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.
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?
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