pedicle tram flap/abdominal buldge complication

[absintheminded]

Wondering how many woman suffering severe abdominal bulge/weakened stomach wall and severe digestive issue's years post pedicle tram flap? I am finally finding some admittance of this severe and debilitating side effect. Not many Dr's seem to want to associate it with the pedicle tram flap or acknowledge this very serious complication. Granted, in 2004 this was a relatively new surgery, we could not know all side effects. However, I seem to see this happening not just to me but to others and no one wants to discuss or find a fix. My left side of my abdoman has completely buldged out. This happend in 2011. My surgery was 2004. You can actually see the outline of my intestines. I went to ER thinking I had a severe hernia, possibly a blockage. The "Buldge" had increased greatly in size. Along with this came constipation and pain. It seems I am experiencing on going blockages in my intestines and colon. Without the strength of the rectus muscle my stomach has become so weak it cannot perform the contractions necessary, I beleive, to push the waste through my body. I swell with toxins. I notice it is at its worst when my toes swell from the toxins as well. I have to give up all fiber as I cannot digest it or break it down. I am forced to take laxitaves like milk of magnesia and suppository laxitives at least 2x a week or I develop horrific blockages which I fear can burst and become sepsis. A recent episode last week sent me to the ER where x-rays ordered to be sure blockage passed. It had but the inflammation, pain and gas are horrific. You cannot even touch my left side abdomin without pain. I am not able to eat fruit, vegetables, whole grains etc., I am losing vitamins and now adding ensure to my diet. They say the only possible thing they could do would be to find an abdominal wall specialist to try and tighten it, however I was warned that these surgeries are loaded with serious complications and tend to fail. I'm terrified I'm going to end up on a bag or something. My gastro doctor, primary, etc.,could not answer what was wrong with me...finally a plastic surgeon and my new oncologist says this is a side effect that is just beginning to show up in more and more woman. A warning to other woman, the bulge became it's largest after lifting heavy objects such as heavy grocery bags upstairs...it doesn't take much...you must NEVER lift anhything heavy again...yeah, like that's a possibilty...so, this is kind of a statement to throw out there on a serious side effect of the pedicle tram flap that certainly is being ignored in the medical community...and my question is, is there any hope? Will this neccesety of laxitives (I'm only 50) cause me to be dependent always. If the blockage does not pass can it burst and can I go sepsis? Thank you.


This discussion is related to pedicle tram flap complications.

[patriciacb]

Laparoscopic repair does not work for these complications many many times. I have had two surgeries to repair the complications and none worked. 15 years later and I am still having the same types of problems mentioned above, as are many other women.

[SparklingJules]

Yes,  yes,yes. I found your question when I googled digestive problems TRAM flap.  I had mastectomy in December 2009 and TRAM flap reconstruction in NZ in March 2010 and mesh inserted. As I have put on menopausal weight my tummy has become increasingly tight especially in the scar area and around the tummy button. I have been having trouble with bowels also and the urge to open my bowels has become weaker.  I also have noticed the left side of my tummy is starting to bulge. I am now living in Australia.  Not really sure what to do.

[MarshaOD]

I had tram-flap reconstruction surgery in 2000. As a result, the mesh herniated and I had surgery for that in 2010. I still have pain and itching and gastro issues all these years later. When I was experiencing pain from the hernia, I went to several doctors (inlcuding the one who performed the original surgery) and not one could figure out what was going on. In the end, I was told I would need to live with it and be on pain medication the rest of my life. I finally found a doctor at Georgetown who was very familiar with tram-flap hernias and other complications. He gave me my life back - I cannot even describe how much pain I had been in. I live in the VA/DC/MD area and am wondering if there are any others in this area that have dealt with these complications. I would love to start a support group - in person or online.

[Ksmith824]

Can I please have the name of the Dr that helped you?? My email is ***@****. thanks

[Sandarroch]

I guess like most of us here, when I developed shortness of breath, my physicians immediately thought lung cancer.  Have had several pleural effusions with no real cause found, other than leaky lymphatics.  Of course the original radiation I had for Hodgkin's Disease, upper mantle, twice, caused the breast cancer as well as lung fibrosis and heart valve calcification.  But now with dysbiosis and a weird intermittent diaphragmatic pain, i.e. like a bad stitch, i.e. excruciating, I am starting to wonder if there is a connection to the TRAM flap with pedicle surgery I had in 1997.  
All of the postings here are so useful, thank you everyone for sharing.  Yesterday I lifted a really heavy grocery bag, and realized that lifting too much often does set off my shortness of breath.  Some laser treatment may have helped with some of the scar tissue/ leaky lymphatics, not sure.  Body work seems to help me more than anything, in particular, cranial sacral therapy, which works on the fascia layer of the muscles, especially useful on the thorax near the pedicle, and on my back, near what I have been told is the insertion of the diaphragm.  

Anyone else here with shortness of breath / pleural effusions?

so glad to have found you all ...

[camster1]

I had 2 hernia repairs with mesh after I had tram flap surgery I recently have had dizzyness and severe  shortness of breath for sev eral weeks and my stomach started bulging out huge after I eat a few months ago and its getting worse I feel really uncomfortable after eating also my stomach feels fery tight and hard and bulging.., i look pregnant too.I had tram flap surgery 18 years ago and this experience id fairly new also I have had sever pain in my abdomen off and on if I try to bend down while sitting or even just from sitting.I was surprised to see others with similar symptoms  when I googled this in relation to my tram flap surgery Is there anyone whocan help , I need to find out how to fix this problem it's horrible to live with and scary too.

[oregonbooks]

I had a radical mastectomy Dec 2013 on right side with 18 lymph nodes removed.  After chemo and radiation the expander became infected and I had to have it removed.  I was left with severe scar tissue pain and fibrosis I could barely breath in.  The new PS repaired my chest wall and cured the pain that I was feeling but now I have a new kind of pain.

I went to a new plastic surgeon for a DIEP flap but he convinced me that I would have a better success rate with  TRAM.  I too thought how bad could it be I just won't lift anything or do sit ups. I looked great the first 2 weeks, but then I started to have severe pain after eating and terrible constipation.  I have a big bulge on the lower right side near the scar.  I cannot digest anything and am taking digestive enzymes with everything.  

I can put up with the numbness and lack of feeling but the bulge is very painful. The thought of putting a mesh in only seems like it would push my intestines in further causing more pain.  The PS did not seem to understand my digestive issues nor did he admit that I have a hernia issue.  I don't really care if my stomach is not flat, but the bloating and the pain in the bulge is unbearable.  My breast is fabulous however, but the stiches on the side came open and now I have an open wound for a month.  The PS just wants it to close up from the inside out, so after 6 weeks I still cannot wear a bra.  

I wonder if I need to see a gastroenterologist.  

[canthetram]

New here, but I had a double pedicured TRAM in July 2012. I found out I had developed 3 hernias in March 2013. My original PS and doctor denied anything was wrong. It took me going up to NY, after recovery from chemotherapy, to be diagnosed by two excellent surgeons. I was diagnosed by them in March 2013. I had to have a 3 hernia repair. They have a 10 yr success rate in repairs holding. Our bodies will never be the same, but at least I have the mesh holding in my intestines and its secure now thanks to Dr. Ron Israeli, PS, and Dr. George Denoto, gastroenterologist who worked in tandem to repair me. So far I've referred 7-10 women to them for repair. They developed this technique because there is such a high risk of hernia formation after Trams. It's a shame. I really wish this surgery was not an option. Had I of known, I would not have had it. But I was ill advised and told "it will be just like a tummy tuck, except you may not be able to do sit ups." Malarkey! Now dealing with back issues on top of it all. I asked all the right questions, and thought and believed in my original PS. He left out a lot and lied. Feel free to contact me, I can possibly help if your still dealing with these issues.  Hugs and hope.

[patriciacb]

how do they repair ? I have searched for years to find help.

[canthetram]

Please search for my FB group-
TRAM/DIEP- Complications And Hope. Great support group and information on their repair. It's also Published in The Atlas Of Abdominal Wall Reconstruction, Vol. 2, Chapt. 21
You can also google their names and contact them. They would be more than happy to supply you via email, their repair technique.

[Puddington]

I have just read all the post here as I was searching to see if anyone has severe constipation!! I couldn't believe what I was reading...... I live in Adelaide Australia and in 1995, wow 20 yrs ago,I had a double tramflap operation. I got breast cancer in my right breast, in 1993. then had an implant put in.  Then in 1995 I got it in my left breast. Saw a plastic surgeon who said the implant would need coming out as it was encapsulating. He then suggested to do the double tram flap. Back then, I suppose Doctors didn't know a lot about what happens in the future. Well in 2000 I noticed I was having a few issues in using my bowel, became constipated........ The yrs rolled on and 2 yrs ago I saw a GI specialist who did Sitz marker tests which showed I had severe slow transit constipation. Roll on 2015, and a lot of tests later, unfortunately I am going to have to have my bowel removed. I am devastated beyond words as you can imagine. My specialist who has done a lot of research In constipation cannot give me a reason why this has happened, my peristalsis nerves in my bowel no longer work. I also have low back pain from straining and having weak stomach doesn't help. I came on this site as it just crossed my mind if others had bowel issues.. I suppose I will never really know, now I am worried about adhesion !!

[Puddington]

I have just read all the post here as I was searching to see if anyone has severe constipation!! I couldn't believe what I was reading...... I live in Adelaide Australia and in 1995, wow 20 yrs ago,I had a double tramflap operation. I got breast cancer in my right breast, in 1993. then had an implant put in.  Then in 1995 I got it in my left breast. Saw a plastic surgeon who said the implant would need coming out as it was encapsulating. He then suggested to do the double tram flap. Back then, I suppose Doctors didn't know a lot about what happens in the future. Well in 2000 I noticed I was having a few issues in using my bowel, became constipated........ The yrs rolled on and 2 yrs ago I saw a GI specialist who did Sitz marker tests which showed I had severe slow transit constipation. Roll on 2015, and a lot of tests later, unfortunately I am going to have to have my bowel removed. I am devastated beyond words as you can imagine. My specialist who has done a lot of research In constipation cannot give me a reason why this has happened, my peristalsis nerves in my bowel no longer work. I also have low back pain from straining and having weak stomach doesn't help. I came on this site as it just crossed my mind if others had bowel issues.. I suppose I will never really know, now I am worried about adhesion !!

[Toboo]

Yes, I did not find out until much later that hernias occur after TRAM Flaps. I can only direct you to 2 excellent surgeons who have dedicated their practice to repairing this. Start with Aestheticplasticsurgerypc. This will get you going in the right direction and on the road to healing. There is hope, and I am proof. They have a -0 year success rate. I wish this surgery would be banned. And perhaps one day, I will fight for just that. I did not find out what was wrong with me until I saw theses 2 surgeons. Up until I saw them, I was told, everything was fine and healing well. Look up Dr. Ron Israeli and Dr. George Denoto, out of Long Island, Ny. Please, there is hope. So far, 6 women I've referred to them have been repaired and doing well.

[karenlewis55]

I am fed up with my pain.Sounds like no one can help us. I will love to help save other women from this surgery. My life is just here.I went though all this in 1998. I look 5 months pregnant at 55.I have constipation problems. I have depression due to my limitations. YES THIS SURGERY NEEDS TO BE OUTLAWED. ***@****
I am in search of a cure of these terrible side affects.

[Showinup]

Ladies we should ban together and have Tram reconstruction surgery outlawed!! The medical field odten does not want to acknowledge or understand the issues that we have as a result of the risks from this surgery!!  but the surgeons who know they KNOW and have told me this is the worst surgery a woman could have and he thinks it should be outlawed!!! I don't want to rehash all of my  risks but I will say we have had the carpet pulled from under us and we will never be the same!!! But we are alive and survivors!!! I get up and walk a little.  I go to occupational therapy! I do Not clean my house not do I lift anything over 10 lbs.  I can't sit too long stand too long or walk too long!! I've cut down on my pain meds. I am accepting this is what it is and reinventing myself!! Pain is a constant but I refuse to be in the dark hike I was in with the depression!!! Medicinal marijuana helps a little bit not much!!  I use disovabke ziofran for the nausea . Meditation reiki and mother nature does wonders!! It all ***** being in pain constantly but I try not to talk about it except to the experts and all they can say is I can't help you...but then disability wants to tell you you can work ha ha!!! I say we get TRAM  crap OUTLAWED !!!  My heart and positive healing energy is sent out to all of you! I live with all your same pains...and misunderstandings and ignorance of the medical field and our family and friends.  But we show up!!! May you find some peace... Peace love hugs n tyedye survivors!!!!

[Showinup]

Ladies we should ban together and have Tram reconstruction surgery outlawed!! The medical field odten does not want to acknowledge or understand the issues that we have as a result of the risks from this surgery!!  but the surgeons who know they KNOW and have told me this is the worst surgery a woman could have and he thinks it should be outlawed!!! I don't want to rehash all of my  risks but I will say we have had the carpet pulled from under us and we will never be the same!!! But we are alive and survivors!!! I get up and walk a little.  I go to occupational therapy! I do Not clean my house not do I lift anything over 10 lbs.  I can't sit too long stand too long or walk too long!! I've cut down on my pain meds. I am accepting this is what it is and reinventing myself!! Pain is a constant but I refuse to be in the dark hike I was in with the depression!!! Medicinal marijuana helps a little bit not much!!  I use disovabke ziofran for the nausea . Meditation reiki and mother nature does wonders!! It all ***** being in pain constantly but I try not to talk about it except to the experts and all they can say is I can't help you...but then disability wants to tell you you can work ha ha!!! I say we get TRAM  crap OUTLAWED !!!  My heart and positive healing energy is sent out to all of you! I live with all your same pains...and misunderstandings and ignorance of the medical field and our family and friends.  But we show up!!! May you find some peace... Peace love hugs n tyedye survivors!!!!

[hoodd]

Oh m  gosh that's me! i feel like I'm going crazy because no doctor wants to tell me what's wrong! The surgeon I just saw recommended I have all the nerves in my stomach killed because they were causing the severe contractions and swelling in my stomach. I had my surgery in 08 and now experiencing everything you're talking about. D in Oregon

[AlyParker]

good afternoon I ahd the tramp flap procedure in 2001 in the UK, I do have a right sided bulge which is very unsightly. But what i ahve experienced is unexplained episodes of stomach pains cramps and unexplained episodes of diahorrea and vommiting, which comes on suddenley and unexplained.
Not food related, but takes about a week to subside.

Can this be along term effect of tram flap procedures, I dno nto know what type of mesh was used in my operation.
many thanks

[Hvala]

I had a bilateral mastectomy in 1999 with pedicled TRAM flap. Here I am 13-14 years later and am experiencing the same things you describe. I experience bulging, bloating, increased gas, indigestion, pain. The pain worsens when I lift things such as groceries. Last spring I ended up in the ER with severe pain. It was determined that fluid was collecting on top of the mesh that was inserted to support the abdominal wall in 1999. Some docs have said there is no way this can be related to surgery in 1999. A plastics doc referred me to a general surgeon who said that the risks of opening the abdomen outweigh any benefits that might be gained due to the possibility of infection. A plastics doc that specialized in breasts made me feel crazy bc the pedicled TRAM isn't performed anymore. I look like I am 3 or 4 months pregnant. I have to wear pants below the bulge bc any pressure on the abdomen is uncomfortable. I wear maternity tops because they hide my bulge.  Have any of you found any relief or answers? Obviously we are not crazy and this is very real.  Any comments or suggestions are welcome!

[Ellen2672]

Hi my name is Ellen, live in Perth west Australia. Had my double mastectomy in August 2012. It is now January 2014 and I too have had terrible bouts of constipation ever since the surgery. These bouts at first were spread by weeks .. Now it is every week.  The bulge is huge on the right side as that is where the donor  ab muscle was harvested. My left breast was compromised as I had breast cancer in 2007 and had radiotherapy. Then in May 2012 after many biopsies found the cancer had returned to the same breast .. So obviously to me, I chose a bilateral mastectomy  using the TRAM and DIEP methods.  The right breast is smaller as it already was compromised by radiotherapy so had tissue necrosis.  The left side is significantly larger. But I am alive.  It's the bulge and the constant constipation that are annoying.  I will see my GP tomorrow as my ultrasound showed no obvious hernia.  Has anyone had or tried colonic irrigation?

[Ellen2672]

Hi my name is Ellen, live in Perth west Australia. Had my double mastectomy in August 2012. It is now January 2014 and I too have had terrible bouts of constipation ever since the surgery. These bouts at first were spread by weeks .. Now it is every week.  The bulge is huge on the right side as that is where the donor  ab muscle was harvested. My left breast was compromised as I had breast cancer in 2007 and had radiotherapy. Then in May 2012 after many biopsies found the cancer had returned to the same breast .. So obviously to me, I chose a bilateral mastectomy  using the TRAM and DIEP methods.  The right breast is smaller as it already was compromised by radiotherapy so had tissue necrosis.  The left side is significantly larger. But I am alive.  It's the bulge and the constant constipation that are annoying.  I will see my GP tomorrow as my ultrasound showed no obvious hernia.  Has anyone had or tried colonic irrigation?

[Jamy4]

I had breast reconstruction in 2003, I've not been the same since, can not carry anything , can not walk my 10km that I use to, now I have Rectom prolapse and bladder buldge,and need surgery,I'm afraid i might get worse ,my plastic surgeon never warned me of any complication in the future ,and Iworn all woman not to get the flap reconstruction done, what should I do..

[Sharon1116]

I too have had a tram flap reconstruction on the right side about 10 years ago and my stomach is huge, size 16 at the waist, and size 12 everywhere else. My stomach expands 3-4 inches after I eat, I have to lay down, I cannot walk or breathe easily.  I feel like an old lady.  I cannot work, I cannot bend over, etc. I went to the best Univ. of Miami hernia surgeon and he said from the CT scan of the stomach it was a "thickening of the stomach wall" not a hernia and that if he operated and inserted mesh to push down the bulge, it would cause more pain, told me to leave it alone.  Every day I cry and am in pain and complain to every doctor I see.  No one has suggestions or can fix my problem.  I also have IBS and have had all kinds of tests, colonscopy, CT scans of my stomach, and ultrasounds and no one can find anything wrong except the bulge and the thin and thickening of the stomach wall.  The last CT scan I had with contrast was to look and see if the main blood vessel going into the stomach was constricted or blocked from the large "load of bread on the right side" hernia I have (even though the Dr. says it's not a hernia, I can see the large loaf of bread when I lay on my back and lift my head.  I am single, no man wants to date me with my large pot belly and my pants fall below my belly and I can hardly walk after I eat.  I have tried to lose some weight (I'm 168 lbs and in my 60's) but to no avail.  My grandkids make fun of my tummy and I hate it but I'm so depressed and sad, cooking is my love but most of the food I cannot eat.  I have just started on a low-fodmap diet and am trying to do this but there is so much I cannot eat.  Can anyone help me????

[badtram]

Well this is 2017 and I have the exact same situation and symptoms as you do.  I asked the doctor for a DIEP flap and he bullied me into a tram flap.  THEY SHOULD BE OUTLAWED!!

[canthetram]

Look up Dr. George Denoto & Dr Ron Israeli and Tram Flap hernia repair. They are now published in The Atlas Of Abdominal Wall Reconstruction, Vol. 2, Chapter 21. They are also featured online. I had 3 hernias as result of bilateral Tram. In 2013, I was repaired by these surgeons. It's 2017, and it's holding strong. No regrets. Best decision I made. Please google both of them and contact their office. They are on LI, NY and work in tandem to repair Tram and DIEP women with bulges and hernias. You don't have to live with this, and there is hope for repair.

[canthetram]

Sorry for spell errors. I was repaired in May 2013* and it's still holding*
You don't have to live with this. I also have a FB group called TRAM/DIEP- Complications And Hope. It's 67 members and growing. A lot of good information and help to get you through this and repaired.

[glozzer]

I cant tell you how glad I am to find this website and to see that I am not the only one having such a problem following tram flap reconstruction.
I had a tram flap reconstruction in 1998 after 5 previous failed attempts with implants that infected or burst.  It was a nightmare from the off, what could go wrong did go wrong. After three days the abdonimal incision broke down and started oozing and it was then noticed that the sugeon had not put in a mesh, I then got an infection in the naval and at the breast area. I spent a month in hospital and ended up with one boob 3 cups sizes smaller than the other one (the reconstruction being the smaller).  After a month or so I noticed a lump in my stomach, so after waiting 2 more months went to see the surgeon who said I had a hernia and would need a mesh inserted. When i mentioned that the reconstructed boob was much smaller he stated "well you shouldn't have expected the body of an 18 year old" I was quite taken aback and he then said "we can always reduce the good boob, unless of course you like having large breasts!"  I was quite upset by this remark, and said that I had already had it reduced when I had my first reconstruction and was not going to have it done again.  In 2000 I had the mesh inserted but again 3 months later developed a large bulge I was told the mesh had broken down and would need another one put in. This was done in 2002 and yes it again broke down and the mesh ended up rolled up round my middle. After the second op the drain was taken out too soon and I developed fluid build up and had to go back to hospital every other day for 2 weeks to have it drained off.  In the end I was so depressed I just gave up going back.  I was in such a lot of pain and discomfort I went to a pain clinic,   Well 10 years down the line and things are really no better, the bulge has got much bigger and spread over most of my tummy and at times really painful with a stinging sensation as if the whole thing is going to burst.  It has affected my bowel movements and I get the most dreadful wind, (luckily I live on my own!!).  It is the pain which is the worst but I dont seem to get anywhere with the doctors who just dont seem to understand.  I have changed surgeries in the hope that a new doctor may be more sympathetic.  I am soooo cross with myself for going through this but I just wanted to look like myself again, is that wrong?  The surgeon who did the tram flap just did not care and I wish I had never met him, he was horrible to me. I understand that this op is not done anymore and I am glad for that. I am now seeing a counsellor as all this has had quite an effect on me.

[peach0621]

I also had a double tram flap done in 2004.  In 2009 I had repair of hernia and mesh from hip to hip and rib to rib b/c the lining of my stomach was so compromised and weakened. I just last weak 7/23/2012 had a small bowel obstruction surgery, and the "tacks" used to keep the mesh in place were removed as they were sharp and actually cut the surgeons glove.  I was not properly informed of all the possible complications or I would have just gotten the in plants!  This has been a living hell that never ends and I have been in pain almost every day since my original surgery!  This is barbaric and NO women should ever have it!
Debra L Peach
CT  

[peach0621]

I also had a double tram flap done in 2004.  In 2009 I had repair of hernia and mesh from hip to hip and rib to rib b/c the lining of my stomach was so compromised and weakened. I just last weak 7/23/2012 had a small bowel obstruction surgery, and the "tacks" used to keep the mesh in place were removed as they were sharp and actually cut the surgeons glove.  I was not properly informed of all the possible complications or I would have just gotten the in plants!  This has been a living hell that never ends and I have been in pain almost every day since my original surgery!  This is barbaric and NO women should ever have it!
Debra L Peach
CT  

[absintheminded]

It's a little hard to describe without a photo, however you can actually see the outline of my intestines on my left side. Oncologist and Plastic surgeon informed me of the trouble with intestinal blockages. Again I reiterate, I do not have a Hernia.

[absintheminded]

Thanks luebutterfly, I will search!