Home Health General Health How To Survive A Tram Flap Reconstruction

How To Survive A Tram Flap Reconstruction

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Written by Sandra Harris-Gompf   

The discovery of and the options for treatment can be overwhelming for the person diagnosed with breast cancer.  For those who opt for a mastectomy and reconstruction, a tram flap may be the answer.  The tram flap reconstruction takes two surgeries and uses abdominal tissue to rebuild breasts.  In the first surgery, a tram flap delay, an incision is made from hip to hip.  The doctor attaches clips to blood vessels.  This technique encourages the growth of more vessels to sustain the abdominal tissue.  The second surgery, a tram flap, takes place two weeks later.  The doctor cuts along the same incision made for the tram flap delay.  He makes another hip to hip cut about six to eight inches above the first incision intersecting the cuts at the hips.  A tunnel is made from the incision to the breasts.  The abdominal tissue is passed through this tunnel, with the blood supply still attached.  It is shaped into breasts and sutured in place.  The hip to hip incisions are sewn together and an incision is made for the navel.

Step one: Research the pros and cons.

There are several pros to having a tram flap reconstruction.  The person’s own tissue is used, eliminating rejection issues.  Abdominal tissue feels like breast tissue.  Repeated surgeries for maintenance are not needed.   The person gets a tummy tuck in the process.

There are some cons to having this surgery.  This technique is the most invasive of all reconstructions.  The hospital stay is longer.  The recuperation period is more painful and longer.  There is always the possibility that some of the tissue will not have enough blood supply to be viable.

Step two: Ask your plastic surgeon questions.

How long after chemotherapy or radiation treatment do you have to wait before getting reconstruction surgery?

What steps do you need to take to prepare for surgery?

What size breasts can be made from your tissue?

How long will recuperation take?

What should you do to care for your breasts after the surgery?

What will need to be done if the non vascularized tissue starts to die?

When will the paperwork for disability need to be filled out?

How long will you have to wait to have the surgery that shapes new nipples?

Step three: Preregister at the hospital.

Before surgery, a questionnaire about your general health needs to be filled out.  It’s best to do this a few days before the actual surgery.  On the day of your surgery, all you’ll have to do is verify information to be admitted.

Step four: Have family members or friends sleep over at the hospital.

Ask family and friends if they will take turns staying in your room at the hospital after your surgery.  The hospital will provide a cot.  They can advocate for you if you need more pain medication or they can get help when you have to get up to go to the bathroom.

Step five: Provide doctor approved breast care after surgery.

Your doctor will schedule you for follow up appointments after your release from the hospital.  During the first or second visit, the waterproof bandaging will be removed.  Vitamin E will be applied to the scar tissue and covered with paper tape.  You will need to apply Vitamin E nightly over the tape.  The tape will need to be changed about every five days.  More frequent changes will irritate your skin.

You will be given approval to shower.  After showering pat the breast dry before drying the rest of your body.

Do not lift more than eight pounds until your doctor tells you it’s okay to lift heavier weights.

Do not put heat or cold compresses on your breasts.  You will not have the neural connections in your new breasts that allow you to feel heat or cold.  This makes you susceptible to serious burns and frozen tissues.  Both conditions can destroy the new breast tissue.  (You will be able to feel pressure on the muscles underlying your new breasts.)

Step six: Ask for help at home.

You will be on pain medication around the clock.  You will not be able to bathe, go to the bathroom without assistance, care for children, cook, clean or do laundry.  Prearrange for family members or friends to provide these needs for you.

A sponge bath goes a long way in making you feel decent.  Tell your helper to avoid getting the surgical areas wet.

You will be able to clean yourself after urination, but will not have the range of motion to reach behind to wipe after defecation.  Use baby wipes and clean yourself from the front, wiping away from the urethra.  Or ask a family member to help.

Ask family members or friends to provide child care, prepare meals, help keep the house livable and keep up with laundry needs.  You can call the American Cancer Society to ask for volunteers to help out with some of these needs.

Step seven: Arrange for a driver for doctor visits.

You will need a driver to take you to the many follow up appointments after surgery.  You will be on pain medication and will not have the range of motion to safely drive.  Ask a family member, friend or the American Cancer Society for help.


Once your new breasts have settled, the doctor will set a surgical date for nipple construction.

Once your new nipples have healed they can be tattooed a darker color than the abdominal tissue.  Some women choose a hue close to actual nipple color.  Some choose decorative tattoos like hearts.  The choice is yours, but be sure to ask the doctor for approval if you go to a tattoo parlor instead of having the doctor tattoo you.  You want to make sure the ink will not inhibit future breast check ups.


What types of complications should you watch for and what should you do for them?

If you suspect an infection, make a doctor appointment immediately.  The doctor will take a culture and prescribe an antibiotic to cure it. If the breast incision opens and drains, make a doctor appointment immediately.  This may be a sign that the transplanted tissue doesn’t have an adequate blood supply and is dying.  The doctor may prescribe iodaform gauze to pack the wound if it is large.  This promotes healing from the inside.  The doctor may have to schedule another surgery for debridement and remove the dying tissue.  A debridement defect may be corrected with a follow up surgery.


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