• Latissimus Dorsi Flap or Tram Flap?

    Asked by SoccerLisaMom on Wednesday, April 10, 2013

    Latissimus Dorsi Flap or Tram Flap?

    I had a double mastectomy with one breast reconstructed with an expander and then an implant. The other breast had to have radiation so no reconstruction was done at the time of surgery. I can now have reconstruction on that breast and they have given me the option of a Latissimus Dorsi Flap or a Tram Flap, my choice. Would like to hear from anyone that has had either one of these done and if they were happy with their choice.

    10 Answers from the Community

    10 answers
    • karen1956's Avatar

      sorry I can't help...I had TE and now have silicone implants....I too had rads, but took the gamble that it would take....hope you find the answers....best of luck

      over 4 years ago
    • carm's Avatar

      Hello SoccerLisaMom,
      I am an oncology nurse and I hope this link can answer any questions you may have until the good people here who have faced that decision respond to your query. Best of luck to you, Carm RN.


      over 4 years ago
    • suzanne's Avatar

      Hi soccerlisamom,
      My name is Suzanne and I was diagnoised with breast cancer stage 3 in 2008 , I went through surgery and opted to have both breasts removed. I also, had chemo and radiation. I was given the sam opitions you were for reconstruction of my breasts. I choice the Latissimus Dorsi Flap.
      I want to be very honest with you about this because I know how important this is to you. It was a painful. I now have a long scar on my back and I am just now getting some feeling back where it wa done. I was never told that the scar would be so long and that I would loose so much feeling on my back. As far as the breast... once yoou have radiation on your breast it is very hard to work with the skin. I went through expanding the breast for 3 weeks once a week with expanders and then went through this surgery. There is a chance that the breast tissue wont accept the new skin. Which is also something I was not told. So now where the skin from the back was attached to the breast is not a smoothline. The skin had trouble adhering to the raditied skin.. I have a breast that looks like a mess. I wish I could send you a picture so you could really see as it is hard to explain like this.
      Afetr all was said and done and I sit here now talking to youI would say if I had the choice again I would do nothing. Sure I had=vea lump for a breast so that you can't tell when I am dressed, I hate the way I look when I take off my bra. The pain and the result were no worth it. I can sit here and say it was a waist of valuable time having the surgery and then the recovery and I am sill after how many years just getting some feeling back onmy back. And I am left with a deformed breast and a huge scar on my back. Also because of the radiated sking I could not have a nibbles done. which now is no big deal as I don't miss not havin them.
      I am sorry I am just trying to be very honest with you. I wish smeone would have talked to me before I had this done. Please let me know what you decide and if you would like to know more. God bless you.


      over 4 years ago
    • savingrace's Avatar

      Hi SoccerLisaMom, It has been approx. 6 yrs ago but I had the tram flap and have been completely satisified. Do your research on both procedures and ask your surgeon all the questions that comes to mind so you will have peace of mind on your decision.

      over 4 years ago
    • MarS676's Avatar

      Hi SoccerLisaMom-

      I recently had DIEP Flap reconstruction which is very similar to TRAM Flap but does not use the abdomen muscles. I have to say that I am ecstatic with my results! My belly is the flattest is been in years, and there is still some swelling since its only been 6 weeks since my surgery. My breasts look great also. Recovery has been much easier than I expected, even faster than my bilateral mastectomy!

      I think what's important is that you have a skilled surgeon. When looking for a plastic surgeon I went to one who said that I did not have enough belly flat for the DIEP Flap which I found ridiculous since I gained almost 40 pounds during chemo. I found my current surgeon and she was able to make me a C-cup! On Monday I will be having phase 2 of my surgery that consists of nipple reconstruction and liposuction to even things out as well closing some open wounds that have refused to heal.

      If you have not gone for a second opinion I suggest you do that first. From my research I've read that TRAM flap can lead to some complications such as hernia's because they use abdomen muscles. If I were you I would research for doctors in your area that perform the DIEP Flap.

      over 4 years ago
    • Nancebeth's Avatar

      I had a bilateral mastectomy and immediate reconstruction with silicone gel implants. However, my left implant has been replaced once (Initial bilat on 2/3/12, implant replaced 11/1/13). Lefty is again needing to be replaced. My body just doesn't like Lefty I guess. I have an appt on May 14 with a surgeon who specializes in DIEP flap recon. I was told originally I did not have enough fat for a TRAM flap and did not want teh Lat Flap at all! I would just stick with my implants if Lefty wasn't being such a jerk. I have nothing but good things from women who have the DIEP.

      over 4 years ago
    • MaryMoo's Avatar

      I had reconstruction after radiation. I had an expander put in at mastectomy. Then it was decided that I needed radiation because there was just a smidge left. Margins looked clean during surgery but further examination of the tissue after surgery showed minute traces. We decided to inflate during chemo, deflate, radiate, reinflate then reconstruct. I had lat flap because you have to create a pocket of unradiated tissue for the implant. The reinflation, not surprisingly, did not go great but we did get about 75% reinflated. I am a B cup so we were not going for a big volume. The reconstruction went as well as it could but it took a LONG time to recover. I have been VERY aggressive with weekly massage therapy (2 hour session with a specialist) for 5 years. I am still not back to normal and I would not do this again. I still have discomfort and weakness in my back muscles. I probably could have just had the expander removed but felt a bit pressured by optimistic doctor and husband. I am 54 so my answer might be different if I were a young woman. If you do decide to do it, ask your doctors a LOT of questions and do NOT compare notes with ladies who had reconstruction on UNRADIATED tissue. It is a whole different ball game to reconstruct after radiation

      over 4 years ago
    • whirl's Avatar

      Looking at the answers I too went with implants. The reason I decided to do this route is that when you rob peter in one area to pay paul in the other there is often a trade off. A tram using some of the muscle in the back may affect the stability of you back. Some women experience back pain after this proceedure. I am a runner and do many miles a week and didn't want to risk the back or core possible risks.

      over 4 years ago
    • whirl's Avatar

      Looking at the answers I too went with implants. The reason I decided to do this route is that when you rob peter in one area to pay paul in the other there is often a trade off. A tram using some of the muscle in the back may affect the stability of you back. Some women experience back pain after this proceedure. I am a runner and do many miles a week and didn't want to risk the back or core possible risks.

      over 4 years ago
    • Catchat's Avatar

      Was Stage IIIB with 14 positive lymph nodes diagnosed in 1992. Had left mastectomy in 1992 with high dose chemo and radiation. Had right mastectomy in 1993 after finding another lump myself. Found out this lump was not cancer after a biopsy, but opted to have the mastectomy anyway as a preventitive measure. At this time there was a lot of controversy about Silicone implants which were being used, so decided to have double tram flap surgery which would use my own tissue instead. This surgery was much worse than the mastectomies and recovery time much longer. I still do not have feeling in most of my abdomen. My appendectomy scar is now on my left breast. I have what looks like two navels. One was formed for me by the plastic surgeon and the other is scar tissue from a drainage tube. Because the abdomen has more lymph nodes than any other location in the body, I now have lymphedema sometimes in my abdomen from some of those nodes being removed. Also have lymphedema in my left arm too. So, would I have this type of surgery again? No, I wouldn't knowing the facts afterwards. Would I opt for implants? Haven't personally gone through this procedure, but after following up with many women after they have had this type, I definitely would research the pros and cons. Some women do very well and are very pleased. Some women get infections with the expanders, have a lot of pain and are not pleased with the results. Success depends on many things such as amount of radiation damage to the skin, size of the breasts, plastic surgeon's skill, etc. You have to make the decision yourself but make an informed decision after researching. How important is it to you to have breasts?

      almost 4 years ago

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