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Plastic Surgery/Tram Flap post surgery admominal issues


Below (after question)is an artical I read and my wife is having the exact same issues. Morning time not so bad with pain and swelling. As the day goes on it gets worse.Her obdomine averages about 3 inch growth during the day. Here tram flap was 5 months ago and we have seen 6 doctors and ran all the test which are normal. They're telling us that we may have to go to a specailty clinic maybe Mayo, Clevland Clinic or JH.  Any more info on this issue?

I had a tram flap done in 2001. history of breast cancer - 1986, bilat. mastectomies, with silicone implants in stages at that time. The reason for the TRAM was, one of the implants had ruptured(dx during a CAT scan in 2000) I was told the TRAM was the "gold standard", so I went ahead with it.  It had complications at the time of surgery (not enough fat tissue to make bigger breasts, needed skin from abd to close the wounds  in the breast areas, surgeons had trouble closing abd. wound,( due to the extra skin they took from the site), and used marlex hernia mesh to help. The incision opened up (approx 8") and had to heal from the inside out, over the course of a couple of months, until closure was possible.  Since the time of my TRAM, I've had miserable abd. pain, and swelling. CAT scan, ultrasound all normal.  The docs want to keep sending me to gastro docs, but I believe it's due to the surgery itself, more interstitial, and not an "inside" stomach problem.  Have you had any experience with other women who have had pain, such as I have?  My quality of life is so poor, I HAVE to work, but each day is a struggle with the swelling& intolerable pain.  It seems to be worse the more active I become- so by the end of the day, I'm in bad shape.  The pain seems to be relieved by rest, on my left side, curled up for about an hour. I went into the ER one night, the pain was so bad, only to be told I have IBS. Maybe I do, but I don't believe that is the significant dx.  It has been most frustrating for me to have this kind of pain on a daily basis, and I cannot seem to get the docs to HEAR me.I believe it has something to do with the complications of surgery, maybe the use of the mesh- maybe the lack of the abd. muscles not being where NORMALLY they are.  Any insight you can shed, will be a godsend. By the way, if it's helpful, I was 34 when dx with b/c, and I'm 57 now.  I'm too young to feel this bad

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I'm sorry you've had so many abdominal problems after your tram flap breast reconstruction. While some abdominal issues (like bulging and even abdominal hernia) are not uncommon, the problems you are describing are certainly rare.

Abdominal CT scans and ultrasounds will pick up weakness in your abdominal muscle layer ("fascial laxity"), hernias or fluid collections. If these tests have been "normal" , you may have other issues going on that would not be shown on these tests. This is why your docs have sent you to see gastro docs and hence the diagnosis of IBS.

Having said that, I agree with you; it is certainly very possible that your TRAM surgery complications are contributing to your symptoms. Abdominal complications such as yours after TRAM flap reconstruction will generally lead to a lot of scar formation. Scar can be painful. Sometimes nerve endings (nerves are cut in any surgery) can get caught up in the scar and cause pain ("neuroma"). If you have a very specific tender spot on your abdomen (like a trigger spot) then you may have a neuroma. If you do indeed have a trigger point ask your surgeon for a referral to a physical therapist for a course of desensitization.

If your pain is more of a generalized ache then it may be due to muscle weakness and muscle imbalance. Though fairly uncommon, TRAM flap surgery can sometimes also lead to back pain. If your surgeons give you the go-ahead, you may want to try a course of physical therapy to strengthen your trunk.

The swelling you mention is a direct consequence of the surgery and generally only gets better with time. To be honest though, I would have expected the swelling to get better by now since your surgery was in 2001. Wearing an abdominal binder or girdle may help you get through your day at work easier.

I realize your problems are very real. I'm sorry I don't have great answers for you but I hope some of what I've offered will help.

I'm sorry. I don't have any further info to add to the above answer. It wouldn't be a bad idea to seek a formal evaluation at another institution if that's what your local doctors are recommending.

Minas T Chrysopoulo, MD

Plastic Surgery

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Minas T Chrysopoulo, MD




Dr Chrysopoulo is certified by the American Board of Plastic Surgery and is an active member of the American Society of Plastic Surgeons (ASPS) and the American Society of Reconstructive Microsurgery (ASRM). Dr Chrysopoulo's areas of special interest include breast reconstruction following mastectomy (including DIEP, SIEA, TUG and GAP flap procedures, fat grafting, Alloderm one-step), and scar healing.

Certified by the American Board of Plastic Surgery.

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