when all fails

I had a TRAM flap that had to be removed due to negligence by the hospital.  3 weeks ago I had a breast implant put in 500 cc after a tissue expander.  The implant is 4 inches smaller than my other breast and my ps says the only thing that can be done now is a latissimus flap.  Can you tell me if you know of other options?

[Howard Rosenberg, MD]

Your history of breast reconstruction is obviously quite complicated with loss of the TRAM flap.  You did not mention if this was a pedicled TRAM or a free microvascular TRAM.  Other alternatives to reconstruction might include a free microvascular flap from you buttocks or other area.  Latissimus flaps can also be quite successful.  Obviously, your plastic surgeon, who knows the full details of your reconstruction jsitroy and the condition of your chest wall, is in the best position to advise you.

[faye827]

It was a pedicled TRAM.  I really don't want to try a free microvascular TRAM.  It was devastating enough to go through the first one, and I would be afraid to try again.  The latissimus flap is iffy for me too.