Tram flap breast reconstruction and weight loss

I'm considering bilateral trams to replace my current saline implants which have been in for almost 15 years now (bilat. mastectomies for breast ca).

However, I'm about 40 pounds overweight and plan on working on that.  If I have the tram, will the reconstructed breast mounds shrink?  Should I lose the weight first?  

Thank you.  I'm just torn between just replacing my saline implants with silicon, or going for the tram.  I could use the tummy tuck, but I am not looking forward to such a big surgery, either.  If I'm going to go through all that just to lose the breast mounds via weight loss, I wouldn't be very happy.  

[Howard Rosenberg, MD]

With weight loss after having a TRAM flap, there would be some reduction in breast volume, but it would be difficult to predict the degree of size loss.  I believe that if you are within 15 to 20  pounds of your weight goal and decide to proceed with this surgery, you will be OK.

[mumsaloopsa]

I would not do it.  TRAM flaps are horrible to recover from.  I am 3 years out and still not ok.  Do you want details?

[Grateful505]

A related discussion, Weight Gain After A Tram Flap was started.