What I Wish I Knew: Getting TRAM Flap Reconstruction

In May of 2011, I celebrated my 40th birthday with a rockin’ dance party. Friends and family joined me on the dance floor and toasted my milestone birthday. At home, my 3- and 6-year-old daughters slept through the night. In February of 2012, I had my first mammogram. In retrospect, I guess I should have known something was amiss when the mammographer offered me a big hug and said, “We get concerned when theses things pop out of nowhere.”

Fast forward to March of 2012. By this point, I’ve been diagnosed with invasive breast cancer, and in a late appointment, right before I hopped on a flight to North Carolina to visit my parents, my breast surgeon explained to me that I was no longer a candidate for breast conservation surgery. I had to have a modified radical right breast mastectomy. For months, I had been banking on the fact that I was having a lumpectomy, so when the conversation shifted to mastectomy, I wanted to explore my options.

In 2012, I lived in Philadelphia and was being treated by the top breast cancer doctors in the country. They had access to the newest research and were trained in cutting edge surgical techniques, such as “advanced microsurgical techniques.” So when my plastic surgeon suggested a TRAM flap reconstruction, a surgical procedure in which my TRAM (transverse rectus abdominis) flap of skin, fat, and part of underlying rectus abdominis muscle are used to reconstruct my breast, I jumped at the chance.

Here’s what I learned:



Tape and Marker: TRAM flap reconstruction is an intricate process. You need two surgeons in the room: a breast surgeon and a plastic surgeon. Your surgeons are sewing two vascular systems together, it is a long and involved process and they need an intricate roadmap for their work. On an early Tuesday morning in May (a day after my 41st birthday), I was prepped for surgery with a marker. A surgeon came in and began to mark up my whole body — at the abdomen, at my breast, under my arm, around my collarbones, and my belly button — with a black Sharpie. I looked like I had been drawn on by my 3-year-old!

It took me months to remove their marks. Even though I was in pain and healing two major wounds, I had to scrub my body for weeks to remove that black Sharpie. It wasn’t until I finally removed their last marks that I was able to see my new self.

Bellybutton: In a TRAM flap reconstruction, the part of the abdomen they use to construct your breast contains your bellybutton. As you know, your bellybutton marks the spot where your umbilical cord was once attached, and it carried the nutrients between you and your mother.

I was not ready when I saw my reconstructed bellybutton. After surgery, naturally, there was a circle of black Sharpie, but inside this circle was not the same bellybutton. It was not only higher than it used to be, but it was also stretched and oddly puckered. Like a trompe l’oeil, it looked realistic and three dimensional, but in fact, my new bellybutton was merely an illusion.

Only after I saw my newly reconstructed and converted bellybutton, did I realize it was something to be missed, to be mourned.



Drains: For me, one of the most challenging parts of this type of surgery and recovery are cleaning and maintaining drains. After surgery, I had multiple drains at my breast and on both sides of my abdomen. In a mastectomy surgery, drains are used to drain fluid from the surgical site and to prevent swelling. Though I knew that my plastic surgeon had talked about these drains, I was not ready for the energy it took to clean them.

Every day for almost 3 weeks, I had to clean the tubing of my drains and empty their fluid. This involved me in my bathroom, alone and away from my two children, learning how to do the procedure correctly, while also getting used to my newly reconstructed body and nipple-less breast. Truly, it was a lesson in humility and nonattachment as I had to learn how to breathe into the discomfort of seeing the plastic drains attached to my body and learning how to accept the loss of my breast and the reality of my new life.

I was so self-conscious about the bulkiness of the drains, that, ultimately, I think I healed more quickly. Because I refused to leave my front stoop or walk anywhere other than my beautiful neighborhood, I allowed myself to truly rest and heal.

Although a TRAM flap reconstruction is not a choice that is available or the right option for every woman, it was the best choice for me. I had the chance to reconstruct me with parts of me! Now, when I look at myself — my perfectly round, nipple-less right breast, my lopsided bellybutton, and my long abdominal scar — it is hard to imagine what I used to look like. Though the emotional healing process is still ongoing, I am glad to be here to show my now 11- and 13-year-old daughters what it means to be proudly reconstructed.

If you are recently diagnosed and would like to learn more, be sure to check out our Guide for the Newly Diagnosed. If you want to participate in the What I Wish I Knew series, you can share your story with Living Beyond Breast Cancer.

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