Putting aside cosmetic concerns, looking at the scope of surgery in a TramFlap vs. implants after extenders, it seems that the implants are a safer easier route. Is this the right medical conclusion? My biggest concerns after a double masectomy are risk in the surgery, post op potential complcation and medically living with whatever choice. Years later is my own skin healthier than implant? . I Do not really care how they look in the nude.
Better yet, consider DIEP Flap, which uses your own tissue, and does NOT disrupt any muscle (resulting in fewer complications). lf you have extra abdominal fat, this procedure can provide a free tummy tuck in the process.
If you use the "search this community" box to the right of your screen, you will find previous posts about it, and even a link to the Web site of a highly recommended (by one of our members) clinic and doctor who is very experienced in this type of reconstruction.
Have you had or do you need radiation to your breast area?
Are you located in the USA?
If you have NOT had or don't NEED radiation, expanders followed by implants OR direct to implant reconstructions are a likely route for most women. There isn't any muscle taken and it's pretty straight forward a surgery with a 6 to 8 week recovery time frame. You have options of silicone or saline implants. The expansion process can be very irritating and painful after each fill. They also tend to create wierd shapes depending on what was pressed against them. Sometimes they stay square all day long. Very odd :) And then there is the second but easier surgery of placing the implant. You get to choose what "model" implant you prefer (and what your PS is comfortable working with) and after 3 to 6 months of expansion you have a tradeout of expanders replaced by implants.
There is also the direct to implant route and there are a few VERY good teams that do that surgery IF you have not had your mastectomy yet and IF you're a good candidate for it and IF you aren't going to have radiation. Certainly you can get implants and have radiation but there is a 70 to 90% failure rate. Radiated skin doesn't stretch. And radiation done on expanders/implants can create capsular contraction. Not a good mix.
A lot of women have implants and are thrilled with them. Then there are a lot of women who feel like they have weights stuck on their chest. The feel of implants is more of a firm feel with a slight tissue cover. They don't have natural movement. Last of all, implants must be replaced so you are looking at future surgeries and the potential for complications.
LIVE TISSUE TRANSFER FLAP RECONSTRUCTION - muscle moving surgery
There are two groups of tissue transfer FLAP reconstructions, two of which move MUSCLES (TRAM FLAP and LATISSIMUS DORSI FLAP). These are the most COMMON reconstructions that every plastic surgeons can do and are the older style of reconstruction.
The Latissimus Dorsi Flap is taken from the back and the MUSCLE is tunneled (moved) from back to front to create a sling to support either a large enough flap & it's blood supply or an implant. Most require the use of an implant and also alloderm to help support it as well. This surgery is recommended mostly for people who don't qualify for TRAM FLAP reconstruction (of the muscle moving reconstructions). Please look this surgery up and you will see what it looks like. Please note that with this surgery you will be turned over during surgery and will have scars on your back and front.
The TRAM Flap comes from your stomach. The donor site will begin just at or below your belly button. With bilateral mastectomies they will take BOTH of your 6 pack stomach MUSCLES and crisscross them tunneling the left muscle up to the right breast and the right muscle up to the left breast. And though those muscles are great slings for the stomach tissue, skin and blood supply, once tunnelled you no longer have stomach muscles. The PS will insert MESH to hold things in where the stomach muscle had done before. Please read on this and you will see that there can be a lot of complications with MESH. Those stomach muscles are crucial right where they are and in my honest opinion should not be moved. They support your lower back. Tram flap patients have a high risk of hernias.
Recovery is 8 weeks. These flaps were the traditional way to do tissue transfer reconstruction. These are LIVE, soft breasts as the blood supply is moved right along with the tissue. They will have natural movement.
The next post will be about tissue transfers with live tissue and NO MUSCLES MOVED. Not sure if I'll get to that tonight but I will for sure by tomorrow. The choices with that are ALOT and they DO tolerate radiation whether the transfer is done before or after radiation.
Tissue Transfer MUSCLE SPARING FLAPS.
You're looking at 8 weeks recovery.
Some of these reconstruction options have been around for 10 or more years but are considered the most sophisticated technique for reconstruction for those that want their own tissue used.
These flaps hold up VERY well to radiation and also work beautifully with skin that has already been radiated. These flaps work wonderfully with both women who have already had mastectomies and women who haven't had it yet. The difference is the scars. If you go in for bilateral mastectomies with IMMEDIATE FLAP reconstruction, you have teeny tiny scars vs. the 7 or 8 inch mastectomy scar.
The DIEP flap employs skin and fatty tissue in the abdomen to restore the breast. The result in the abdomen is much like a tummy tuck in that the abdominal contour is often improved significantly as well. In contrast to the TRAM flap, the DIEP procedure does not sacrifice the muscles of the abdominal wall. This preserves the abdominal strength and avoids the need for implanted mesh.
Perforator flaps represent the state of the art in breast reconstruction. Replacing the skin and soft tissue removed at mastectomy with soft, warm, living tissue is accomplished by borrowing skin and fatty tissue from the abdomen or hip. This is accomplished without sacrificing muscles and strength. This is the surgery that I had and I'm thrilled with my results.
In some women the superficial vessels in the abdominal fatty tissue provide the dominant source of blood flow to this region. In those cases the SIEA (superficial inferior epigastric artery) may be chosen as the source of blood supply for the borrowed tissue necessary to reconstruct the breast. The procedure is otherwise the same as the DIEP procedure and represents a second choice for women whose superficial vessels are more dominant than the deep inferior epigastric perforators (DIEP's).
For the thin woman or those with otherwise inadequate tummy tissue the breast may be reconstructed with tissue borrowed from the gluteal area. Skin, fat, and the tiny feeding blood vessels are collected without loss of underlying muscle tissue. The fatty tissue is removed from the excess in the upper hip providing a closure line that is concealed even in the most delicate of undergarments.
The IGAP is similar to the sGAP except that fat is collected from the lower hip and buttock.
Bilateral Simultaneous Immediate GAP Flap
My surgery center was the first to develop a protocol that allows those seeking reconstruction of both breasts the option of reconstruction in one operation when the tummy tissue is insufficient. Historically GAP flap procedures have been performed one breast at a time requiring two separate operations usually several weeks apart. The center for restorative Breast surgery now offers this option routinely to those women who are either thin and athletic or who for other reasons are not candidates for our procedures that borrow from the abdominal fatty excess.
"Stacked" DIEP Flap
Pioneered at my surgeon's center, the "stacked Flap" provides another option for the thin woman who needs reconstruction of only one breast. This procedure allows for use of more abdominal fatty tissue than conventional TRAM procedures or single dIeP flap procedures. Using sophisticated microsurgical techniques, our surgeons are able to provide a greater volume to the reconstructed breast than has been historically possible. Our development of the "stacked Flap" has provided the opportunity for reconstruction with abdominal tissue for women who would have previously not been candidates.
I am going to say this about these muscle sparing tissue transfer surgeries. These are performed by plastic surgeons with several YEARS of micro surgery training. They are moving and re-attaching teeny tiny blood vessels. This is a very specialized surgery and is NOT performed by most plastic surgeons. My surgery was done by one of the best teams in the world and I would NEVER go to a surgeon or team of surgeons who have NOT done THOUSANDS of these. This is not something you want to be "one of the first" for them to LEARN on. My team of surgeons have less than a 1% failure rate. That matters!!!!! I am so thankful for all the women who went before me.
Benefits are: soft swingy bouncy beautiful breasts with less than 1% breast tissue (proven by MRI) left in my body. I have all of my muscles intact and can do sit ups if I want to. They look and feel like real breasts because they are my own tissue. They match "ME". Nothing artificial here. I am a stomach sleeper and am quite comfortable doing so. I am going to be 55 next month and I have the breasts of a 25 yr old and go braless when I want to. It's an incredible feeling to be cancer free and not have what I called 38 longs trying to reach into the waistband of my shorts! :)
I had two microsurgeons working on me at the same time and my surgery lasted 6 hours. That was stage 1 for me.
Stage 2 was when I went back to get a little tweaking done (liposuction is done by my surgeons afterwards to help reshape the body from where they took the donor flaps). also had my nipples created at that time. They cut into the 3 month old flap and twist the skin and stitch it until it forms a nipple. There was no pain involved with that. The liposuction was another matter entirely!! Talk about bruising! wooooo hooooo!
Then at the end of the year I decided to go back again to get my tattoo's of the aureola & nipple to give them the color that I used to have. That was stage 3. No pain, no problem. I am thrilled I went back for that! I chose the full enchilada and let them do whatever they wanted and some of what I wanted. I'd do it all again if I hadn't already done it.
This is major surgery. ALL of these procedures are major surgery. This was covered by my insurance and I know women who had this procedure done and it was covered by medicare. I also know that it's not covered by ALL insurance companies but you can always work out a deal with the surgeons.
I'm not sure if you were interested in ALL of this information but hopefully it gave you something beneficial to help you make your decision. And just maybe it helps someone else who is trying to decide what their options are.
Best wishes to anyone reading my reconstruction ramblings :)
Hi Sue Young your explanation on breast reconstruction is really interesting and I must say you are the only one who has given me such useful explanation. Can you tell me how much it may cost for a DIAp recons?
I have not made a final decision as of yet -I got to see my onocolgist surgeon today... still LOTS of questions for him. I am not BRCA positive which is a huge releif to me as I have 2 teenage girls! I'm glad not to pass that on to them.
My main concern is making the wrong choice. The one I will regret in a couple of years. It is SO hard to make a decision now. In talking with my girls, they said, mom, just take off the whole breast, so we don't have to worry about it coming back. My younger daughter (15 today!)is so scared that I am going to die from this, she can't hardly look at me. So I really just want to get done with it, adn get on to recovery!
I am mostly afraid to come out deformed. If I cannot look at my body, how can my husband? So I am afraid that a lumpectomy will leave me disfigured. I know a mastectomy will leave me disfigured, but they will fix that. Will they fix me if I have a lumpectomy and am disfigured?
I have 2 pages of questions for my doctor today, and I guess I will wait til he answers them to decide. I know my heart will tell me the right thing to do.
Thanks for your information. I will be back to let you all know what is happening
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