I have been told by my surgeon today that it would be best for me to have a tram flap reconstruction and wondered if anyone out there who’s had one done could let me know what it was like.
I thought that I would be having muscle taken from my back and an implant, but he says that because Im young, fit and non smoker etc, that this op would be a better outcome.
I’ve been reading up on the op and know that it is longer and more indepth, and trying to decide now what to do.
Anyone out there that could help me it would be much appreciated. What have been the advantages and disadvantages etc?
I had a team flap recon ( New Years Eve 2005). Advantages are:
No implant required
All scars are hidden by a bikini so no clue what you’ve had done ( the back muscle op leaves quite visible scars)
Instant tummy tuck
No battling for arm mobility after the op ( moving back tissue & muscle means your arm is affected and you may need physio)
Disadvantages:
It’s a big op and recovery time is longer
The scar is long ( hip to hip) and will need drains post op
I was very happy with mine & recommend that you go for the finishing touches ( nipple & tattoo) as it’s great to be looking pretty normal again.
I had a tram in July last year and it was described to me by the surgeon as ‘the gold standard’ !!
I had it done in Livingstone hospital and was and am very pleased with the results. As Twinky says, it is a big op but as long as you have prepared for it by getting as fit as you can then getting time to recover fully, I think you wont regret it.
I have to say, I was quite surprised by how quickly I was on my feet and moving around and I do think this was down to the pre-op exercising/swimming I did for the 6 months before.
I havnt got as far as the nipple as Im waiting to get a bit of lipo on ‘dog ear’ and the new breast as it’s a bit too bit, but I hope you get the same good outcome.
Cheers
Cathie x
Many thanks for the replys, it has put my mind at reat a bit. Just wondered what type of tram flap it was,pediculed or free(diep)? to those of you who have had the operation.
Hi Julie
I had a TRAM- big bust and LOTS of jelly belly to transplant, so the perfect op for me.
I also liked that it wont need to be ‘maintained’ unlike with implants, so it feels like the end of my cancer road, apart from the nipple.
Take care
Cathie x
That’s the say I look at it, hopefully the end of the cancer journey, a finalisation to a final degree. Im average on top but do have a bit of a stomach, so will be glad to have that taken away. Were your vessels left intact or did you have the other op where they use microsurgery?
Just not sure which to go for if offered both.
I had a DIEP ie free flap in November. With this one they dont use any muscle, just fat from the tummy below the navel and a patch of skin. It involves microsurgery to give the flap tissue a blood supply, so a blood supply is taken from somewhere around your groin and rejoined either under your arm (mine was) or near your breast bone. All my stretch marks were below navel level and I’ve got rid of them all and my navel is now very shapely too! If you want to pm me your email I can send you a link to an animation which shows how it’s done.
The TRAM flap takes some or all of the lower tummy muscle and therefore the blood supply remains joined and it is all fed up, under your tissue into your breast area. The muscle is replaced by a mesh to give some support but from what I’ve read, this op can lead to weakened tum strength.
. In both types of op you get a tummy tuck effect and a more natural new breast than with implants. Again from reading, if you don’t have any adverse health conditions, the DIEP seems to be the preferred Op these days. My surgery took 6 hours which was much better than the 10 I’d been expecting!
I’m kind of in the same position as you as I have to make a decision in the next two weeks on what type of recon I want to go with my MX next month. I can have any of them, so have to weight up the pros and cons for all of them! An extenuating factor for me is that after being diagnosed and having WLE and SNB in London, I have come back to my home country New Zealand for chemotherapy and now the MX and recon, as this is choice I was given based on lots of grey areas in my diagnosis (extensive lymphovascular invasion being the main one!) so I have to factor in an eventual long-haul flight back to London which I will have to be medically cleared for.
At the moment I’m leaning towards a standard TRAM flap rather than the one involving micro-surgery as it’s less time on the operating table and gives much better long term results than an impant (even though an expander plus implant would be much less recovery, it involves two operations with a three month wait in between, so for me I will be looking at three months plus before I can head back to London) and another factor for me is that micro-surgery is only performed at one hospital where I am and that unfortunatley doesn’t have the greatest reputation (I also have very bad memories of it from when my grandfather was there on two occasions) and the standard op is performed at an almost brand new super clinic where the facilities are much better and I would be in a room by myself or with just one other.
The main thing I’m concerned about with a TRAM flap is the loss of tummy muscle strength, but the plastic surgeon I saw said this can be regained, and I have a very good friend who is a yoga teacher who has said he will put some extra exercises together for me for when I get back to London, as he is currently doing this for a client of his who had a TRAM recon in January.
Any advice about having the TRAM flap op would be very gratefully received!
Hi girls, just to say i’m waiting for my recon date hopefully anytime in the next 8wks!! had my mastectomy (left side & calcifications removed from the right side) in 2004 and had been refused reconstruction which i was really upset over, but in July last year i went for my yearly check-up and met a new surgeon who was gobsmacked at the thought i had been refused reconstruction, he decided to send me for some tests and a pre-op! and everything came back fine hoorayyyy!! recon here i come! i am having a Tram Flap, last week i went for my pre-op photo’s, really excited but very scared at the same time, but since being on this site i feel much easier with the tips and advice i have been given especially by nonsuch, who has been a godsend! XX
I opted for a TRAm flap op last june.I had seen “the work” of my surgeon on an other woman and on pictures and was impressed.I went along mainly because of this and because he has a brilliant reputation. Here in Germany a pediculed Tram-flap is supposed to be old fashioned but I’m very happy with it.The stomachmuscle is a bit tricky at first:Mine went into a spasm every time the temperature changed or when I walked (?) running or exercising didn’t effect it…After 3 month i could do normal sit-ups and do not have any backpain or other SE.I have seromas al around the new breast, probably because of to much activity, that is very uncomfortable but they are hardly visible and seem to vanish slowly so don’t overdo it.The tummy tuck meant that I lost a dress size,when i wear a bra you would’t notice anything but a fine line.
Many thanks for the replies.
I have decided to go ahead with the free tram flap and have met the surgeon and it has now made me feel more confidant.
She explained that in any cases until you are on the operating table, it is hard to tell how well the blood vessels etc are situated. Also that my new breast may be a tad smaller. The operation is a huge one and not to be taken lightly. She showed me lots of photos of ladies that had all different types of reconstruction, and gave me the pros and cons to them all. I still think that in the long run that this will give me the best outcome, and that it will prevent me having to have too many future ops.
I am worried that the new breast wont take and will be back at stage one, but I suppose its the risk you have to take. Also I have a young daughter who is going to find it hard to start off with as to why I cant play with her as much whilst Im recovering.
Just awaiting a date to go in for my pre op, hopefully sooner rather that later as I just want to get on with my life now.
Diagnosed with DCIS Oct’11, I had 3 lumpectomy ops Oct, Nov and Dec followed with an Mx with LD flap reconstruction op end Jan '12 so am now 4 wks post op. I also had an expander implant inserted.
I was really concerned about what I was going to look like afterwards but 4 wks later, and with only a little swelling left I am so much happier!
I do have a large (long) scar on my back but its really thin and and I cant credit the surgeon enough with his stitching, fabulous! Like I said its only 4 wks so imagine how much better in 4 months or a year.
It was a big op for me, apx 4.5hrs, and I was in hospital for 7 days however although it didn’t feel it at the time it was definitely all worth it for me as my results showed I had DCIS in all four quadrants. I count myself extremely lucky that none of it was ‘invasive’ so know I can move forward.
I know you’ve chosen the Tram op, which I cant comment on, but just thought that as Ive only just had my op so recently it would be good to let you know that things do get better quite quickly. I still have some follow ups to come i.e. the expander/valve replaced/removed and the nipple reconstruction will happen later.
Im sure you’ll get your date through quickly, keep us posted on how you get on. Good luck!
Thanks for the email, great to hear from you and glad your recovery is going well. I am hoping a op date will come through very soon, its the waiting thats horrible. I hope my surgeon is just as careful as yours with the stitches so its nice and neat.
Il keep you posted.
Hi Juls I’m like you at the moment just waiting for my date, finding the wait nerve-wracking to be honest! I’m excited but terrified, hope you get your date soon love, bigbird41 sounds like she is doing really well,I have great-nephews who are aged 3 and 4yrs and i play and roll around the floor with them all the time, after my op they are going to wonder why “aunty lynn” can’t act daft with them for a while! take care, xx
Bigbird41 well done to you! four weeks and sounds like your doing great, soo pleased for you! i was diagnosed in 2004 with DCIS, just waiting for my Tram Flap date! can’t wait nervous but excited, take care, Lynn xx
Hi Juls
I’m in the same dilemma as to which op to have - although I want mine at the same time as the Mx. I have concerns about loss of back strength and ability to do some sports with the LD so thinking about going for the TRAM, but will have to travel as my hospital doesn’t do it. Might have to fight for what I want!
Hi Shoez and VJ and all the girls messaging on this subject. Hope you’ve all had a great weekend, the weather is at last improving! Makes you feel so much better when the sun is shining.
V,I like you were concerned about the strength and how agile I would be to do sports, especially since some of the mobility etc is already weakened, hence swaying towards the free flap op. All I keep thinking about though is the recovery afterwards and the success of the op. I know I have to keep positive about it, but I am worried this time (think it’s because it’s my choice to have the op, where the mastectomy was a necessity). Keep thinking about my husband and daughter and how hard it will be for them, although I know that it has to be what I want. Role on op date, hope I hear soon. xxx
Hi Juls
I remember the same feeling about the mx operation (unplanned) Versus Recon (Planned). My partner and some friends thought I was mad to undergo such a big op without ‘needing it’. My response was to say it felt like the closure I needed after the MX.
No-one else but you can understand what a cancer DX does to your confidence, self esteem or physical appearance, so although I understood they were just worried for me,the recon was nothing compared to the original DX.
I still feel it was the best decision I made, as Id felt up till then that I hadnt had a lot of choices.
Keep well and hope you get the date soon-and glad youve got the nice weather. Send us some in Scotland its GREY GREY GREY and now very wet : (
Cathie
I am 10 days post op of mx and immediate free tram flap recon. I decided to go for this op because I didn’t want an implant which I would had to have had with a back recon. I had to have some muscle taken and mesh inserted as I have Crohns disease which can make the veins a bit crumbly so the PS needed the blood supply from the muscle and might have had to use extra from my ankle if more was needed, amazing, I can’t imagine how they do it.
Luckily the op went very well although it was 12hrs with another couple of hours in recovery. I felt very sick and horrible for a couple of days afterwards (I’m not very good with ops) and quite uncomfortable but every day feels a bit easier. Today I went for a short walk with a friend to a pond about 5 houses away and that was quite easy, she was amazed how upright I am this soon after op. I wake up lots in the night due to feeling uncomfortable but apart from that its not too bad.
Hope this helps, please ask any questions you want to.
