Breast Cancer Expert Forum
TRAMM flap or Implant after mastectomy?
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Questions posted in the Breast Cancer Forum are answered by medical professionals and experts. Topics include Breast Biopsy, Chemotherapy, Hormone Therapy, Lumps, Lumpectomy, Lymph node dissection, Lymphedema, Mammograms, Mastectomy, Radiation Therapy, Reconstruction, Self Breast Exam, and Surgery.

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TRAMM flap or Implant after mastectomy?

For women who have had bilateral mastectomies, are implants a possible component for reconstruction or is the TRAMM flap the only real option?
If both are viable options, what are the pro's and con's of both types of reconstruction?

My concerns with the flap include 1) the fact that I'm very skinny and there may not be much to "flap" and 2)  if I get tissue from the shoulder, it will hurt my mobility and if I get it from the abdomen it will affect childbirth.

My concern about implants is that they may impede future screenings for recurrence. Also, I've heard anecdotes about them being unsafe.

By the way, are there different types of implants available?

I'm just starting to get info about reconstruction so any info or links would be helpful.
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More info on my status is below.

Recently diagnosed, with 1.3cm cancerous lump removed. DCIS.  I'm very young (early 20s) No metastasis  seen yet, though the lymph nodes still need to be checked. The doctors are saying chemo will definitely be necessary, as well as some sort of surgery, likely mastectomy on at least one breast though I'll probably opt for both.
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Dear Patricia 99:  Technically both reconstruction techniques are options, although a good plastic surgeon would be the best one to advise you on the best choice for you based on your anatomy.  Is there any invasive component to this lump?  If not, DCIS is technically a precancerous condition and standard treatment would generally be lumpectomy + radiation or mastectomy (not usually chemo) They may follow with tamoxifen, especially if estrogen receptor positive.  If there is any invasive cancer, then surgery lumpectomy + radiation or mastectomy (either with chemo) would be standard.  If you are very thin, a lumpectomy may not be possible - at least in terms of leaving you with a good cosmetic result.  In this case, mastectomy + reconstruction may be better.  It would be worth while discussing all of this with a very experienced breast cancer expert.  Bilateral mastectomy may be unneccessary.  Of course, I do not know your family history or your BRCA gene status and this may influence decisions.  In terms of implants, there are both saline implants and silicone implants.  Silicone implants are only approved for post-mastectomy patients.  The consistency is a little more realistic, although both types look acceptable.  You would not do follow-up mammography after a mastectomy - there is no breast tissue left to be mammogramed.  So implants would not change this.  In terms of flap reconstruction - a plastic surgeon could look at your anatomy and advise you better as to asthetic results, pros and cons.
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