Hi all

I need some advice please.

I cannot decide which recon to go for. I have already had tissue expander, hate it, and can’t have nipple due to thin skin.

Seen three plastic surgeons, and they are now recommending that i go go for either tram or ld flap.

I am looking for a recon that gives me as natural shape and feel as possible (i do not have this at the present).

So, please ladies, if you have had either, share your experiences, opinions and what about recovery time? Things you can/cannot do whilest recovering.

I also have a six yr old and a three yr old…so very nervous about having either!

Naz xx


Hi Naz

I’ve had an LD flap. I posted on the thread below all about it.–t32097.html

Hope this helps - If you have any questions, don’t hesitate to ask.

Good luck with your decision.


I had an LD flap recon 8 weeks ago and I have no regrets! I took it easy for the first six weeks, no driving, lifting, gardening etc. All I did was go for long walks, rest and do the arm exercises. The exercises are very important so make sure you do them. I am now driving, swimming and going to the gym (no weights or rowing machine yet). I do get some funny sensations in my new boob but things are definitely settling down and most of the time I hardly notice it!

Feel free to ask me any questions.

Thanks for much for your replies.

I am really keen to chat to as many people as possible who have had it done, as i am moving towards that direction now.

MairiMac,do you mind me asking, do you think given time,that your new boob will feel like a boob, if you see what i mean. Will it move about and be quite soft do you think?

Hi there,
Im quite a new patient of the TRAM which I had 8 days ago-and im so very pleased with the results already!!.Im 52 and I had a single MX in OCt 09 so had some time to consider the options. I was a 40C/D so needed a decent sized result and had plenty tummy skin to use. I wa surprised how quickly I became mobile and relatively pain free. I had been going the the gym and swimming for the 16 mths since referral so had developed not bad core strength which seems to have helped. Im quite upright and had tummy button stitches out yesterday and most of the paper stitches are off now.
I will say that I dont have any small children to consider and I dont know how I would be if I did. You would need to have help Id say for a few weeks cause of that. Im pottering around and doing the simple daily exercises to improve movement.
My boob(to me) looks great but just having one back of any shape is so brilliant, although its still understandably firm, as is my tum.

I intend to take things easy and recover as well as poss. no driving for 6 weeks or housework-yeah!!, so I know how you feel, but I had complete faith in my surgeon(who does around 20 per year) and he called it the GOLD standard op, as did the nurses on the ward.The op was approx 10 hrs long but I was back on the ward after HDU at 11am next morning.Any questions, please ask, I know how much the advice and support I got on here helped me to prepare.The BCC helpline can also ‘match’ you with others to speak with who have similar lifestyle/history as you which was brilliant too.

Good luck with your decision

Cathie xx

Thanks for sharing your experience Cathie!

I am so glad that you are recovering well, and that you are pleased with your results.

I would like to go for the tram flap if iam honest, but that fact that i have two small children and no family within 150 miles, does put me off.

However, i see it as an investment for the future, and would hope that once it is done, no more surgery!

It is a hard decision to make i feel , particularly as i do wonder how we would cope with day to day things and as i say, the children.

Wishing you a speedy recovery!

Hi NAZ. I have made friends with other LD flappers! and everyone I’ve met are happy with the results. I made my mind up when I saw someone who had had the LD and as I said I have no regrets. I’m hoping it will eventually soften up a lot more and I’m absolutely sure it will, to be honest once I get the nipple done I doubt if anyone would notice!! Certainly at the moment no one can tell the difference unless I was to parade topless.
Please remember that after your op you mustn’t lift anything heavy but I think that applies to all reconstructions and also if lymph nodes have been removed. Like I said in the earlier post I did very little for the first 6 weeks apart from the arm exercises and walking and I am now swimming 20 lengths a couple of times a week and cycling at the gym.
I spent 6 days in hospital and had 3 drains in. All the drains were removed before I was discharged. I also had seroma (build up of fluid) after I came home and the bcn drained that a couple of times. When I met my pc after 2 weeks he gave me a steroid injection in my back and that stoped the seroma.
Good Luck and I hope that everything works out for you whaterever your decision.

Thanks MairiMac

I still don’t know what to do!

I am scared of another op, have a young family, don’t like the expander recon as i can’t have a nipple recon (this is a big must have for me).

I guess i need to know that the flap will be an improvement on the existing recon, and that i won’t experience any back problems or problems of any other kind.

Back to the ps me thinks, for a final blast of questions…

Hi Naz

I had tram flap recon 6 years ago. It has been fantastic!. It is very lifelike and similar to the “real” breast.

The operation is major - I felt as though I had been run over by a bus at first. I was in hospital for 8 days. When I came home I was walking very slowly. But if you have underlying fitness you recover very quickly. I started by walking round the garden and within a week or so was managing a mile a day and within two weeks several miles. By six weeks post op I felt fine.

I don’t think about my good breast any differntly than my recon now - with the exception that it have very few nerves and therefore feelings in it.

I was alarmed when I realsied I might have to lose it as a result of local recurrentce. That doesn’t look likely at the moment and I am very relieved!

If you have any specific Qs about tram flap I would be happy to try and answer them

Good luck with your decision

K x

Hi Naz, I’m another LD flap girl. I concur with everything the others have said about this option.

I had a skin sparing mastectomy and immediate LD flap in Feb, so a bit different from you. My plastic surgeon offers NHS sysmmetry surgery if needed to reduce (or presumably to enhance) the unaffected side.

My new breast looks amazing and is a “good C cup” according to my surgeon :slight_smile:

The TRAM flap was not suitable for me because - amazingly given I’m midlde aged and a tad overweight - I didn’t have tummy enough fat!!!

Either is quite major surgery, but both seem to get good results. I’m sure you’ll make a good choice whichever you choose.

Hope it goes really, really well for you

Hi kmans, i have pm’d you if that is okay…xx

RevCat, thanks for sharing your experience with me.
So, does your new breast look and feel like a breast? Is is soft and does it move? (sorry for personal questions, just trying to get an idea of what it might be like).
Are you going to nipple recon?

Many thanks.

Naz x

Hi Naz,

My reconstrusted breast looks just like a breast but without the nipple/areola area (that will be done later once the skin has settled after the radiotherapy and my weight has settled post chemo (ha, ha!)). Because of how mine was done, I have a round scar (they bascially cut round the areola and scooped everything out)but most LD flaps have ‘eye’ shaped patches. The nipple will be made (probably from skin) and then the areola area tattooed. You probably knew this, but I don’t like to presume.

It is firmer than the real one - not too unexpected as it is made of muscle not breast tissue - but it does move quite naturally (I still end up holding on when I run!!). The muscle does sometimes twitch - a well known factor of LD flaps because the brain still tells the muscle to do its old jobs. I’m told this eventually goes away. The skin is mostly still numb six months on but recently I have noticed it is starting to get a bit of feeling back (it can take 2 years apparently).

Ask you plastic surgeon to show you photos - mine takes heaps and heaps (all headless in case you wondered) - as this will help you see how it might look. I go out in open necked tops some of which reveal a little cleavage and feel quite confident. If it’s not inappropriate to say this (especially given my job!) I recently had a man look me up and down and say he wouldn’t know if he hadn’t been told!

Whichever you decide will be right for you, I hope you get a result that leaves you as pleased as I am.

Hope this helps. Best wishes for your decision-making.

Hi Naz,
I am now four months on from a Diep reconstruction and have not had a moment’s regret. It is major surgery, but that’s the price you pay for a good result. I am really pleased with my new boob. It is a lovely shape and the hardness is reducing daily. It feels really natural and, once the scars have faded, it will be brilliant. It does leave a big scar from hip to hip, but my bikini days were long gone anyway! It took about a six weeks to get back to doing light housework and driving and about four weeks to being able to stand up straight. I’m going back in September for fat transfer to fill it out a bit more and then will have the nipple and aeriola done in the new year.
I can’t wait to have the reduction on the other side now so they match. Good luck whatever you decide to do.

Hi RevCat

Thanks so much for sharing all of that info with me, it really does help to hear other people’s experiences of having this procedure.
I really really want to have a breast that looks and feels as natural as possible…that is so important to me.

Flossie, thanks to you too!
You sound really pleased wtih your new boob, and that is great to hear!

It is touch and go as to whether i have enough stomach fat for a tram flap i am told, in which case, I will have to go for the ld flap,which i do not dislike the idea of…as long as i can see loads of photos of what i am likely to end up like!

Thanks once again ladies, much appreciated.