Smoking and flap recon/TRAM

Hello all. I don’t know whether I’m having mast or lumpectomy yet, but I understand that I won’t be offered TRAM as I am a smoker. Obviously, my consultant will tell me, but I’m not seeing him again until Thurs/Fri. Might he do a TRAM if I give up smoking soon, or if I cut down? Otherwise, it’s an artificial implant - is that right?

Thanks for any experiences or advice you have.

i was an ex smoker (gave up in march this year) and i had back flap recon, which is very good, it really is, no you can’t have tram as the risks are too high for narcosis, and believe me, i started to smoke again, and the skin around where my nipple used to be died, had to have it cut of and stitched back on, did a good job mind you, but its my own fault for smoking! if you go to it will give you all the details that you need to know about back flap and tram, its really very good

Alison xxxxxx

Thanks Alison. Did you have your flap and tram at the same time as mastectomy?

Hi Emma, yes i did, i had the muscle taken from my back, and yes, i have been smoking again, but the risk is lower with the back flap, have you not been offered this Emma? think i only got offered it as i had been a non-smoker since march, but the stress and all that, well, i knew i would have risks weather i was still smoking or not.

Alison xx

Thanks, Alison. I haven’t discussed surgery type/recon yet because I was only told I had bc yesterday. I am having MRI on Tuesday to determine the exact size of the lump, and then discuss type of surgery and recon. I’m not at all worried that I won’t be offered everything feasible because we have a brilliant breast institute in Nottingham, state-of-the-art etc. so, do you think they might say, stop smoking now and you can have TRAM/whatever in few weeks, or do you think they’ll want me to have stopped smoking for longer than a few weeks? I know you don’t know everything, but it’s worth asking!

Hi Emma,
I was also concerned about my smoking- I had given up last september and the day that I was told I had cancer (in January) I brought a pack of 20 and smoked them on and off throughout my chemo. I had also heard that I would not be offered reconstruction if I smoked so I basically lied (I feel guilty even typing this and am not condoning or suggesting that you do this)
I have had my reconstruction, but prior to surgery I read up on all the facts re smoking and surgery and took on board alisoncameras experience and realised that smoking does make a huge difference to surgery, so once my date was through, I stopped completely cold turkey and found it remarkably easy. I read on the net that there was evidence that someone who had stopped for 3 weeks prior to surgery was in the same category as that of an ex smoker. In hospital, there was a lady in the next bed to me with emphasima and listening to her suffering has put me off cigarettes for life now so in a funny sort of way she did me a favour.
I have had no problems with my reconstruction- tram flap was not an option for me due to my body build and like alison, I had the back flap reconstruction which I am over the moon with
Hope this helps

Hi Emma, they will ask you if you smoke, and yes i was a little economical with the truth, but i have been so very lucky, and really should give up smoking now, i have cut right down again, but when i get agitated its the first thing i go for, feel ashamed at my lack of will power! but more ashamed as my surgeon is so lovely, and has done such a good job for me, and saved my life, try to cut down now if you can, when i was in hospital i never even thought about smoking, don’t know why i ever had to have another one, but what can i say?

lots of love

Alison xxxx

Dear Alison and Katy. That’s useful - I am armed with more info now. Consultant has already asked me if I smoke and if it was a lot, and I told him straight. I am not inclined to stop until I see him at the end of the week - just a few more days of pleasure! I really do want “natural” recon, so I will stop. Have no idea how I’m going to do it, but I’ll do it. Hopefully, then I won’t have to have implants. Don’t want them because they only last 10 - 15 years max, as I understand it.

Thanks so much for taking the time - it’s really helped, and thanks for being so honest. Don’t feel too bad or ashamed - smoking is a serious addiction.

Lots of love

Hi Emma, i have an implant and am not in the least bit worried about it, don’t forget, its only a little one put in just to pump up to make you more equal on both sides, ive not been told that i’ll have to have it replaced in the future, and my surgeon goes into every detail, worth asking yours when you see him

lots of love

Alison xxxx

Oh, thank you, alison. Yes, I will ask my surgeon. I don’t know if I’m having a lump or mast yet. But everything I’ve read (admittedly, not that much) has said that saline implants usually have to be replaced. Have you not read that?

I really think that its more for the larger size implants, mine is only tiny, and looking at it, i personally don’t think it will need to be inflated, just looked at the cancerbackup site and that doesn’t say anything about implant replacement, for this op or just using implants, apparently they use some gel stuff now, you should look at that site, its very good

Alison xxx

I’m a bit confused, Alison. You had back flap + implant? You don’t mean full-sized saline “breast enlargement” type implant, do you? You mean an extra little one to go with the back flap?

Hi Emma, yes, its under the back muscle, that was put in, its quite usual for this to be done, i look down on them and they do look about the right size on both sides, but the left has not had the nipple put on yet, but yes, i have an implant, and i can feel the the little bit near my ribs where they inflate you, it doesn’t hurt or feel uncomfortable, but thats how they pump it up, you really should go to, it will tell you all about it, you have no reason to be confused at all, at the end of the day, the surgeon just wants to make sure that you have the best cosmetic finish that they can achieve, i might not need to have mine pumped up, but if i do then it’ll be done, and in years to come, well, they will uplift the good side as well so that i always match, we are so much more fortunate than women many years ago

Alison xxxxxx

Hi Alison. Yes, we are so much more fortunate than women years ago.

I had biopsy on other breast with calcification today. It hurt a bit and I fainted when the local went in. I hadn’t eaten anything, that was the problem. They gave me biscuit and grapes and I was fine then. Then, horrid MRI scan. That b****y noise! I am complaining and moaning, but at the same time I know how lucky I am to have all this modern treatment.

I stopped smoking at 8.30 this morning, after being a heavy smoker for 26 years. All my tobacco is in the dustbin. I do not know how I’m doing it, but I am.

Thanks, Alison, for clarifying that. You are being a great help to me.

Thank you for the kind words Emma, if you ever want a chat, just send a private message, i’m normally about. you take care, and if you need a fag, have one, don’t add to stress more than you have to, but if you can keep off em, well, thats even better

lots of love


Not followed this all the way but wanted to add that my surgeon would not consider any flap if I smoked.Fortunately I had quit last year.

Thanks, morgaine. I don’t think mine will either - just guessing. However, he did mention rads at the first meeting with him, so I am thinking I’m not going to be offered an immediate recon if I have to have mastectomy, rather than lumpectomy. Could have smoked for a bit longer! No going back now - I’m not throwing these 2 days of torture away.
Cheers, girls.