Complications from a TRAM flap breast reconstruction

Don LaRossa MD
Last Modified: November 1, 2001

I had tram-flap reconstruction. A reaction to Morphine caused me to vomit. I pulled out a stitch at beginning of my incision as well as internally. I am not in any excessive pain but must wear a binder to hold my stomach when I stand up. It's been almost a month and my stomach is still extended. I feel I need to be up, and yet wonder if staying in bed without any pressure on my stomach would help me to heal more quickly.

My reconstructed breast is very small compared with my natural breast. I had been expecting something close to my other breast. Now, the doctor says they will make the remaining breast match my new one. This is starting to depress me, because I was not expecting extra surgery. I'm afraid the insurance company will try to find some reason not to cover it. I was told it would take about three weeks of recovery time. Now I've read that it is more like three months!

I just want to know if you have anything regarding the recovery time.
Thank you again.
M

Don LaRossa MD, Professor of Surgery at the University of Pennsylvania Medical School, responds:

You are experiencing some of the complications that can occur with a TRAM flap. It sounds as though the sutures that gave way in your abdomen may have resulted in a weakness in the abdominal wall or a hernia. It may require repair later. Although it is not necessary for you to stay in bed, you should take your doctor's advice and use a binder to prevent it from getting larger.

The size of the reconstructed breast is limited by the amount of available tissue in the abdomen. Sometimes adjustments of the reconstructed breast or the normal breast may be needed. This cannot always be predicted in advance. As far as the insurance matter goes, many states have passed laws regarding coverage for the extra surgery required to bring symmetry back to the other breast. Please check The Plastic Surgery Information Service for a reference on your state.

A two-month recovery period is typical. Almost any surgical procedure, including mastectomy alone, will require 4 to 6 weeks for full recovery.

You should continue to work with your surgeon as I'm sure he/she would like you to ultimately be pleased with your result.