At 32 I was Dx w/stage 3 BC, completed chemo, radiation & the Latissimus flap which failed. Should I try TRAM flap?

after radiation We tried expanding but my skin was to tight and thin. so we went with the latissimus flap. after 3 surgeries (due to the skin & half the muscle not taking) We started the stretching process again but once again my skin is to thin. My plastic surgeon said I could go with a small implant but that would be a temporary solution, with the chance of the implant coming out or I can do the Tram flap procedure. what are your thoughts.

Doctor Answers 7

Breast Reconstruction - DIEP flap

I'm sorry that the latissimus surgery did not work; but yes the next option would be abdominal tissue. I typically perform the DIEP flap which spares the muscle as opposed to TRAM flap which sacrifices the rectus muscle  (sixpack). DIEP is performed by specialized plastic surgeons in this advanced technique.   

Houston Plastic Surgeon
5.0 out of 5 stars 25 reviews

Breast reconstruction after radiation

Please be seen and evaluated by a Plastic Surgeon who routinely performs breast reconstruction.  I will typically not place an expander in someone who is radiated because of the issues you described.  My first choice is the DIEP flap procedure which we perform routinely in our practice.  Feel free to look at our site and come to Austin for a consult.

Three basic forms of breast reconstruction exist. You can use your own tissue, implants or a combination of the previous two techniques. Your own tissue can be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting. Implants can be done in one stage or two stage. Two stage reconstructions are started by placing expanders at the time of mastectomy. Once they expanders are placed they are able to be inflated as determined by wound healing. The final time consists of combining any of the above techniques.

If you are interested in being seen in Austin please give us a call. I know this is a difficult time for you. The majority of my practice is devoted to reconstruction for women with breast cancer or who are BRCA+

Breast Reconstruction

Breast reconstruction is definitely more challenging after radiation therapy.  You have the additional history of multiple failed attempts at reconstruction.  I would favor a muscle sparing Free TRAM Flap for reconstruction.  This type of reconstruction brings in new vascularized tissue to a scarred, poorly vascularized recipient site.  A Free TRAM carries more blood supply than a pedicle TRAM flap.  This is a highly specialized reconstruction which should only be performed by a Plastic Surgeon with extensive microvascular training and experience.  Despite your disappointing experience thus far with breast reconstruction, a Free TRAM Flap can offer a very gratifying, long lasting, and reliable result.

Best of luck to you.

Gilbert Lee, MD
San Diego Plastic Surgeon
4.8 out of 5 stars 23 reviews

TRAM flap

In order for you to be a candidate for a TRAM flap, you need to be evalutated inperson and see if the tissue can provide adequate coverage. One has to be sure there are no contraindications such as certain medical issues, previous abdominal surgery, to name a few.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast Reconstruction

Breast reconstruction after radiation and thin skin envelope the chances that an implant will be successful is slim. Your best option is autologous tissue transfer. TRAM, or Free Flaps.

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

Reconstruction after latissimus flap failure

I am sorry you are going through this.  A complete analysis is beyond the scope of this message board.  Please work closely with your surgeon and understand ALL of your reconstructive options, even options that your surgeon may not personally perform.

Fat grafting for partial and total breast reconstruction is common in my practice.  Fat grafting may have a role in your case.

Your post to this forum was 3 weeks ago.  Can you give us an update?

Best wishes.

Timothy Connall, MD
Portland Plastic Surgeon
4.8 out of 5 stars 37 reviews

At 32 I was Dx w/stage 3 BC, completed chemo, radiation & the Latissimus flap which failed. Should I try TRAM flap?

Hello!  Thank you for your question.  I am sorry to hear of your complications with your breast reconstruction.  It is very rare for the latissimus flap to fail, but given your description that the skin and muscle did not take, I trust that this was needed to be removed for this reason.  

After radiation, you have an increased rate of complications including wound problems, infections, thinning of the tissue, and decreased vascularity to the skin/tissue of the area.  The best method to reconstruct a breast following radiation therapy is with a flap.  The flap, which is skin, fat, and sometimes muscle, will serve to bring in healthy, well-vascularized tissue to the chest/breast area that will significantly ameliorate the radiation issues compounding the problem.  Microsurgical perforator flaps (such as the DIEP flap and SGAP/IGAP flap) are the newest and most-innovative procedures in breast reconstruction today.  As these are muscle-sparing flaps, the pain, morbidity, and complications such as those above, of these procedures are much less.  They are highly-complex procedures that few plastic surgeons performed and consult with one who is well-versed, trained, and skilled in these procedures if you are interested.  

There are many options to breast reconstruction including implant-based and flap-based procedures.  The complication rate with implants following radiation is reported as high as 60-70% in some studies.  Flap reconstruction is usually recommended, but there are several centers who perform implants following radiation with great success and results.  I typically prefer flaps, such as the DIEP flap. 

You are a candidate for other procedures, if you are willing to continue with your journey for a reconstructed breast.  Flaps such as those above, including others, are available.  The decision to continue with this will be your decision and what you are willing to go through.  There are risks and benefits with everything that we do in Surgery - discuss the various options with a board certified plastic surgeon who will educate you on all of the options and help you to decided if breast reconstruction or which procedure will be best for you.  Good luck with your decision and best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.