x-ray result with tram flap

[lyd]

I had a tram flap 6 years ago.  I have had regular blood test, chest x-rays and mammograms.  I have never viewed the any routine x-rays or mammograms since the original ones.

I have a new doctor, same institution, and she asked me if the hardness in my tram was normal. I said it had always been there and that it was the muscle piece from the tram flap. (had a Free Tram Flap)  I then went to x-ray for a chest x-ray.
When I looked over at the computer monitor that the x-ray was on, I saw from a side view x-ray, a large white looking , dense looking spot. Is this what the muscle of the tram flap looks like or is this bad news?

I have not seen the doctor yet as I am scheduled for a follow up in a week and a half. (this being scheduled before the x-ray was performed.) I am going to have a trans vaginal sonogram and a routine mammogram before going back to the doctor. I will be having my first mamo on the tram breast. The previous doctor never thought it was necessary.

[Pati]

Re: white spots on mammo of TRAMed breast:  I recently went through the same process.  The radiologist first said my implant had burst!  I did not have an implant.  Then she said my silicone injections had moved.  I did not have silicone injections, I HAD A TRAM!  Finally, it was decided the spots were fat necrosis.  Because the lumps were hard and bothersome, my ONC suggested I have them removed.  Went back to my original plastic surgeon, (tram was 5.5 years ago..) to have the lumps removed.  He also talked me into a nipple at the last minute.
Surgery was 3/6/02.  No drains were inserted.  I developed a huge amount of fluid, (600ccs were drained) 2 weeks later. Shortly thereafter, the breast and surrounding area, from collarbone to bottom of ribs and around to back, turned red.  I was in the hospital for 4 days, dx'd with 'cellulitis', and received much antibiotics.  PS drained breast twice while in the hospital (from 4/19-4/23). First drainage (before hospitaliztion) was yellowish red, semi clear. Drain in hospital and all subsequent drainages (total of 11)  have been blood.
The breast, which was pretty and pink, is now horrible!  Brown, puckered, deep creases under arm and painful.  What went wrong and what do I do next?  PS always answers 'I don't know' or 'I hope so' when I ask what caused this and will it get better.

Think I should get a second opinion?!?

[lyd]

Thanks for the response. Today I had the tram flap mammogrammed. In six years the previous doctors did not think it necessary.

The white spot on the mammo is startling. Same as the white spot on the x-ray. About as white as this paper. The size is smaller than a golf ball but larger than a jawbreaker.  The area is exactly where the hard spot is and exactly adjacent (touching you might say) to the scar tissue from the complications of the tram - so long ago.  I only wish there was another mammo to compare it to.  

The radiologist is very concerned and has scheduled a ultrasound for a week from Tues. I will not see the oncologist until all the test are done.  The radiologist was saying that they will compare the mammo to the ultrasound and make a discision as to whether to biopsy or not.

I failed to ask if the biopsy is a needle biopsy or a removal. If they remove the spot in question, I can kiss the tram good bye, as it will be deformed and miniscule . It is only a B cup.

The worrying is the worst. 50/50 chance its scar tissue, 50/50 chance its cancer.  
Can scar tissue show up so dense?

I remember I had a serious wreck on a motorcycle when I was 15 and the impact on my thigh did not break it or break the skin, but it damaged the muscle or tissue and i had a hard spot for over 10 years. Finally softened.

[CCF-RN,MSN-JS]

Dear Lyd, What you saw could very well be the tram flap, as the muscular tissue would show up lighter on an x-ray, than normal lung tissue which shows up as dark.