Tram Flap or Tissue Expander?

I am 57years old in great health, other than needing a mastectomy in right breast, having been through an excisional biopsy and a lumpectomy without clear margins again. I'm 5'6, 122 lbs, have had silicone implants for 27years.  Plastic surgeon thinks I will be happier with results of tram flap rather than implant, since at this point, Kaiser only covers saline implants. If a silicone implant would give a "great" result, I would consider going back to original Plastic Surgeon for that operation. Keep in mind that left breast still has an implant, but it also has some natural "sag" to it. I am self-employed and very busy - tram flap will put me out of commission for 5-6 weeks (I can handle that if it's worth the long-term effect). I'm not crazy about the scarring I have seen on the breast and stomach that goes along with tram flap, but also want to have the best long-term result.  I like the idea of "waking up" to having a "breast" in place, but wonder about the pain and recuperation.  Would love to hear from women who have had either reconstruction done.  Thank you!  I have to decide in 2-3 days.

[CCF-RN,MSN-JS]

Dear Maryg, Your request is posted.

[neatfreakmom]

I had a bilateral mastectomy on 3/11.  I did not have enough body fat to do the tram flap, so I am doing the tissue expanders.  It was tough waking up to having nothing when I had had DDD breasts, but I started wearing a camisole that I sewed cups into just to give myself a little shape.  I was able to go back to work 3 weeks after my surgery.  And I just go to the plastic surgeon every 2 weeks to have my tissue expanders injected.  This has been almost painless.  I already have 600 ccs of saline in each implant, and the capacity of my expanders is 750 cc, so I am getting towards the end of having them injected.  Two of the times I have gone the plastic surgeon has been able to put 120 cc in each one.  With the expanders, I already have cleavage and most people wouldn't realize that I don't really have breasts.  We are hoping to be able to put the implants in in early July since I teach school and I don't want to have to miss any days at the beginning of the year.  I do have a cousin who had the Tram flap, and she was out of work for 8 weeks, and was in the hospital for 5 days.  I was only in the hospital for 23 hours.  I hope this answers some of your questions!  Best of luck to you!

[maryg]

Thanks for the response!  How does your cousin like the "end" result of her tram?

[neatfreakmom]

She likes it just fine -but she said that she probably would have preferred not to have all of the pain and lost time from work if she would have known ahead of time.  It was hard on her too, because she is single and didn't have the support that I got from my husband.  Good luck!

[ly3]

I had a nipple sparing mastectomy followed by an immediate tram flap nearly 7 weeks ago, due to similar circumstances.  I am extremely pleased with the outcome and feel it was definitely worth it.  I was told my reconstructed breast would probably be smaller and the other would have to be adjusted to match, but so far, they are still the same.  Save for the scar on the breast, I pretty much look the same.  The tissue is a little harder, but the droop is the same.  My oncologist said it was due to the excellent teamwork of my breast and plastic surgeons.  The breast has lost some feeling, but is not totally numb.  The stomach incision and drain areas have been more of an issue regarding pain and recovery, and some days I still move pretty slow.  It does limit your activity and fatigue.  It's a pretty big incision, so it's logical that any movement will produce a pull somewhere.  5 days in the hospital, two with a painkiller pump, followed by pain pills helped big time in the beginning.  Went to sleep scared to death but from the minute I woke up, it has been easier than I anticipated.  The worst part was waiting for bodily functions to return following the surgery, kind of like after having a baby.      

Another occult tumor was found in the tissue, reinforcing the  mastectomy vs lumpectomy issue, which I wrestled with all through chemotherapy.  Now I know I made the right choice, which is what all doctors recommended.  Also, the oncologist's social worker had former patients with implants and tram procedures call me and share their experiences, which helped me make the choice.  In the end, I went with my gut feeling, and there is comfort in knowing it's all still me, just re-arranged.  If I can answer any more questions, please ask.

[maryg]

Thanks so much for your input.  I had decided yesterday to have the tram, and then worried about it all last night- I think I am more afraid of the pain and recovery than anything else.  I just kept reminding myself that once it's done, it's done - kind of like having a baby - once labor's started, there's no turning back!  So, like all the brave souls before me, I will get through it - thanks for your support!

[susan617]

I just had the tram flap done 12 days ago.  I spent 3 days in the hospital and have to say that when I got home I only took Advils for the pain.  Mostly it is numb and not much pain.  I think the outcome is great and by summer they will place the nipple.  
I believe I would be able to return to work soon but am taking advantage and staying out the 3 months my surgeon said I could. If you want anymore info you can email me at: ***@****

Good luck to you,
Susan

[GNP]

When I was diagnosed with BC,stage1,clear margins,no lymph node involment,I made a decision to have bilateral mastectomy with reconstruction,based on my family history.My surgeon recommended TRAM,I started to do research on all types of reconstruction,and decided on DIEP.This type of reconstruction,does not involved abdominal muscles,only your own fat from abbomen and blood vessels attachment to newly formed breast.I had this procedure on May,20,04,and very happy with results and easy recovering because,no abdomen muscles were touched.This message is for all who concider mastectomy with reconstruction.Please,do research,do not eccept the type of the surgery if you feel it is not for you.