TRAM flap or DIEP after mastectomy in South Yorks

Hi. I am about to have a mastectomy and have opted for immediate reconstruction. I have laqrge area of DCIS and although the biopsy states it is low grade - Mastectomy is the treatment advised. Can I ask if anyone in my area has had the TRAM or DIEP reconstruction and how successful they have been? From what I have read the TRAM take muscle and the DIEP does not, does that mean the TRAM has a better result? I’m scared stiff to be honest, and could do with some reassurance!

Hi from another South Yorkshire lass.
I had bilateral TRAM and DIEP in July, after failed LD reconstruction 5 years ago.
I have to go out now but will post a reply or pm you later - just wanted to let you know that I’ve seen your post!
Catch you later

Just to let you know that I’ve sent you a pm x

Hi Undecided

Wow, bet your head’s all over the place with ‘what to do’. I have DIEP in May after being diagnosed with high grade DCIS with 4 areas of invasive disease (found after mastectomy). I chose DIEP because I wanted as little disruption to my tummy muscles as possible. This is because I enjoy kayaking and other sports so didn’t want to have problems with risk of hernias etc (when they do TRAM flaps, as I understand it, they put a ‘cage’ (mesh) under the skin to help prevent hernia as muscle is taken away, (with DIEP, the risk of hernia is much less as the muscle is not sacrificed in the operation). I think a lot of surgeons like TRAM as it keeps muscle attached and therefore blood supply doesn’t need to be reconnected in the breast so doesn’t need microsurgery.

As for results, well, my left breast feels pretty much exactly the same and I can wear tops as low as I like as I’m lucky enough to have kept pretty much all of my breast skin. It’s a bit fuller than my ‘good’ side but that’s because they put a little extra in to allow for ‘settling’. DIEP have given me excellent result with a breast which is ‘all me’. I was off work for just over 3 months recovering (it’s the tummy wound, hip to hip, which, in my experience, took the longest time to heal). I’d definately say go for DIEP but have heard good things also about TRAM so I guess you’d have to get a few opinions and decide which way to go.

Good luck with your decision and please feel free to ask away or PM if you have any questions at all, no matter how daft they may seem - they won’t be!

Lots of love. Cathy x

Thanks cathy. Did you have the diep as an immediate reconstruction? If so, did you have to have radiation or anything after?
I’m also worried because since being diagnosed I have lost weight (with the worry I think) so I’m hoping they can still use my tummy!
dawn

Hi Dawn,

I don’t have any info or experience on reconstruction, but would just like to say hi as am also in South Yorks ( Sheffield). Had my op (WLE) at the Hallamshire and rads at Weston Park.

Also have lost weight since diagnosis almost 3 months ago. Am now a size 8 and weigh just over 8 stone; not been that small since i was about 14!!

Good luck with your decision

Anna x

Hi Dawn

Just a quick post to answer your question. Yes, I had mast + immediate reconstruction and happily didn’t need chemo or rads (there was some discussion over whether I’d need this and I too had large area, 10.2cms, of high grade DCIS - guess the mast was enough to ‘clear’ it, however, I am now on tamoxifen for 5 yrs as and extra weapon incase any cells lurking etc!)

Good luck with your decisions and keep asking until you are completely happy. Lots of love. Cathy x

Hi again. Can I just ask if anyone knows about the blood supply to the tram or diep flap? I know Doxey you could probably answer this? If you don’t need microsurgery for the tram flap (for the blood supply as is needed for the diep flap), because muscle is taken from the abdomen. Does that mean the muscle does get it’s own blood supply when re-attached to the chest?
I think what I’m asking is… if the diep flap has its own blood supply will it be warm to the touch and more ‘breast-like’ than the tram flap? Or is there no difference? Sorry to be a pain but need to be really sure.

Dear undecided,

I have attached a link to an animation about breast reconstruction which you may find helpful.

breastcancercare.org.uk/breast-cancer-breast-health/treatment-side-effects/surgery/reconstruction/breast-reconstruction-an-animated-guide/

Very best wishes

Janet
BCC Facilitator

Hi Dawn

Re DIEP, can only speak from my experience but my DIEP boob feels the same as ‘good’ boob, warmth etc! There are numb areas in the breast but that’ll be the same whatever operation you have. DIEP operation takes blood artery from the muscle and reattaches it to the chest - this is to give supply to the ‘flap’ which is the skin which comes from your belly and is attached to the end of the breast (this can be as small as 2" if your mastectomy is ‘subcutaneous’ where they keep most of breast skin). TRAM, as I understand it, keeps blood supply which is in the muscle anyway. Personally, I imagine breast would be softer with skin & tissue (DIEP) rather than muscle and poss implant (TRAM) but I’m guessing as I have no idea about TRAMS so could be wrong here.

I can so relate to all the questions going round in you head - I’ve searched them all too. Really hope all goes well whether you’re DIEP’d or TRAM’d!! Lots of love. Cathy x

I had free tram flap Dec 07 2 years after my mastectomy (was never given option of immed) and really pleased with the result. My surgoen does use back muscle and implants but felt this would give me the better result.

Its a long op, from what I can remember my PS saying it does have micro surgery as they need to re-attach the blood supply and this is why you get checked every 2 hours to make sure the blood is still flowing and pumping to stop it failing.

I also have hip to hip scarring, was driving after 7 and back to work after 9 weeks. I do several gym classes a week which include stomach excersises I just take the lower ones more steady.

Debbie

The TRAM is an easier procedure because the muscle has the blood supply, with the diep, the blood supply is taken from much smaller blood vessels which are more difficult to attach to the blood supply in the breast so microsurgery is required. My PS always plans to do a DIEP but occassionally has been unable to because of an inadequate blood supply and then does a TRAM.
You have the right to have whichever procedure you wish to have even if it means being referred outside your area.
Another difference is that a DIEP needs more tissue, I think.
Kelley