free tram flap breast surgery

could you please tell me which is the best way to go. a free tram or the diep tram ? I am faceing  the free tram in january 07 of 08 and i am really scared  all i have read on the web  are nightmare stories, please tell me if there is a surgeon in my area that does the diep. and please tell me the ups and downs . i just do not know what to do. if you could please email me at  ***@****  and tell me if you know a DR. in my area that is really good i would be so thankful. I have had so many failed breast surgerys i am really just about at my end and i still belive there is some one out there that can help me. i live in the Indianapolis and fourt wayne indiana area thank you so very much  Jeannie

[Cleveland Clinic]

Dear Jeannie:  In situations of reconstruction, the plastic surgeon is the specialist who is best equipped to make a judgment in terms of what procedure is likely to be most successful for an individual patient.  There is no way, via the internet, to make any specific recommendations with respect to a specific procedure or individual.  We are not able to make specific physician recommendations.  Our suggestion is to contact large academic medical centers in your area and ask about those with extensive experience in breast reconstruction.  The doctor should also be board certified.  Seek a couple of opinions and ask for references.  Oncologists may also have some suggestions based on patients who may have had good outcomes.  While the internet can sometimes be a good source of information, it can also provide information that is inaccurate and based on opinion.  Try not to base your decision solely on the writings you find on the internet.

[jeannie255]

Thank you so very much for responding to my concern. I will follow your direction. I think  i understand the way to go. and you are so right, of all the bad stories i have read about iam sure there are just as many good ones. once again thank you so very much Jeannie.

[lhughes69]

I was so afraid of a tram reconstruction, but because I had radiation, that was the only type available.  My mom had a failed tram (not a free tram, the other kind).  I have read about diep, but don't know of anyone who has undergone that type of reconstruction.

I had a beautiful reconstruction surgery and recovery.  It could not have gone better.  My mom's past experience was quite horrible, so I feared having the same issues she did (being that I share a good deal of her traits).  I chose to go to a different hospital, had two or three people give me excellent recommendations on the doc I chose (some even unsolicited!!).  My oncologists all agreed that he was a very good choice.  I can't say that my mom's doc had anything to do with her failed reconstruction (he sighted only 1 other failure in his 20+ years), but my hospital experience and post-surgery care were totally different.  Keep in mind that they have learned a few things in the 6 years since mom's surgery.

Your best bet would be to talk to people in your area that have gone through reconstruction, talk to the doc on his experiences, what do they do if something does happen to go wrong, what do they do to make sure that things go right...etc.

My "franken-boob" as I've nicknamed it looks pretty durn good in a bra.  My doc did a fantastic job on matching my other one to the newly reconstructed side.  He was very understanding of my fears and I felt like he listened to my concerns before the surgery.  I did everything they asked after the surgery (even when it hurt like the devil to get out of bed).  All in all, my experience was VERY good.

[jeannie255]

thank you so very much for your imput,I really appreciate you taking the time to tell me  of your experience,It really helped me and made me feel a little better about what i am faceing.I am so sorry about your mothers failed tram. I feel certain i have a very good plastic surgeon. And i have spoken to one of his patitents,That to was very well pleased I wish you all the best of luck and God bless you I send you hugs.

[jeannie255]

this is jeannie, i forgot to put who my post comment was to .

[lhughes69]

I hope you have a beautiful reconstruction.  Do you know what time frame?  What all have you gone through at this point?

I think I've read a few things on DIEP, I don't quiet understand the differences, somthing about TRAM takes muscle and DIEP takes underlying structures, but not muscle???  I don't think that DIEP was mentioned when I spoke with my docs.  TRAM is usually the way they proceed.

When you get there, let me know how it goes.  Do everything they ask, and they will ask what seems to be the impossible.  If you've had babies, then equate TRAM with c-section in terms of pain..maybe a bit more, but the recovery was similar.  The first time you get out of bed is the worst, second time is the second worst.  After the 4th time, you'll feel like a champ at it!  Then, start walking...first to the door and back, then to the hall, then around the floor.  It gets easier each time you do it.  However, it isn't pleasant.  You can and will get through it.

Lisa

[jeannie255]

Thank you once again for shareing with me your expereince. my time frame is 10 hrs. seems like a long time to me.But i am sure the Dr. knows best, I ask him why so long, and he assured me you don't wont to rush this type of surgery.Back to what i have went through up to this point. I have had a double mastectomy, i have had so many surgerys it is unreal, first i went with implants, And that was my first mistake.After several sets of implants and a rupture i finally had the latissimus flap done back in2000.Thinking that would be the end, boy was i so wrong. I had trouble right from the start. Then went back into surgery to repair what was wrong as soon as i woke up from the first surgery.that to proved to be another failure. By this time i am to the point that i have had enough. It is now seven yeasr later and i have just abought had all i can stand with the feeling that my breast are under my arms.They haved droped and one side is flat. so i am a mess. This is why i have chose to seek out more help.I feel sure i have found a VERY VERY GOOD Dr. this time there is nothing but good  spoken abought him and, he is board certified which is to a must. And he also  is told to be the best of all around. So i am going to go into it with an open mind. and trust not only the DR. but the LORD also. I think what i worry most abought is getting a hernia. Do you have any trouble with this or your back? I have read that if you have back probelms they could get worse. I sure hope not. I don't think i could stand much more. Thank you again for your imput it really helps and makes me feel so much more at ease about having the surgery                                               JEANNIE

[jeannie255]

I wanted to ask you earlier, Do you have trouble standing up streight?, And does your stomich feel like it is pulling all the time? How much therpy did you have to have? I read like i said befor nothing but bad advice. I realize we have ahard time with things we have to go through in life, and i know sometimes we hurt, But some where there has to be more good up lifting advice like you shared. once again thank you. and yes i know i will come through this ok and it will be worth it all.     Jeannie

[lhughes69]

Let's see...I didn't get any physical therapy (don't know if any one else did).  They do send you home with good information on how to get yourself back to almost normal.  I say "almost" because, let's face it, muscle has moved to a different location!

Day of surgery...scared brainless.  The surgery took 6.5 hours, recovery around an hour.... I was in my room around 4pm or so (7 am surgery).  Didn't rightly wake up until 3am.  Morphine pump is wonderful.

Day two...not hungry, can't really move much.  They wake you up every hour to check blood flow with a doppler (very interesting).  Made myself eat a little breakfast, very little, more at lunch.  Dinner time, I was hungry!  They took out my cath around 1pm or so.  So, you HAVE to get up.  Getting up the first time is AWFUL!  It's difficult to figure out how to make your stomach muscles get you to a sitting position, much less walk.  You walk humped over the first day.

Day three...have been up and down half dozen times.  It gets easier each time.  You learn how to pull with your arms and where you can get people to push to get you up.  Mind you, I'm short and I couldn't touch the ground in a sitting position...this adds a whole new level of difficulty to the situation.  You start walking to the door, out the hall.

Day four...much less pain.  Out with the morphine pump...freedom to walk the halls!

More later..girls need me.

[jeannie255]

I was just wandering, Did you have a tramflap or a free tram flap? there is a diffrence between the two. The tram flap is the one where they tunnel the tissue and muscle up to the chest,And the muscle is actually fliped over and up. The free tram is where they cut the tissue from the stomich and then transfer it up to the breast, and they only use about a nickle size of the muscle. they are both bad surgerys, And in no way can either one be down played, but they tell me the free tram is a little more bearable, due to the fact that only a small amount of the muscle is taken.when did you have your surgery? just wandering how you did on not lifting, it sounds like you have a little one. I hope you and your family are all doing wonderful. It sounds as though you are doing great. I am so glad for you. I just wish the rest of us who are faceing this, the great recovery that you say you have had, and i feel sure i will.   Jeannie

[lhughes69]

Free Tram Flap, yes, there is a diff...I believe (don't quote me) that free tram means that they basically cut out a piece of the abdominal muscle from itself and moved it to its new location.  The other tram flap they pull the abdomenal (abdominal) muscle up to make a pocket leaving some of the blood vessels still intact.  My mom had that version initially, which failed horribly.  And then the rest was not too pleasant...remnants of your story.

I had my surgery 30 April of this year.  I have no hernias to speak of, and my doc did check.  I went back to the gym 30 days after to stretch all the muscles back out a bit and strengthen everything.  Oh, and I had a friend of mine who is a massage therapist do SOMETHING to my bad arm (the one where the mastectomy was) to get my full range of movement back a lot quicker.  She pushed somehow and I could move the durn thing 5 more inches.  That was 3 weeks post-op.

I still cannot get to a sit-up as well as I could, but it is getting better.  I don't go to the gym as much right now since I just started back working.

Standing up straight will happen around day 4.  They sent me home day 4.  Oh, and you NEED a thin pillow to hold your stomach...at least I did.  The hospital had one of those throw away pillows that's just big enough to cover and thin enough not to weigh any thing.... you'll need that to get home.  The seat belt does hurt quite a bit.

I don't think I laid straight out in bed until 3 months later.  I had either a pillow or two under my head and one under my knees to start, then just under my knees for a while after that.  Getting up the first 4 times is the hardest, after that...piece of cake mostly.  Every once in a while you'll find it difficult

You have had a SERIOUSLY rough time with this reconstruction thingie.  I cannot tell you how much I feel for you!!!  I do hope this last surgery is your LAST surgery and it turns out as good as mine.

Things they don't tell you...

you won't have feeling in your abdominal skin area for a LONG time..mine hasn't quite returned, but is getting there.

there is a ridge along my bikini line where they sewed everything back on.  Rougher on the side of the donated muscle.

they might give you heperin shots to keep the blood from clotting.  They HURT.  You'll get through it.

they keep the rooms warm for a purpose.  It does get sortof uncomfortable by the time you leave.  You won't notice it to start.

...gotta run again.....you don't want to know what these two are doing now...oh my  (3 years and little one is 19 months).

write to me if you personally through here if you want to talk more.  I'll keep you in my prayers.

[jeannie255]

I would like to hear from any one who has had  a free tram flap breast reconstrution done. i can't beleive there is no one but me and one other person that has had this surgery. I would like to hear the good and bad of your expereince with the surgery.I have not had my surgery yet, it is coming up real soon. thanks to any who will respond. Jeannie

[jesr30]

I have also had issues with my reconstruction. I just went to see a Dr. today. He is the first Dr. in Houston to perform this surgery and is double certified. I too would like to hear more input on anyone who has had this surgery.

[idobelieveinfairies]

Ladies please go to breastcancer.org. Then community support. Join the forum there. Scroll down until you see breast reconstruction and read and post there. You will more than likely find all the info you need. Hope this helps.

[jeannie255]

thank you so very much for your info. it really did help. again thanks jeannie

[maz112]

Three years ago I had a tram flap reconstruction. Everything went well. Today I am very happy with it. I am able to wear lower tops and it actually looks better than my real breast.  I have had my own tissues from my tummy used rather than a silicone implant.  I have decided for the present not to have my nipple done. As I think  my body has been through enough.  Go ahead and have the tram flap done.  Trust in your surgeons.  By the way I live in Australia.  Good health.

[jeannie255]

Thank you so very much for your words of encouragment, I really really needed to hear this just at this time. I have really thought about not going through with the surgery, But every time i contenplate  not having the surgery, i stop to think and weigh the benifits of it.I am really scared i to have already been through so much. I have a wonderful surgeon.My husband ask him how many of these he had done and he said over 500 so that is a pretty good number for this type of surgery. so again i say thank you, And i have always wanted to visit Australia i know from all i have seen and read about your country it is really beautiful. I live in Indiana May Good Health Always Smile On You. Did you have the free tram flap where they used a small part of your muscle.  or did they tunnel the muscle up? I am having the free tram they say it is the better of all trams.

[lhughes]

Go ahead and do the nipple!!!!  They don't do surgery, just inject you with lidocaine and then make incision in the center, pull up the skin to make a nipple, and stitch you up.  It's not so bad (as compared to everything else we've been through), probably much easier than getting blood drawn.  You don't really feel anything other than some pulling.  However, I did NOT watch!!!!!  It took about 20 minutes to complete.  6 weeks to heal the incisions, then they tattoo the areola to match your other breast.

My mom didn't have her nipple done, and I think I like the look of mine better than hers under clothing and out of clothing.  It helps give the breast a more 'real' look to it, in my opinion.

But, if you are good with your look, you may not want to do anything more.  I understand that.  Just want you to know that the final part is the easiest to complete.