I posted this answer in the comments on the blog, but I wanted to make sure you heard back from me...
I don't know how they did your TRAM back in 1991, but I remember my surgeons saying the same thing, that you can only do it once. I'm not a doctor, but it sort of makes sense because of how they move your muscles around in order to supply blood flow to the new breasts formed from your belly.
There's also a way they can take the skin from your back and somehow bring it around to the front of your chest; I don't know if that is an option for you, but I suppose it might be considered an option if you don't want an implant.
I'm so sorry you have to go through this horrible process again. Please let me know how you proceed.