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Updated: December 2009

Free TRAM Flap after Implant Removal and Capsulectomy

Pre-operative markings for bilateral mastectomies and latissimus flaps
Final reconstruction after nipple areola tattoo left

This patient had breast asymmetry and right breast implant capsular contracture. She is shown before and after right breast implant removal, capsulectomy and free TRAM flap breast reconstruction.

Shavonne's Breast Reconstruction Story:


My first breast biopsy was in 1989 when micro-calcifications were seen on my mammogram. Fortunately, they were benign. Yearly mammograms followed my “fibrocystic breasts”. I had no health insurance at the time and I was due for my diagnostic testing in April of 2000. As such, I went to a clinic for my routine mammogram. A nurse, who was palpating my breasts during the exam, found a suspicious area. A referral was given to a breast surgeon who ordered a sonogram, then a biopsy. When I argued that lumps were common to me, the breast surgeon said, “My lady, you need to get this checked!” It was on Good Friday in 2000 that I was diagnosed with Invasive Ductal Carcinoma.

My surgery was postponed many times due to issues related to my lack of insurance. Between my diagnosis and eventual surgery, I had sought a second opinion. That physician performed several biopsies of the other breast that fortunately were benign. Finally, in July of 2000, I underwent a modified radical mastectomy of the right breast with an immediate saline implant. Aside from the pain and major disparity in shape between the two breasts, I developed capsular contracture. Chemotherapy followed for six months and at the fifth treatment I went into anaphylactic shock, a very unusual allergic reaction.

In 2002, in order to deal with the implant issues, I was referred to a plastic surgeon specializing in microsurgical breast reconstruction techniques. Initially, in an attempt to avoid a big procedure, I decided to have my first implant replaced. Unfortunately, I again experienced a capsular contracture, and two years later, I wanted my new implant to be removed preferring to be “flat” rather than contracted. My plastic surgeon now strongly recommended a TRAM free flap reconstruction. This was then performed with great results. In 2006, I needed hernia surgery and we took that opportunity to simultaneously do surgery to complete a revision of my breast reconstruction. This completed my reconstruction and made me “Good to Go”.

I would do this reconstruction one-hundred times over. My breast surgeon and plastic surgeon both gave me back my LIFE. The plastic surgeon, in particular, gave me back my sense of being a woman. I now felt so whole and comfortable. Other than the scar, which has almost disappeared, no one is able to tell by touch which is the reconstructed breast and which is the real one. Most recently, I have come to a place where, after nine years, I feel confident enough to enter into an intimate relationship. I recently returned to my plastic surgeon for the “tattoo” of the areola in order to complete the circle (no pun intended). I’ve lost 40 pounds within the last two years and feel my sensuality coming to the forefront.

Looking back on this life-changing experience, I can honestly say that this journey has taken me to a new and more positive outlook on life. Someone once said to me that “When God closes one door, he opens another.” My response to that is, “But it feels like hell in the hallway.” We breast cancer survivors understand this from first hand experience.


Photos and Doctor Commentary

Pre-operative markings for bilateral mastectomies and latissimus flaps

Pre-operative markings for right implant removal and TRAM free flap

Shavonne previously had a right mastectomy with tissue expander and implant breast reconstruction. She is seen here following the right mastectomy and implant reconstruction after she developed severe capsular contracture of the implant. She was marked for right implant removal and capsulectomy as well as TRAM free flap breast reconstruction.


Final reconstruction after nipple areola tattoo left Final reconstruction after nipple areola tattoo left

Final reconstruction after nipple areola tattoo right Final reconstruction after nipple areola tattoo center 


This is Shavonne late after her right breast reconstruction with a TRAM free flap (following the right breast implant removal and capsulectomy). Her scars have faded and she has an excellent breast shape with an improved abdominal contour.