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Ask the Doctor: Is there any surgery for a Tram flap patient with a belly bulge, no hernia?

June 20, 2014 by

<img src="image.gif" alt="Pink Flowers" />This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q. Is there any surgery for a Tram flap patient with a belly bulge, no hernia? Breast reconstruction was great and there were no complications. I have heard that mesh can be used, does this flatten the belly, or would I be at risk for complications such as a hernia?

A. Hi Karen, Thank you for your question. If your tummy bulge is due to the TRAM flap procedure then it is possible that repair of the bulge using mesh could help flatten your tummy or repair the bulge. We normally check for a possible hernia by ordering a CT Scan of the tummy wall before planning this type of procedure. The findings help us determine what is the best approach and if we need to use permanent mesh or some other type. If there is no hernia then repairing the bulge should not risk creating a hernia. Depending on the situation, it is possible that the bulge could come back. Prior to this type of repair you should make sure you do all you can to avoid being overweight, as your weight can impact the success of the repair. I hope this answered your question.

Dr. James Craigie

Center for Natural Breast Reconstruction

Have a question about breast reconstruction or post-surgical care you’d like answered from our surgical team? Just ask us!

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Tram Reconstruction and Recurring Cancer in Breasts–How Should I Proceed?

April 18, 2014 by

This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Ask the DoctorQ: I had a mastectomy on my left breast with the tram–which partially failed–then Latisimis Dorsi surgery. I now have breast cancer in my right breast. What is the likelihood of decent symmetry and matching both breast shapes during this procedure?

A: I’m sorry to hear about your new diagnosis. In our practice, we have treated quite a few people referred to us with similar situations. We do not perform tram reconstruction but instead use the skin and fat of the lower tummy without taking the tummy muscle. If we have a patient that later develops a second breast cancer we would use skin and fat from either the upper buttock or the back of the upper thigh below the buttock. This can create a very good match for the tummy fat or a tram reconstruction. I would be glad to give you a more detailed answer with more specific information about your situation, let me know. I do think you most likely have good options without needing to give up any other important muscles. For more specific answers I will need to have my staff contact you for more details about your medical history.

Dr. James Craigie

Center for Natural Breast Reconstruction

Have a question about breast reconstruction or post-surgical care you’d like answered from our surgical team? Just ask us!

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Is It Normal to Experience Pain Years After a TRAM Flap Surgery?

April 26, 2013 by

Ask the DoctorThis week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your questions.

Q: I had tram flap surgery 6 years ago for one breast in Atlanta at Emory with a good plastic surgeon. I am experiencing horrible pain under my breast and around my upper rib cage where it has been mostly numb for all these years. It feels like 1000 bees are stinging me all the time. It also feels like something has pulled loose. There’s a bruised feeling as well. I wonder if the nerves are just now growing back which is causing the pain? My breast is very heavy. Is it possible to “re-do” this breast to relieve the constant pain? Or is this “normal” after six years? I am miserable.

 

A:  I’m sorry you’re having so much trouble.

It is certainly possible that something could have “pulled loose,” although, as you might suspect, it would be a little unusual after all this time. Also, while there is no theoretical time limit on how long sensory nerves can take to grow back, it would also be unusual to have that process stretch out this long.

Probably the best idea is to go back and see your original plastic surgeon. She or he may wish to obtain a CT scan, MRI, or some other type of imaging study, depending on your physical findings. If nothing unusual is detected, she may possibly send you to a pain therapist for treatment.

Richard M. Kline, Jr., MD

The Center for Natural Breast Reconstruction

 

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

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Can a Mammogram Hurt My TRAM Flap?

April 5, 2013 by

Can a mammogram hurt my tram flap?

This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your questions.

 

Q: I have an 18-year TRAM (Transverse Rectus Abdominis Myocutaneous) flap. Recently I have found a perpendicular ridge about an inch from my sternum. It feels like a lump. I have had an ultrasound and now they want to do an MRI and an mammogram. They found nothing on the ultrasound. My concern is the mammogram. Could this cut off blood supply to my TRAM flap? I would like to ask my original doctor but he is strictly doing plastics. Thank you for your help!

 

A: While it’s not impossible, a mammogram is highly unlikely to hurt your TRAM flap, especially after this length of time. Certainly it is important to find out what the lump is, anyway.

Good luck, let us know if we can be of any help.

 

 Richard M. Kline, Jr., MD

Center for Natural Breast Reconstruction

 

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

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What Is the Recovery Period for a DIEP Procedure?

November 9, 2012 by

I’m getting ready to have reconstruction surgery in Mount Pleasant and the procedure I’m having consists of the tissue being taken from my abdominal area. How long is the recovery period for this procedure versus having the tissue taken from my back?

If the tissue from the abdomen is being transferred as a DIEP flap, you will probably require 4 – 8 weeks for recovery, of which less than one week will probably be spent in the hospital (usually 4 days in our practice). If the tissue is being transferred as a pedicled TRAM flap (in which your abdominal rectus muscle is sacrificed to carry blood for the flap), the time quoted by your surgeon for recovery may be about the same, but some patients may complain of discomfort for considerably longer periods. With either procedure, some patients will heal faster, and some will heal more slowly, not surprisingly.

When you say tissue is taken from your back, I assume you mean a latissimus muscle flap will be used. This is generally done in conjunction with a prosthetic implant being placed, as the latissimus muscle rarely has enough bulk to make a breast by itself. Generally speaking, a reconstruction using the latissimus is easier to recover from than one using the abdomen, because the latissimus is not used constantly for activities such maintaining posture and breathing. Additionally, at least two other muscles, the teres major and the pectoralis major, have functions which strongly overlap the function of the latissimus, and they are able to “take over for it” to some extent. There are no muscles which duplicate the function of the rectus abdominus quite as closely.

—Richard M. Kline Jr., M.D

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What Are My Reconstruction Options After a Lumpectomy?

August 12, 2011 by

DIEP flapThe below question is answered by The Center For Natural Breast Reconstruction team:

What are the options for reconstruction surgery after a bilateral lumpectomy?

Great question! Your options would be very similar to those you would have if you had a mastectomy. Keep in mind that if your lumpectomy was followed by radiation, the behavior of the radiated skin and tissue can complicate a reconstruction procedure utilizing implants and your best option may be to use your own tissue to restore your breast size and shape. Nonetheless, it’s your plastic surgeon’s responsibility to tell you all of the options available to you and let you choose how to proceed. Also, discuss with your surgeon any procedure that may need to be done on your unaffected breast to achieve symmetry.

Here’s my short list of options:

1. Tissue expanders and subsequent replacement with permanent implants. Ask about silicone vs. saline implants. How about the use of a skin and tissue replacement like fat or a dermal matrix (like Alloderm)?

2. Autologeous reconstruction with latissimus flap (back). Will implants be needed, as well?

3. TRAM flap (transverse rectus abdominus muscle). Uses the muscle, skin, and fat of the abdomen to rebuild the breast. Make sure you have been told of the risks involved in removing this muscle.

4. DIEP, SIEA (deep inferior epigastric perforator or superficial inferior epigastric artery). Uses the skin and fat of the abdomen to rebuild the breast but leaves the muscle of the abdomen intact.

5. GAP (gluteal artery perforator). Uses the skin and fat from the upper (inferior) or lower (superior) buttocks. Like the DIEP, no muscle is removed for this procedure.

6. TUG (transverse upper gracilis). Inner thigh donor area, utilizes skin, fat, and muscle of the upper inner thigh.

7. Intercostal perforator. Utilizes skin and fat from under the arm.

8. Maybe you’re happy with the size of your post-lumpectomy breast but would like the shape addressed. Procedures such as mastopexy or reduction mammaplasty on the unaffected breast may be the procedures to investigate.

9. If it’s a small defect, a simple fat transfer from another part of your body may remedy the problem.

Best Wishes,

The Center for Natural Breast Reconstruction Team

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