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Updated: March 2009

Metastatic Breast Cancer, Free TRAM Flap

Photo of Pamela's Procedure
Photo of Pamela's Procedure

After having chemotherapy to shrink the tumor size, this patient underwent a right mastectomy with immediate reconstruction. These images demonstrate her appearance before and after right breast reconstruction with a free TRAM flap.

Pamela's Breast Reconstruction Story:


I have seen devastation in my life. Working near the world trade center, in the back of Seven World Trade, I experienced devastation first hand on September 11, 2001. Never for a minute did I think that only a few years later my life would take another devastating blow. In January of 2005, I went for my first yearly mammogram. I was 41 years old, and had no family history of breast cancer.

A few weeks later, I was told that I had breast cancer. Based on the tumor size and pathology, I learned that I had stage two invasive ductal carcinoma. My oncologist thought it would be best if I was treated with neoadjuvant chemotherapy to shrink the tumor, given both it’s location behind my nipple and it’s large size.

In February of 2005 I began chemotherapy. Three months of Adriamycin and Cytoxan, and then a course of Taxotere. It was no easy battle. I wasn't prepared for the utter devastation of losing my hair. Although my doctor told me it would fall out within a month, I just didn't expect it to happen like it did. I sat on the toilet brushing it over and over, and more and more came out in clumps. Finally, fighting back tears, I took scissors and began to cut it off. My mother suggested that I go and have a professional do this for me. I found a wig shop, and decided to choose a three-colored blond wig, which was beautiful. I’m brunette and I always wanted to see what it was like to be blond! I actually really loved my new look and it took my mind off of losing my hair.

I'm not shy about admitting that I'm a vain person. To help me feel better, it was important for me to look good throughout this entire ordeal. Each chemotherapy drug was pretty bad in it’s own way, although for me, the Taxotere was a nightmare. By the end of the chemotherapy, the tumor had shrunk in size, and I was ready for surgery.

Because the cancer was behind the nipple, I was unable to have a lumpectomy. My surgeon suggested a mastectomy with immediate TRAM free flap reconstruction, rather than an implant reconstruction. I trust, love and respect my surgeon, and I agreed that we should do the free flap, even though the surgery was eight hours and I was worried about the more difficult recovery.

I had surgery on August 16, 2005. A right mastectomy was done to remove the cancer, and I later found out that I had positive lymph nodes. Immediately after the mastectomy, my breast was reconstructed. I am still amazed that the fat from my abdomen created my right breast. It was a long and hard recovery, but the results are just fantastic. The bright side of this is that I got a free tummy tuck out of it. In the past, I always worked out at the gym, but no matter how hard I tried, I could never get my stomach to look this good.

When I was first diagnosed with breast cancer, I cried so hard that I actually howled in front of my surgeon. Being the great guy that he is, he always reassured me that everything would be alright. Having a team of doctors you love, trust, and respect is very important. They helped me understand everything that was happening, and made my treatments easier to deal with.

After surgery, I began a year of Herceptin treatments because my tumor was HER2neu positive. One month before the year had ended, I thought I was in the homestretch, but during a routine examination metastatic tumors were discovered. With one above the collarbone, one below the collarbone, and one in the liver, I was immediately started on Tykerb and Xeloda, which are both chemotherapy medications given in pill form. In three months there was significant improvement in all of these areas.

In September of 2007, the PET scan showed no progression, and although the metastatic lesions were stable, they weren't getting any smaller. My oncologist decided to add Avastin to my regimen to give me the most aggressive treatment possible. He is very hopeful that this is the treatment that will work.

I am hopeful too. There are plenty of days that I'm tired of all of this, but I know I need to keep the faith, and I'll be on my way to recovery. Three years have gone by, and while I am still going through chemotherapy I am doing better. My desire is to be well, and I have faith that my doctors will guide me in the right direction.

Breast reconstruction has been an amazing part of this experience for me. Looking at my breasts, you would never know that the right one was reconstructed. In this long hard journey, my reconstruction has definitely been one of the best parts, and for that I am so grateful. Many women with metastatic breast cancer opt to not have reconstruction. In some cases, being in active treatment means you can't have it. If you are a patient with metastatic disease, and reconstruction is an option for you, my advice is to have it done. For me, a new and improved breast, and an amazing relationship with my doctors is really what has gotten me through this experience.


Photos and Doctor Commentary


Photo of Pamela's Procedure 


Photo of Pamela's Procedure

Pre-operative with markings for a TRAM free flap

Pamela was marked pre-operatively for right breast reconstruction using a TRAM free flap from the left side of her abdomen.


Photo of Pamela's Procedure 

After right mastectomy and TRAM free flap breast reconstruction


Photo of Pamela's Procedure
Photo of Pamela's Procedure

Markings for right breast revision and nipple areola reconstruction

Four months after the right mastectomy and TRAM free flap breast reconstruction, the right reconstructed breast appears fuller than the left breast. Pamela did not have a skin-sparing mastectomy because of the large size of her tumor. As such, there is a large skin island from the abdomen. At this time, markings were made for liposuction of the reconstructed breast to improve her symmetry. Also, markings were made for right nipple areola reconstruction.


Photo of Pamela's Procedure  Photo of Pamela's Procedure
Photo of Pamela's Procedure

Final reconstruction

Pamela is seen here fifteen months after her right mastectomy and breast reconstruction, and six months after tattooing of her reconstructed nipple areola.


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