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Tram Flap Breast Reconstruction


The worst day of your life

 The day the doctor tells you you have breast cancer is the worst day of your life.  It's hard to explain the emotions, feelings that race through your brain at the time.  Do you laugh with disbelief, or do you cry?  It is uncomprehendable until you have experienced it.  It's like you have just received an instant death sentence, and it doesn't matter how carefully the doctor tries to couch the diagnose, how they try to soften the blow, the news you have breast cancer will still hit you like a ton of bricks.  You will be at a loss for words, retreat into yourself, and try to do as much research as possible to find out exactly what is wrong with you.  Your loved ones and friends will flurry around you, give you advice and support and there's a good chance you might put up a wall to try and keep them out.  When you're dealing with the worst news on the worst day of your life, you struggle to cope with distractions, and that can be friends and loved ones.  You are tring to focus on the news you've just received, not on how your friends and loved ones are coping with the news.  Your focus is solely on you and that is okay.  That is normal. 

Your doctor might tell you that your breast cancer has to be tackled aggressively.  In doctor-speak, that means remove the breast.  Mastectomy.  The dreaded word for any woman.  mastectomy.  It sounds so final, like they are removing an important part of your body. Which they are.  Your breast is what makes you a woman.  It is your obviously womanly bit.  It juts out of your chest, visible to all.  Your boobs feed your babies, excite your man.  You worry when they droop, so imagine how much you might worry if they are not there.  Will you still be a woman without a breast?  Will people think of you as a freak?  Will your partner still want you?  These are valid questions asked by a woman on the worst day of her life.  If your doctor refers you to a breast surgeon, then that usually means a mastectomy is on the cards.

Breast Reconstruction

The good news, is that you can have breast reconstruction surgery.  Breast surgery, which will make you look normal.  However, it does take a while before you feel normal again.  Tram Flap Breast Reconstruction stands for transverse rectus abdominus myocutaneous.  A mouthful, but a lifesaver.  The thought of losing my breast made me contemplate suicide.  My breasts were my best bits, my most attractive feature, with a missing boob, I'd be half a woman, or so I thought.  But enter the plastic surgeon.  The breast surgeon will give you a few options.  Reconstruction later on, a padded bra, or reconstruction done straight away.  Being somewhat fixated at the time that my breasts were my only good feature, I chose reconstruction done straight away.

How it works

You meet with the breast surgeon, who tells you how they will cut away the malignant tumor until they find clear margins.  They will remove some of the lymph nodes under your armpit to check them out as well to see if the cancer has spread.  You will then meet with a plastic surgeon.  His part in the whole mastectomy/reconstruction is actually the greatest.  He will check to see that you are not a smoker, aren't severely underweight or overweight.  If you are any of those three things, they won't do the op on you.  He will discuss different reconstruction options with you and tell you the gory details of each one, just so that you have a greater understanding of the whole process, so you can make an informed decision.  The date will be set for the op.  The whole kit and kaboodle takes about 8 and a half hours.  Don't worry, you'll be asleep at the time!  An appointment will be made for you to meet up with a person from the Cancer Society, to give you some much needed support.  However well-meaning you family and friends, their support is not what you need, you need the Cancer Society.

The Tram Flap

You will be terrified on the day of the op.  That's normal.  The anaethetist will make some corny jokes and then put you to sleep.  The breast surgeon will remove your aureola and nipple, and scrape out all your breast tissue and all the tumor, until you just have your breast skin remaining.  They'll then remove some of your lymph nodes.  They will stand back, smile and wish the plastic surgeon luck.  They will leave the operating room, their job is done.

The plastic surgeon will take over.  He (or she) will slice your lower belly from hip to hip.  That will be your only nasty ugly scar.  Your belly button will be removed, a new one will be created.  You get a free tummy-tuck.  Skin from your lower belly will be removed and stitched onto the breast skin to replace the missing nipple and aureola.  A section of your tummy muscle and fat will be sliced and flipped backwards to fill the breast skin to make you a new breast.  the plastic surgeon will have studied your good breast beforehand, so will be able to mould your new breast to match the other.  When you wake up, you will experience more pain than you ever knew was possible.  But you will have a breast, and the same cleavage you had before.  You will have at least, maybe more, three drain sites.  One from your lower belly, one from your breast and one from your armpit.  You will be on so much morphine, your blood pressure will drop, you'll feel nauseous, you might even vomit everywhere, and will slip in and out of consciousness.  Your family will think you are dying.  But you will have both breasts and they will look normal.

After the op

The pain is so great you will welcome death.  You cannot walk, you have effectively been cut in half and stitched back together again.  They will put contraptions on your legs to make them move so that you don't get blood clots, because the pain is so great you won't be able to move your legs by yourself.  But three days after the op, when they've removed the morphine drip, you will start feeling a little better, and will start taking your first few steps.  You're not supposed to drive or lift anything for about six weeks.  A single mother with kids to look after, I was in a car driving the next week.  Which is probably why I had complications.  I had a district nurse visiting every day to change the dressings, clean the wounds and empty the drain bottles still hooked onto my drain sites.  (When going to the supermarket, I just put all my bloody bottles in a bag, and slung it over my arm.  Didn't want to upset the good shoppers!)  Unfortunately, my belly kept swelling with fluid.  I'd go to outpatients and they would stick a huge needle into my belly to withdraw some of the fluid.  It didn't hurt as I no longer had feeling in my belly, my breast or the top of my arm.  Six years later and that feeling has never returned.  My belly, breast and upper arm are still dead, devoid of nerves.  But they look good.

The swelling wouldn't stop, the wounds started getting pussy and I started getting boils erupting all over my body.  Two weeks in a hospital's isolation ward.  I had somehow or other picked up MRSA, the hospital superbug.  Very nasty indeed.  They had to re-open the cut on my belly and clean out the inside, which is why I still have this revolting scar that goes from hip to hip, as thick as my thumb.  But I have a nice-looking breast without any scars.

Seven months after the Tram Flap, I had a nipple reconstructed, and a ball of keloid scar tissue inside me the size of a tennis ball which was digging into my ribs removed.  That was only a four hour op, but it meant my large scar on my underbelly was opened again.  About 14 months after the op, I had a new aureola tattooed on to match my healthy one.  The plastic surgeon has his own tattoo artist, imagine that?

Since then, I have had to undergo several physicals when applying for work visas to work in different countries.  Not one doctor who examined me, has noticed that my right breast is fake.  I think the thing is, is that the breast is all me, made up solely of my body tissue.  Also, the aureola they tattooed on covers up the scar where they stitched the lid from my belly skin onto my breast.  Of course, the lower belly scar is a different story.

Do I recommend a Tram Flap Breast Reconstruction?  Most certainly.  Especially if have both breasts looking normal means a lot to you.  If I had my life over, would I go through all that.  Yes, most definitely.  The pain and suffering was worth it at the time.  If they find cancer in my left breast would I have it done again?  Probably not.  I don't think physically I can survive that again, definitely not mentally or emotionally.  It would have been better to just have had both breasts done at the same time.  One Tram Flap Breast Reconstruction is enough in one lifetime.  Of course, if they couldn't get clear margins or your cancer has spread and you need chemo or radiation, then they won't do the Tram Flap Reconstruction straight away.  They'll wait until you're over your chemo.  Something to look forward to, eh?


Cindy Vine (author) from Cape Town on January 14, 2014:

I think everything hurts to a certain extent. Some things just hurt more than others and it does depend on your pain threshold.

mary53 on January 12, 2014:

does a sentinal biospy hurt

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H on July 16, 2013:

Sure the breast looks good afterwards, but the stomach hurts like hell. Tight rope stretched across you, concrete block sitting on your stomach so heavy you can't breath, indigestion, painful movement.....really!!!! No one told me about these things, but I'm finding more are more women with the same symptoms. My advise to you...DON'T HAVE THIS DONE FOR ANY REASON!!! I like my breast as much as anyone, but I would rather live with an implant. The worse thing is, they can't undo what has been done.

Cindy Vine (author) from Cape Town on April 09, 2012:

Mimi, what kind of reconstruction you have is a totally personal choice. I just know having had both, I wish the first time they would have given me an implant as an option!

mimi on April 05, 2012:

I was recently diagnosed with bi lateral breast cancer. The good news is that it is stage 0 and contained, not in my lymph nodes. I have a choice of 3 lumpectomies with radiation, followed by tamoxifin. I was thinking of have the double masectomy. This way I do not have to have any radiation or drugs and not have to worry about this going forward. The plastic surgeon told me about the Tram process and the implants. I am still uncertain of what to do. This helped me, but I was pro tram and after reading this, I may not do it and go for the implants.

Cindy Vine (author) from Cape Town on February 23, 2012:

Diana, mine is still as ugly as ever, 8 years later! But that could be because I got MRSA and it all got infected!

diana on February 22, 2012:

does the awful tummy tuck scar ever go away? It's been 5 years for me.

Cindy Vine (author) from Cape Town on January 24, 2012:

Editorsupremo, I hope others can learn from my experience!

editorsupremo from London, England on January 22, 2012:

A very well written and informative hub. Thanks for sharing your experience.

Cindy Vine (author) from Cape Town on January 05, 2012:

Hey BP haven't heard from you for ages. How you doing?

blondepoet from australia on January 01, 2012:

Wow it is great to see you spitting out the hubs Cindy and what a flattering pic of my boobs it turned out to be xx

Cindy Vine (author) from Cape Town on December 01, 2011:

Smeagle mine was made worse with the MRSA I contracted, making all my wound areas go septic!

smeagle on December 01, 2011:

I had a tram flap at age 35 and it was worth every bit of pain and recover - it's a forced tummy tuck yet there is no foreign material in your body - making your new breast - so with a good surgeon it's a great idea - a big thanks to science

Cindy Vine (author) from Cape Town on February 24, 2011:

Hi there 30andconfussed! Goodness, you are quite young to be going through this, sorry to hear this. I'm not too clued up about taking the muscle from your back, I had the muscle taken from the front. I've had no problems with hernias at all. For me personally, I sleep on my back and my side, and if they work on both breasts on the front and the back, how are you going to sleep? I'd rather have everything on the front. The ps has never had this procedure done to them, so they would not think about the difficulties in sleeping afterwards. Remember the tramflap takes a lot longer to heal than the breast,

30andconfussed on February 23, 2011:

hi, I have read your post and so sorry. I am 30 yrs old and soon will be having a Prophylactic Mastectomy both breast and was thinking of have the tram surgery done after reconstruction but my ps talked me out of it and suggested the back one instead. i am a mother of three and was worried about the effects down the road the Tram may cause. was wondering if you had any problems from hernias. if i do tram they will be taking both stomach muscles. any information anyone has on either of these that's been done or know of and which you would prefer would be so helpful.

Cindy Vine (author) from Cape Town on February 22, 2011:

Lily, yesterday doctor said no, wants to rather remove my ovaries!

Lily Rose from A Coast on February 21, 2011:

Yikes! Well, take it easy - I hope it clears up soon and you're back to normal again. I forgot to ask - are you needing to go through chemo again?

Cindy Vine (author) from Cape Town on February 21, 2011:

Lily, started a small infection next to the new implant on Friday, so am on antibiotics at present.

Lily Rose from A Coast on February 21, 2011:

How are you doing?

Cindy Vine (author) from Cape Town on January 24, 2011:

The sad news is that I now have cancer in my other breast.

Cindy Vine (author) from Cape Town on January 10, 2011:

It is gorss but it does give you a realistic looking breast.

plastic surgeon sydney on December 31, 2010:

my stomach aches while watching the video, so gross

Cindy Vine (author) from Cape Town on October 03, 2010:

Thanks Tinyteddy. They recontructed my nipple by pinching the skin together and putting in stitches. It didn't come from my ear, but could have been originally from the umbilicus as they made me a new belly button.

tinyteddy from INDIA on October 03, 2010:

dear cindy

good hub

as a surgeon performing tram flap may i inform that the mound on the belly has to be good

tram flaps are taken as cross ove from the opposite side of the lower belly mound

nipple needs to be artificially constructed with ear pinna or umbilicus so will be insensitive

Cindy Vine (author) from Cape Town on September 10, 2010:

Anne, I can't imagine having two done at once, but I guess the pain would probably be the same. the worst part for me was the stomach cut. I agree, implants were not for me either.

Anne on September 09, 2010:

Thankyou for the clip. I had a tram flap done 16 months ago and have always wanted to know what my body went through. I also had the other breast done at the same time. My surgery was 11 hours. I had two surgeons preforming the task. Its is the best way to go. The thought of having implants was not for me. It took me two years to decide.Very happy with the outcome.

Cindy Vine (author) from Cape Town on May 02, 2010:

Holly my friend, good luck with your op!

holly on May 01, 2010:

I will be shortly going through a bilateral tram reconstruction and thank you for being so honest. Now I know what to expect and can prepare myself, my children an my husband. thank you so much for being so honest.

Cindy Vine (author) from Cape Town on April 16, 2010:

Keywc58, personally I didn't want silicone or fake bits, at least my new breast is all me, and made of me.

keywc58 on April 15, 2010:

Wouldn't it be better and easier to just do a breath implant, instead of going through all of this?

bijujeep on April 11, 2010:


Cindy Vine (author) from Cape Town on April 10, 2010:

Rita, it is not a nice experience to go through.

Ambersky from Brisbane on April 09, 2010:

Hi Cindy,

I admire your courage in reliving your experience so others can know something of what those with breast cancer suffer


Cindy Vine (author) from Cape Town on April 09, 2010:

Thanks Matrix

Jerilee, I definitely won't have it done if my other breast proves to be cancerous, but I am pleased I had it done with my first breast. I just wish that someone had told me how awful the op would be, and how long it would take afterwards for you to recover.

Jerilee Wei from United States on April 09, 2010:

Great subject that should be written about more. I chose a different route, although the reconstruction is still open. Here at the VA (veteran's hospitals) do the surgery and have you come back for the reconstruction anytime after 6 months. At first, that option seemed attractive because a tummy tuck after having had C-sections years ago, seemed like a good deal for an old woman.

Then I remembered all the complictions I had after those C-sections and got used to the scars where my boob used to be. For me, it came down to the fact that I am 60 years old, and my while my husband might notice if I don't make him dinner, missing one boob at my age, makes little difference. Had I been younger, yes I would have had the reconstruction.

I was more concerned with the recovery and the potential for MRSA infections in US hospitals these days.

The prostectic boob and bras they give me look like the real deal and comes in handy for international travel as a safe place for extra money. LOL

Matrix00 from egypt on April 09, 2010:

Nice hub page

Cindy Vine (author) from Cape Town on April 07, 2010:

Alekhouse, it is amazing what they can do. My gran had a mastectomy in 1969 and the scar she had was like it had been done at a butchery.

Lily, it is a horrible operation, one I never want to repeat.

Enelle, it's not knowing what to expect which makes the whole thing more terrifying.

Enelle Lamb from Canada's 'California' on April 07, 2010:

Not something that I would ever want to experience, but if I ever find myself in your shoes, I would do the same thing you did! Thanks for writing this - it's much better to be prepared.

Lily Rose from A Coast on April 07, 2010:

Excellent hub, although I couldn't even read all of it - too many bad memories from my own bilateral mastectomy/tram flap reconstruction!

Nancy Hinchliff from Essex Junction, Vermont on April 07, 2010:

Great hub, Cindy. I can relate to most of what you've said here, only when it happened to me the treatment was a little different because it was so long ago (20 years) and they have made such strides since then.

Cindy Vine (author) from Cape Town on April 07, 2010:

Pam, Tatjana and Hello Hello, when you get told you have breast cancer, you want to find out as much as possible about it, and speak to people who have survived it. Family and friends, unless they have gone through it themselves, just can't comprehend your personal pain at the news you've just got. When I got the news on the 24th December 2003, there was nothing like this hub for me to read to let me know what was going to be happening to me. the surgeon's descriptions of the process made it sound so simple and not the huge pain and emotional ordeal it was for me. I reckon if I'd had something like this to read before hand, I would have been better prepared and would have avoided the post traumatic stress I was treated for some months later.

Hello, hello, from London, UK on April 07, 2010:

Gosh, Cindy, what have you been through. It was very brave of you to go back to those memories to help others. You wrote a great and explicit hub. Thank you.

Tatjana-Mihaela from Zadar, CROATIA on April 07, 2010:

This is great Hub, Cindy, and thanks for sharing your experience on so detailed way. Breast reconstruction is certainly the best option after masectomy - for many woman loosing of brest withour possibility to reconstruct it, situation would be so traumatic and this trauma would cause even worse health problems in following years...

From now on, I wish you the best health possible, you certainly deserve it - you are very brave.

Hugs and love

Pamela Oglesby from Sunny Florida on April 07, 2010:

This is an excellent hub and the information is so important for people to know. I have had several friends with breast cancer and their stories are all different. One friend had a very aggressive cancer, had a bilateral mastectomy, chemo, etc. then the reconstruction and she looks great and is cancer free after 4 years. I have another friend who opted not to have the reconstruction but she is a widow,a little older and is okay.

It is great that you could share this information is such detail as I know it will help many women who need to know to hang in there and things will get better. I'm glad you look good, and finally feel better.

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