Tram Flap reconstruction - information please?

Hello - I had stage 3 lobular cancer dx in May 2011 - 8 rounds of chemotherapy followed by a radical left mastectomy in December. 15 x rads which finished at the end of February 2012.
Today I had my first meeting about delayed reconstruction. I am told the best one for me is a Tram Flap. I was told that they take flesh from the stomach with muscle attached and use this to form the new breast. She did say that I would be unable to stand from a crouching position as a permanent result of this muscle repositioning. Also said there could be some strange bulging both above where the mesh is inserted and also from where the muscle used to be. Operation is a 5-6 hour one with a stay in hospital of up to 8 days. I was shown some “after” photographs and some were pointed out as being a poor result and that most turn out very well indeed.
I have an appointment to see my surgeon in January but the sister talked about bringing this forward and once seen then the operation would be done in a matter of weeks rather than months.
The hospital I went to is Chorley in central Lancashire where they have just opened a new breast clinic.
Can any of you lovely ladies give me words of encouragement about embarking on this next stage of my journey?


I had a mx in Dec 2006, with 8 Epi/CMF. I had delayed Tram Flap reconstruction in 2010. It was a very long op of 10 hours and I had a 7 day stay in hospital. The first few days were rough, not so much with pain, but the heated room I was in to help with blood flow and after effects of long aneasthetic. After the first few days I was up on my feet and moving about. My husband took 3 weeks off, and by the 3rd week I was out and about again. The results are great, I never had any problem with healing either breast or tummy. I still have a nice flat tummy 2 years on and reconstructed breast still looks good. I have had an uplift on natural breast and nipple reconstruction 8 weeks ago. It looks good. If you have any questions feel free to ask.
Take care

Carolyn x

Thanks Carolyn - I have no doubts that I want to have this done, just need a realistic view on what it involves and the recovery time. How much time did you have to take off work? (if that is applicable) I only work three afternoons a week but my boss needs to be aware of how long he will have to manage without me. My job is a desk job at a garage, no lifting involved and I could get lifts to and from work.

Hi Supertrouper I had my delayed DIEP/TRAM one year today! so its my right boobs birthday. It is the best decision I ever made and I am very pleased with the result. He intended to do a DIEP which means you don’t use any muscle but as my blood vessels were not too good he took out a small part of Muscle and put mesh into my tummy to avoid me getting a hernia. It is a big Op I was in the theatre for about 10 hours. Afterwards its difficult for a couple of days and they keep you in intensive care, but I was soon up and about and walking although I couldn’t really stand upright for a few weeks. I go to the gym 3 times a week and I do Pilates - I have to be a bit careful with my tummy and don’t pull on it or lift anything heavy but apart from that I lead a normal healthy life. I did the 5k race for life this year too (that was about 6 months after my Op) Its not about conforming, for me its about getting my body back and its so nice to be able to wear normal underwear and in the summer was on the beach in a bikini and so nice not to have to worry about my prothesis slipping. I am a D cup and there was plenty of flab on my tummy to make my boob the same size. I am now awaiting an uplift for the other side and a nipple for my new boob. good luck with your op xxx

Happy birthday to you, happy birthday to you, happy birthday saffronseed’s right boob, happy birthday to you.
Sorry - couldn’t resisit!
Oh bikinis - don’t think that I could do that at my age (56) although I did see a elderly lady on holiday earlier this year wearing one and apart from looking like her skin needed ironing - she didn’t look that bad!
And I think there is plenty of flab on my tummy to recreate my D cup - with some left over.
How will they create the nipple?


I dont work, but care for my little grandson, who was then 1 year old and required a lot of lifting. He went into nursery for a few month to give me some time off. I would say after 6 weeks I was well able to look after him. I had my op in Dec and enjoyed a holiday in March. I would think you should be off 4 to 6 weeks depending on how you are. Maybe a bit quicker if you have no lifting etc. Better taking etra time off than hampering your recovery. Like the others I have a D cup and had plenty of spare flesh on my tummy.

Carolyn x

supertrouper, Thank you for the birthday song - one of my friends from a facebook site gave me a ‘picture’ cake! when I say bikini read tankini lol… I too am wrinkly… but I soo wanted to show off my cleavage. The nipple (I think) they put extra skin on the flap (which is the bit they take from your tummy) and when they do the nipple they just cut into it and shape it - its quite a small procedure in the scheme of thing but won’t do it until your new boob has settled - so they get the positioning right. Like Carolyn it was a few weeks before I was up and about and able to drive - 6/8 weeks should do it for your work then as long as you are careful re lifting ect you should be ok. I couldn’t do any housework or ironing for a few months though (bliss…) xx


My nipple reconstruction wasnt done at the same time as the reconstruction. The cut into the skin and sort of twist it round, when healed it makes a really good nipple shape, didnt feel any pain as that boob doesnt have a lot of feeling after the reconstruction.

Carolyn x

Hi ST,
Did your surgeon go through all of the options for recon with you? I suppose all surgeons are different but my one said he alwaystries for a diep (muscle sparing) and will use muscle (tram flap) if he can’t do the diep. I had a ct scan to check my blood vessels and he was able to identify whichvessels he would use. He was even able to tell me where the tummy scar would be. BCC has just published some really good guidelines in reconstructions, they are definitely worth a read.
I had my diep 6 weeks ago, it was 8 and a half hour op and the best thing I have done. Ok, it’s not perfect, it’s smaller than the other one and I have an extra scar where he used the skin around my belly button but I love it. I’m still off work and will have another week off but that’s because I commute to work and I dOn’t feel up it it just yet.
I was out of bed the day after the op and walking up and down the ward a few days after. I was bent over for a while but am now able to walk tall and straight with just a slight pull on my tummy.
Good luck honey,

Hi Lisa
My surgeon won’t do the diep operation so it has to be the tram flap. I understood all the different options and specifically asked for this one as I don’t particularly want scars on my back and to be honest, I could do with a bit of a lift in the tummy area.
I woke up this morning feeling uncertain about it all - after all I have been through, why would I want to put myself through surgery again unless it was absolutely necessary. Then I got up and got dressed and just know that I need to do this for myself - to try and get back some of what this disease has taken from me.


Thats a perfectly normal feeling. One day I would be thinking I could manage with a prostheses. Next day I would be hating it, deep down I knew I wouldnt be happy using a prosethesis for the rest of my life. Tram Flap was right for me, though I understand its not for everybody. Its the best thing I have done since my diagnosis. My family did say why was I wanting to put my self through more surgery that I might not feel happy about. I researched on the internet and read all the stories good and bad, but the final decision was my own and one I have never regretted, two years on I can honestly say I have no ill effects, I get out of bed ok, push my little grandson in his buggy, go swimming etc.

Take care
Carolyn x

Hi ST,
I’m a little confused as to why your ps won’t do a DIEP? Did she say why she would prefer to do a TRAM? (DIEP being the current Gold Standard for recon.). Both are massive operations, but DIEP is preferable as it leaves your muscles intact.
Sue x

Hi Sue (Samos) It was the Sister who said my ps wouldn’t do a DIEP and she didn’t go into the reasons. I have my appointment with ps on Monday 17th so will add the question to my list.

Yep, I’d Defo ask because a DIEP is preferable, although once they ‘go in there’ they may change it to a Tram if the blood vessels are inadequate.
Good luck!
Sue x

Totally forgot to ask my ps why he didn’t do DIEP operations. He is confident that he can do a sucessful pedicled Tram flap and I am now on the waiting list. Apparently I will have to be “done” within three months. Another appointment has arrived today for January 14th so not sure what that is for? Will try ringing them after the festive season.
My surgeon has advised me to try and put on a bit more weight - said I should drink and eat more but not to start smoking! (as if I would) I am not comfortable with the weight I am now which is a stone heavier than I was before I started chemo etc. Has anyone else been advised to put on weight before reconstruction?

hi Supertrouper

I had the tram flap done on 27th November and my ps told me to try and put on weight to as it would give him more skin to work with. im not that big a size 14. there was only 3 weeks between him telling me and operation , so I did not manage much but he said anything helps.
Hope this helps, op went ok and i now have a flat tummy

Thanks bmw07 - I haven’t got a date for my operation yet and Christmas is just around the corner so should manage to put a couple of pounds on but feel bloated and heavy. I suppose once the operation is done then I can try and lose what is left. I was a size 10 - now approaching a size 14.

hi supertrouper
Since my operation I have lost just under a stone , so I would not worry about the weight
Best wishes

I put on a stone through Chemo, which I determindly hung on to to provide as much tummy as I could for my surgery - an immediate bilateral DIEP. Even then my ps told me she ‘would have liked more to work with’.
Anyhow, she managed to make two boobs out of it, very similar in size to my original 32DD’s.
I still don’t know how she managed as I was a size 10/12, and still am, having lost the chemo stone.
If it was me though I’d want to know why they have discounted a DIEP, and why not a free TRAM which would be less damaging to abdominal muscles - although the pedicled is a quicker and less risky op.

Hi there

I have just logged on as only recently been diagnosed. I am 40 and have had a mastectomy with immediated tram flap reconstruction 10 day ago. I am assuming that you have already had your operation, and hoping it was agreat success. 

I was wondering if you could tell me how you felt immediately afterwards. All was very successful and the results on the eye are amazing. my only concern is that my stomach feels tight and my appetite is very small. My stomach appears swollen and quite hard to touch. I was wondering if this happened to you and if so how long did the swelling take to go down. After having a tummy tuck procedure my waist is the same saize as before and i hope this is due to swelling.

I trust you are now doing well and I look forward to hearing from you soon