Tram Flap Follow Up

[MissyMouse]

What is the best way to follow up a breast cancer survivor who has had bilateral masectomies with a tram flap reconstruction?

[CCF-RN,MSN-JS]

Dear missymouse, Follow up after mastectomy with tram flap reconstruction is mammogram (only one view) and clinical breast exam (physical exam by health care professional).

[surgeon]

the problem with mammography of tram flaps is that if cancer were to recur, it's nearly impossible that it would do so WITHIN the flap, so xray of the flap is viewing mainly tissue not at all at risk. But, because it's been mobilized, trimmed, dealt with vigorously from a surgical point of view, it's likely to go thru changes, including sometimes the development of calcifications. So you get a bunch of information about changes and shadows in tissues that have nearly zero risk of harboring breast cancer. Nor, in my opinion, does it make sense to get only one view if one were ordering them: the purpose of the two views is in part to get the areas near the chest wall: recurrance within the field is more likely to appear there, so if you are looking for anything, it would be at the chest wall and not in the flap, so getting two views would make more sense. However, it's my personal view that mammography is more of a problem than a help, and that regular physical exam is the best approach to surveillance, unless there were a particular reason to worry about local recurrance, which is in general quite unlikely after mastectomy.

[agl]

I had a tram flap ten years ago with chemo and tamoxifin (tamoxifen) and recently had a mammogram on the tram flap side.  I had a recurrence to the chest wall on that side.  I was greatful that I had the mammogram on the reconstructed side.

[MissyMouse]

Well I guess I will talk to my surgeon, oncologist and plastic surgeon and see if maybe once a year would be a good test for me to have.