bulging. I thought it was due to my moving around more. It kept getting bigger and bigger. My doctor confirmed it was not a hernia, but the bulge sometimes makes me look pregnant. I noticed it got bigger after much walking and eating lots of vegetables. Nonetheless, it will never be flat again. That's what my plastic surgeon told me. He was very difficult to get any information from. I felt like I was pulling teeth trying to get information out of him. Prior to my surgery, he explained the procedure to us. My husband asked, " won't cutting her stomach muscle weaken her stomach ?". He replied " Don't worry, her stomach will be fine. We put a mesh in there to hold the stomach to prevent it from weakening".  We believed him. Every time I went to see him, he always remarked on how beautiful my breasts turned out. I have a 2 foot incision across my belly that he never looked at, just focused on the breasts. When I told him I was upset with my stomach, he told me he could do another surgery to try to fix it but of course it's a major surgery. I asked him what percentage of his hundreds of patients who received TRAM flaps had bulges ? He told me twenty to thirty percent !!!!! He never told me this before surgery ! Through my own research, I know that surgery to repair this bulge isn't always successful. It is my opinion that you should seek the advice of 3 or 4 plastic surgeons before choosing one. My friend used this PS with wonderful results. She had a double masectomy with immediate reconstruction with TRAM flap. I had my surgery one year after she had hers.When my bulge started to appear, I contacted my friend. She told me in the time I had my surgery, she had developed a hernia. So now she has a hernia and I have a bulge. DO YOUR RESEARCH before making a decision. I think had I known all this, I would have done implants instead of this. I am starting to feel that FLAPS and DIEPS may not be the way to go !!!

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Apr 7, 2012 09:37AM thankful4life wrote:

Wow! It is incredible tht so many of us have the same story. I had BMX with free TRAM in January 2010. Have had 2 more reconstruction surgeries since then. My breasts look fantastic. All my doctors remark on how wonderful they look. However, my stomach is bulging, too. It started about a year ago. My PS said it was not a hernia; he said it was torn tissue. He said he can repair it surgically, but he wants me to first lose 20 to 30 pounds. Yeah -- I've also had hysterectomy, oophorectomy, total of 7 surgeries in 2+ years, I'm on Femara and Effexor. I'm trying to lose weight, and my husband tells me I need to eat more than I do, because I don't eat a lot. But the weight isn't coming off. Last month when I went to see my plastic surgeon I cried and told I really wanted the surgery, but he said not yet. Sigh.

Sherry - Age 48 at diagnosis; ILC, IDC, Paget's, Lumpectomy on 11/18/2009 w/out clear margins, BMX w/free-TRAM reconstr.01/05/10; hyster/ooph 03/29/2010; Femara Dx 10/28/2009, ILC, <1cm, Stage Ib, Grade 2, 0/4 nodes, ER+/PR+, HER2-
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Apr 16, 2012 07:00PM bdavis2 wrote:

yes, i am seeing a physical therapist tomorrow.  my upper abdomen is still swollen and i am very very depressed.  It nevers leaves my mind because at work i am constantly pulling up my underwear and my pants that continually roll down because i no longer have any natural waist.  i know it sounds selfish of me to be so upset since I am cancer free (which I know I should focus on) but i'm very very upset and go deeper into a depression every day.   I feel I was not told the whole story about what the results of this surgery could be and because of that I feel betrayed.  My doctor and his nurse tried to tell me that my upper abdomen just appears larger because i had a breast reduction and my lower abdomen was removed for the reconstruction.  If that were true then all of my clothes should still fit me around my abdomen and they don't!  My abdomen protrudes and my tops span over the protrusion.  That is not what my stomach was like before this surgery.  I really hope the physical therapist will  be able to help me.  I've never felt more down in my life. I feel ugly and malformed and feel i've lost a big part of myself and will never get it back. Thank you very much for writing to me..it was very nice of you.sincerely,   Barbara

Dx 8/12/2011, DCIS, Stage 0
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Apr 16, 2012 07:19PM bdavis2 wrote:

yup--i have the frog belly also that gets worse as the day goes on.   I also was not told about this possibility.  Has anyone considered a lawsuit---???

Dx 8/12/2011, DCIS, Stage 0
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Apr 16, 2012 07:38PM , edited Apr 16, 2012 07:40PM by jeskachi

Okay, you all know that TRAM and DIEP are not the same surgery, right? TRAM takes muscle, DIEP takes no muscle. That difference is huge. No muscle is sacrificed with DIEP, so there's no weakness caused by it. Some people have trouble with scar tissue and tightness, some people have trouble with swelling, but it all eventually resolves. It gets better with time. The same can't be said for TRAM I'm afraid.
I hope physical therapy helps, bdavis2.

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Apr 17, 2012 04:08PM shelly56 wrote:

jeskachi - Yes, speaking from my DIEP experience, the diep takes no muscle, but we do notice a bulge where there wasn't one before.  It basically re-arranges tissue and fat that's still there.  I hope it does indeed get better with time. 

"Courage is resistance to fear, mastery of fear - not absence of fear." Dx 1/26/2009, IDC, 5cm, Stage IIIa, 4/15 nodes, ER+/PR+, HER2-
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Apr 17, 2012 07:11PM bdavis2 wrote:

I went to the physical therapist today who specializes in breast cancer patients.  She is concerned about the hardness of my stomach.  She is writing to my oncologist and PS at Penn to express her concern and thinks I should have an MRI to see what is happening inside my body.  It could be a weakness in my abdominal wall and because of the weakness it can no hold my organs in place as it should or it could be a hernia.  She needs to find out if the PS used mesh during the surgery because if he did there is nothing that can be done to fix the problem.  If he didn't then there is a chance something could be done.  Sometimes its hard to believe this is real. 

The bulbus stomach is causing problems with my back and I tire quickly after any exertion. 

If anyone has a good relationship with their plastic surgeon maybe I could get some answers.

My own doctor isn't letting me know anything.

Thanks for your input ---  I really appreciate it!

barbara   

Dx 8/12/2011, DCIS, Stage 0
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Apr 17, 2012 07:28PM bdavis2 wrote:

Hi Binney,

I just wanted to say thank you for being so helpful.  I just finished a post stating that I went to  Lymphodema therapist today at Penn Partners/ good Shephard (they are affliated with U of Penn).

I'll see what the doctor's responses are (my oncologist and Plastic Surgeon) after she emails them with her concerns about how hard my stomach is.  She will be able to get more of a response then I will ever get as a patient and she is going to advocate on my behalf.  I am praying and on the way to work saying the rosary.

Thanks again for the information you posted---it's been very very helpful.

Diep patients should have a convention somewhere where everyone could meet!!:)

Dx 8/12/2011, DCIS, Stage 0
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Apr 17, 2012 08:15PM Binney4 wrote:

barbara, I'll add my prayers to yours for real answers and a quick fix.

Hugs,
Binney

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Apr 23, 2012 06:47PM maryanne64 wrote:

Hello girls,

Is anyone experiencing any side effects to Tamoxifen ? I know what some of the side effects are, but this weekend I felt extremely achy and tired all over. I was walking around Boston and barely had the energy to get back to the hotel. I took 3 advil and rested and was still a little weak afterwards. This lasted until the next day. I have been taking Tamoxifen for 6 months now and I never experienced this before. I walked alot this weekend and wonder if this walking brought it on. I'm normally pretty healthy, except for the breast cancer I had 6 months ago. I am 48 years old and just experienced a hot flash for the first time  a week ago. Oh well, the hot flash I knew was bound to happen eventually but this achiness and weakness out of the blue was wierd.

Maryanne 

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May 8, 2012 07:58PM bdavis wrote:

Barbara.. I had my DIEP in August... and I did not have a bulge afterward that I can remember... But after stage II in Novemeber, I do... I have photographed it and spoken with the doctor's office regularly since then. They say that the muscle was manipulated (not cut, but rather pushed to the side to get to the vessels) and then the vessels were teased out of the muscle. They recommend crunches and get in as good shape as possible and if that doesn't work, plication may be the next step. I have the overall pregnant look, but also had a specific bulge left of my belly button, and belly is firm and the little bulge is tender. I am assured it will be resolved.

Betsy... 1.9cm tumor, micromet in SN, ER/PR+ 98% .. Had my BMX and Reconstruction in NOLA Dx 11/12/2010, IDC, 1cm, Stage IIa, Grade 2, 1/2 nodes, ER+/PR+, HER2-
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Jul 29, 2012 10:59PM arseweryn wrote:

I too am 5 years out from TRAMFLAP on the left and simple mastectomy on the right side each one year apart. I do have an abdominal bulge. What surgery is offered for this?

I was never warned of this. I was encouraged by my plastic surgeon to have the TRAM because it would be a "free tummy tuck"....I have a bulging abdomen and no muscles to pull it in....would never do it again!!!

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Jul 30, 2012 08:26AM bdavis wrote:

I would inquire about plication. I had DIEP so no muscle was removed, and know that plication is a procedure that pulls the muscles together, but for TRAM, I am unsure if this is an option, but you should ask.

Betsy... 1.9cm tumor, micromet in SN, ER/PR+ 98% .. Had my BMX and Reconstruction in NOLA Dx 11/12/2010, IDC, 1cm, Stage IIa, Grade 2, 1/2 nodes, ER+/PR+, HER2-
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Nov 7, 2012 05:52PM dngdonnelly wrote:

I too have the abdominal bulge on the side where my muscle was used for the TRAM flat a year and a half ago, and have basically had it since shortly after the surgery. I have been told by 2 doctors that it's a hernia, and 2 doctors (including a general surgeon) that it's not. Mine also is smaller in the morning but seems to get bigger during the day. If I work out too much, it starts to bother me a little and seems to get bigger, at least for awhile. I am having a hysterectomy at the end of the month, and the surgeon is going to be part of the surgery to see if it is indeed a hernia. He also said it has something to do with the mesh and how it was attached and is stretching (because there was no muscle for it to be attached to in the first place). My general surgeon also told me this is becoming more and more frequent that he is seeing this "bulge" after a TRAM flap, but has yet for it to be determined as a hernia.

Gina Dx 5/4/2011, ILC, 1cm, Stage Ia, Grade 1, 0/4 nodes, ER+/PR+, HER2- Surgery 06/22/2011 Mastectomy (Right) Surgery 12/07/2011 Reconstruction: TRAM flap (Right) Hormonal Therapy 03/14/2012 Arimidex
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Nov 7, 2012 06:18PM bdavis wrote:

I tend to disagree... I say this because I didn't have a TRAM and I have the bulge.. more of a distended look. It has improved, but is still there, especially later in the day. My PS says that a) I am not fatless, meaning I have fat in and amongst my organs b) because my lower abs are flat and tight, the upper abs appear more bloated. Of course I don't know your sepcific information or if your bulge is like mine... and I am not a doctor. It would be good for them to rule out the hernia though, as hernias are common with TRAM.

Betsy... 1.9cm tumor, micromet in SN, ER/PR+ 98% .. Had my BMX and Reconstruction in NOLA Dx 11/12/2010, IDC, 1cm, Stage IIa, Grade 2, 1/2 nodes, ER+/PR+, HER2-
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Dec 30, 2012 12:12PM giddles wrote:

I had a mastectomay a little over a year ago with a Tram Flap.  Since then I have developed a bulge that feels like a hard softball on the right side of my stomach.  Doctor says that it is because of the weak muscles and that I should wear a very tight girdle or spanx to hold it in place.  Otherwise I have to live with this.  It is terrible especially when I wake up in the morning.

I wish someone would have told me.

Dx 9/4/2011, DCIS, <1cm, Stage 0, Grade 1, HER2-
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Mar 10, 2013 04:03PM mszw2 wrote:

I too have the lovely "frog belly" as you put it.  I HATE IT.  I was not informed this could happen.  In adition I have a bluge the size of a childs fist right under the diep flap.  I though this was part of the muscle that they had to pull thru for blood supply.  There is a surgery that you can get to take care of the frog belly?? I didnt know this....I told my doctor about the pants falling down thing, and he didnt say anything about it.  I have an appointment coming up with him for a follow up of having scar tissue being removed in 3 places that was actually causing pain. Again I will be talking to him about this belly thing. I dont think it will be covered under my insurance so I will see what he can do about it.  I too am angry that people are not being told EVERYTHING even if they ask.  Sounds like maybe a new PS for me.

Dx 4/16/2011, DCIS, Stage I, Grade 2, 0/1 nodes, ER+/PR-, HER2-
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Mar 12, 2013 10:36AM Tummytuckhaha wrote:

Good morning...so glad I found you all!!!!! I am 21 years post TRAM. And I have had pressure in my abdomen every day since. I was fortunate to have a housekeeper for the last 10 years so the pressure was not too bad and only escalated if I did something that "disturbed" my abdominal muscles. Well, I retired and the housekeeper is gone. I have resumed my household chores and boy oh boy am I feeling those abdominal muscles. The squeeze is debilitating most days. So I appreciate the info on this board. I am going out to buy a Spandex.....picture a 65 year old chest.....one really great original boob and one that never got a nipple hanging out of a Spandex!!!!!!!! May all of you have longevity and some peace of mind knowing there is an old lady out there who is still smiling despite what some well intentioned surgeon did to her body!

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Mar 23, 2013 11:12AM MsTori wrote:

Hi Ladies, I had a bilateral pediculed TRAM flap in July 2012. Went brought chemo afterwards and about 3 months ago (I'm guestamating) I started with lower abdominal bulge, tenderness in different spots of my abdomen. Started looking around for information (scholarly articles) on what can be done for this. On initial surgery, mesh was placed to reinforce abdomen. I spoke with a a couple plastic surgeons that said more mesh could be placed, but I have to live with it and wear binder. I finally found an article written by a plastic surgeon and a gastroenterologist. In the article, they described how many patients have had this issue of bulges, (even DIEP, because its the cutting of the fascia that cause the weaknesses, not just muscle removal), and they have developed a technique to repair this, with great results. On 5 year follow up, patients were still doing good with the repair and no further bulging. Private message me for names. They are located in New York. I am still recovering from chemo, but plan on having this repaired this summer. Hope this helps.

Dx 6/26/2012, IDC, 1cm, Stage Ib, Grade 3, 1/25 nodes, ER+/PR+, HER2+ Surgery 07/30/2012 Mastectomy (Left); Lymph Node Removal: Sentinel Lymph Node Dissection (Left); Prophylactic Mastectomy (Right); Reconstruction: TRAM flap (Both) Surgery 09/11/2012 Lymph Node Removal: Axillary Lymph Node Dissection (Left) Chemotherapy 10/12/2012 carboplatin, Taxotere Targeted Therapy 10/12/2012 Herceptin
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Mar 24, 2013 12:45PM sher5307 wrote:

Can you please post or send me the article? My Plastic recommend lipo to fix the bulge. Thank you

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Apr 22, 2013 10:20PM maggiesmom39 wrote:

I am so happy that I found this feed, but am sad that so many have the same frog belly. I opted for a tram 2 yrs after tissue expanders failed due to massive infection and I have rads in between. PS said Tram was my best bet. I really researched my PS as my first PS was a hack. Well very, very long story short, I had the tram last July and it failed and now I have this huge bulge. I asked about the potential for hernia and was reassured that it wouldn't be an issue. Really did my homework before tram, or at least I thought I did. Now General surgeon told me to loose 20lbs and even then surgery is risky to fix and no guarantees. PS promises to fix. I don't know who to trust anymore. I am depressed. None of my clothes fit and I look pregnant, not to mention having a concave chest. Just 41 and am not looking forward to a life of elastic waist paints. I know that I am lucky to be alive, but does the quality of my life have to be so poor? I feel and look deformed.

Dx 3/28/2010, 1cm, Stage I, Grade 1, 0/7 nodes, ER+/PR+, HER2-
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Apr 22, 2013 10:41PM bdavis wrote:

I sent you a PM

Betsy... 1.9cm tumor, micromet in SN, ER/PR+ 98% .. Had my BMX and Reconstruction in NOLA Dx 11/12/2010, IDC, 1cm, Stage IIa, Grade 2, 1/2 nodes, ER+/PR+, HER2-
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Apr 30, 2013 12:45PM martyhaney74 wrote:

I am getting my abdominal wall fixed as I have the bulge on my right side and at times hurts so much. Has anyone had the procedure and if so was it a success? I am having to wear a binder day and night.

Surgery 01/27/2011 Reconstruction: TRAM flap (Both)
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May 8, 2013 08:17PM Micah2269 wrote:

I am 9 months post op from DIEP Flap. I too have the bulge. Sharp stabbing pains when I move a certain way, sneeze, etc. I don't know if I will ever be able to sleep on my stomach again. I lived in yoga pants. This was the only thing I could wear. None of my pants fit. I constantly have to pull my pants and underwear up. Wearing a pair of jeans is out of the question. Too uncomfortable! The best option for me.....MATERNITY JEANS! Never thought I would be wearing maternity jeans at 42 yrs old. They have been a lifesaver though. No binding waistbands, no zippers or buttons. My abdomen is way too sensitive for any of that. The spandex that goes over the tummy also offers support.

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May 8, 2013 09:26PM bdavis wrote:

Micah... are you sure you had DIEP?? Perhaps you had TRAM. I had DIEP and my issue was never painful. And I now believe my bulge, which was more of a bloat was related to lymphatic drainage.

Betsy... 1.9cm tumor, micromet in SN, ER/PR+ 98% .. Had my BMX and Reconstruction in NOLA Dx 11/12/2010, IDC, 1cm, Stage IIa, Grade 2, 1/2 nodes, ER+/PR+, HER2-
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May 26, 2013 07:31AM sdunckley wrote:

I, too, am having the same problem on the left side of my abdomen after the same surgery. After my first surgery in 2010, the mesh that was put in to replace my muscle lost its integrity, so a second surgery was performed to correct that. However, when the surgeon got in there, the mesh had already been infused into my own tissue, so it couldn't be removed. Instead, additional mesh was inserted to re-enforce the mesh that was already there. In short, that did not work either. My bulge is still there, larger than ever, and hanging more as time goes on. It is now 2013, and for the past year I have had to wear a body compression garment that they sent me home in after surgery, or a sacroiliac support belt, (which is very uncomfortable), or some other type of compression support in order to get some relief for my back, which is extremely painful if I go even one day without support. I am depressed over this whole situation, but I don't know where to start to get some relieve and/or repair. I went back to my surgeon a little over a year ago, and his only suggestion to correct it, is to release yet another muscle in my side, pull it around and reattach it over the area that is bulging. In my mind, that is just going to move the problem further around the side of my body. No thanks! I have been dealing with this now for three years. Bebe, I noticed that your entry was made in 2010. Have you gotten any relief? If so, can you pass on your results, please. I hope you are still monitoring this website.

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May 26, 2013 10:33AM bdavis wrote:

Would a plication surgery help? That is where they stitch the stomach muscles together, like tightening a corset.

Betsy... 1.9cm tumor, micromet in SN, ER/PR+ 98% .. Had my BMX and Reconstruction in NOLA Dx 11/12/2010, IDC, 1cm, Stage IIa, Grade 2, 1/2 nodes, ER+/PR+, HER2-
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Jun 1, 2013 01:03PM , edited Jun 1, 2013 01:07PM by bjcarroll53

Although I am a newcomer to this site and it has been a while since the original message was written - I would still like to reply.  I had reconstructive surgery in 2004 and had the abdominal bulge shortly after the surgery but never bothered to complain because it was not painful and the bulge was not too bad to look at.  However, just recently, I started having pain that is getting progressively worse and the bulge is getting noticeably bigger.  I went to several General Surgeons, Plastic Surgeons and OB-GYN to have a number of tests done to rule out cancer returning, etc. and found that there is not much that can be done about this problem.  Reading your message and other messages from other women, I see that this is a common complaint with this surgery and I believe not enough study has been done to come up with a solution to resolve the problems we are experiencing.  Let's not give up hope though - there must be a solution.  We need to continue to complain and seek help in order for someone to hear us and notice that this is a problem.  I wish that I had spoke up earlier but instead tried to live with the problem until it became worse.  Lets stick together and make a noise to the physicians so that research can be done to find out what to do when the mesh gets weak and the bulge gets bigger causing pain with normal routine activities.  Write letters and make a fuss until someone hears us and decide to help us.  I am praying for you and the many women out here going through the same problems after reconstructive surgery with the Tram Flap.  Continue to hope for a solution and don't give up.  I believe that there is a solution.

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Jun 2, 2013 01:10PM MsTori wrote:

Hi all! I just had my "bulge/hernia" repaired and am happy as a pea in a pod! I am a RN, and posted earlier in this thread. I have had a few of you reach out to me, and provided the info on the doctors and repair. I to was told by numerous physicians, surgeons and plastic surgeon that I could have more meshed placed and live in a binder. Ahem! Not acceptable. I want to go back to nursing. So, I researched scholarly articles, and found 2 surgeons in Germany( to far away) , and two surgeons in New York. So, flew up from Florida to NY this past March and consulted with them. Discussed the repair technique and success rate and how far out. Beautiful! Scheduled my surgery, and just had it done this past Wednesday. Wow! What a difference. It's performed by a gastroenterologist and plastic surgeon together. PM me if you want the info. I wish you all the best, and don't lose hope, there is a fix, and it's not just laying more mesh and wearing a binder.

Dx 6/26/2012, IDC, 1cm, Stage Ib, Grade 3, 1/25 nodes, ER+/PR+, HER2+ Surgery 07/30/2012 Mastectomy (Left); Lymph Node Removal: Sentinel Lymph Node Dissection (Left); Prophylactic Mastectomy (Right); Reconstruction: TRAM flap (Both) Surgery 09/11/2012 Lymph Node Removal: Axillary Lymph Node Dissection (Left) Chemotherapy 10/12/2012 carboplatin, Taxotere Targeted Therapy 10/12/2012 Herceptin
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Jun 7, 2013 10:18AM , edited Jun 7, 2013 10:28AM by fw00

This Post was deleted by fw00.

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