Fri, 12 Apr 2002 01:10:46 -0400

My TRAM Flap Story

I am disabled because of a Tram Flap breast reconstructive surgery that I underwent in 1997 at age 42, because of breast cancer.

In this type of surgery, plastic surgeons cut open the abdomen from hip to hip and sever the abdominal rectus muscle, just above the pelvic bone, tunnel it up under the skin and attach it to the chest.

Plastic surgeons now claim that these "cosmetic" surgeries are a part of breast cancer treatment.

My story began after I was diagnosed with breast cancer.

I was encouraged by the leader of a local breast cancer support group to go to a national cancer center.

At the center, the program leader for breast cancer unit, pressured me during a two-hour appointment to have a mastectomy and breast reconstruction.

I asked about a lumpectomy but he said that I wouldn't like the look of my breast after a lumpectomy.

The doctor ignored my objections to surgery and made an appointment with a plastic surgeon at that hospital the very same day.

When I went to see the plastic surgeon, he pinched my nipple, photographed my naked breasts, and tossed two papers to me about breast reconstructions, but told me no details.

Although his records state that we reviewed various forms of reconstruction, I had no papers to take home to my family and was totally confused about breast reconstructions.

The doctors scheduled me for surgery without my knowledge or consent. Consequently, I went back to the hospital for a second opinion from a female plastic surgeon.

I showed her a book with a picture of a completed TRAM Flap. The woman in the photo looked beautiful, as if she had no mastectomy.

I asked the plastic surgeon for photos of completed TRAM Flap surgeries, but was told that there were no photos.

The plastic surgeon asked me if I smoked cigarettes or drank alcohol, but neglected to inquire about my chronic bowel and back problems, which should have disqualified me from the Tram.

It is the rectus muscles, which hold in the bowels and support the spine.

The plastic surgeon neglected to inform me about complications of a TRAM, such as hernias, tissue death, injury to the vagina area, and the possibility of spreading cancer cells to other parts of my body.

The plastic surgeon gave me the name of a satisfied patient to talk with whose medical condition was different from mine, and who had the TRAM Flap for only a short time (not long enough to discover post-complications).

The plastic surgeon told me that the TRAM Flap was like a "tummy tuck," and I would be able to swim, dance and do sit-ups after the operation.

I agreed to have a TRAM Flap and went to the hospital in December 1997 for the surgery.

The plastic surgeon did not give me a consent form until minutes before the operation when I was under stress.

That generic form listed none of the complications specific to the Tram.

The consent form from that date states that I was offered alternatives and understood the risks. This is not true.

I was not offered alternatives to the TRAM Flap; on the contrary, I was deceived and tricked into the operation (most likely for my insurance money).

I was not informed of the risks such as hernias, fat necrosis, asymmetry of the abdomen, and possible spreading of cancer cells to my pectoral muscle.

During the surgery, the plastic surgeon severed the wrong muscle, taking it from the same side as the reconstructed breast, rather than the opposite side.

When I woke from the mastectomy and the immediate TRAM Flap, I experienced pain that was beyond imagination. I felt as if I had been hit by a truck and shot in the gut with a shotgun.

The plastic surgeon prescribed a narcotic (Percocet) for the pain, which kept me in a euphoria for months, and caused severe depression.

The narcotic caused constipation, but the plastic surgeon neglected to prescribe a laxative (causing me to herniate 3 months later from straining).

In March 1998, I had a bulging in my abdomen, but the plastic surgeon refused to tell me it was a hernia.

I had a severe depression brought on by the Percocet and the TRAM complications. I had to take anti-depressant medication and go to weekly visits with a psychotherapist.

Another doctor told me I had a hernia. In the fall, I returned to plastic surgeon and was cut me open again. Marlex Mesh (a polypropylene plastic) was inserted in my abdomen.

The repair operation caused nerve damage in my pelvic and the plastic surgeon referred me to a pain-management doctor for a nerve block at the "left ilio-inguinal genital femoral nerve for pain."

When I visited doctors in my HMO group and complained of the problems, they treated me as if I was imagining the problems.

I had two years of continuous bleeding from the uterus, but no Florida doctor would help me. I believe I was black-listed by doctors in the HMO.

As a result of all the illness from the TRAM Flap, I lost custody of my only child, and totaled my car in an accident.

I lost my teaching job in Florida, and my husband told me to leave the house -- our marriage broke up.

I returned to my hometown in Ohio to live in a homeless shelter until I could receive Social Security Disability, Medicaid, and Food Stamps.

The only doctor with an objective viewpoint who would help me was a doctor of Complementary & Alternative medicine in Ohio.

I have had crippling pain near the underarm where the abdominal rectus muscle was sutured in the chest muscle, and I can no longer carry groceries using that arm.

My medical records state:

"The flap was then inset to the pectoralis major muscle using 3-0 Vicryl sutures after hemostatis had been obtained. The flap was then secured to the skin flaps using 4-0 Vicryl and 5-0 PDS subcuticular suture."

I can no longer sit up without help, and must roll to get off a couch or bed.

I cannot stand for any length of time because the diffuse weakening in my abdomen.

I have damage to my genital area (rectus sheath).

My abdomen is distorted with my intestines pushing forward on my left side, and my quarter-like sized belly button off to the right where my abdomen feels sunken in.

This asymmetry is due to the removal of one left rectus muscle and to weight gain and bloating, which pushes my left side outward.

I see a Christian Counselor once a week for the emotional trauma and post-traumatic stress.

My family doctor prescribes Serzone and Ativan for my depression and panic.

I have MRI reports from 2001, which indicate spurs in my lower spine and degenerated discs.

My lymph nodes were negative for cancer in 1997. But in 2001 the cancer was found in my chest muscle where the TRAM flap was inserted.

Because of the Tram Flap surgery, I believe the cancer has been seeded into my chest muscle.

My records from the gynecologist report that my uterus is "asymmetric," and I need to have a hysterectomy, but cannot have any more abdominal surgery or undergo the stress.

I wear two binders to hold in my lower and upper abdominal area. I have to use a cane to walk. I need a wheel chair if I go to a large store.

The plastic surgeon recorded the following complications from the TRAM FLAP that she performed on me:

1.) Ventral Hernia;

2.) Fat Necrosis of the Abdomen;

3.) Fat Necrosis of the Left Breast;

4.) Cellulitis of the Left Breast;

5.) Nervousness, Depression, and Anxiety;

6.) Weight gain after the TRAM Flap;

7.) Nerve Damage;

8.) Asymmetry of the Abdomen;

9.) Abdominal Weakness;

10.) Bulging in the Left Rectus Sheath;

11.) Swelling in the Left Periumbilical Area;

12.) Distortion of the Umbilical Area.

All this damage was done to my body because of infiltrating lobular carcinoma (1.5 x 0.7 x 0.7 cm.) found in my breast (months after a biopsy).

If the plastic surgeon had informed me of the complications and risks of the TRAM Flap, I would have never consented to having it done.

I didn't receive the rights listed in the Nuremberg Code of 1947, of free choice without deceit, duress, and knowledge to make an enlightened decision.

The Social Security Administration declared me disabled after this surgery.

The Plastic Surgeon, was irresponsible by performing this surgery because of the following reasons:

1.) My immune system was fighting cancer and not strong enough to handle a mastectomy and the immediate pedicle TRAM Flap, during the same surgery.

2.) Complications from immediate reconstruction can delay adjuvant cancer treatment. Consequently, I did not receive the proper cancer treatment, because I was constantly fighting the complications from the plastic surgery.

3.) I had chronic bowel problems and a family history of diverticulitis. I needed the rectus muscle to hold in my bloating bowels.

4.) I had degenerated discs and spurs in my spine. I needed the rectus muscle to support my already weak back.

5.) I worked as a School Librarian and needed my rectus muscle to lift books and equipment.

6.) Performing immediate tissue transfers on patients with breast cancer can seed cancer cells in other parts of the body.

My cancer was seeded in my chest muscle, but I found a radiologist-oncologist in Cleveland, Ohio who is also a Naturopath.

He was the only oncologist I have met who has an open mind and will listen to his patients.

He successfully managed my pain with acupuncture, rather than with drugs.

He used radiation to sterilize and kill much of the cancer tumor cells that had grown in my chest muscle/axillary area, after the TRAM Flap.

I still have cancer cells inside of me and have limited use of my left arm, but I reject the idea of any more surgery or drugs.

All that suffering from the TRAM was for nothing!

As long as plastic surgeons are allowed to perform repeatedly failed breast reconstructions, the taxpayers will foot the bill through payments of Social Security Disability, Medicaid, and Medicare.

Thank you,

P.O. Box 32

Findlay, Ohio (USA)

Copyright 2002, Pam Young

This story may be used for non-commercial purposes to educate people about the long-term impact of reconstructing the breast with a TRAM Flap.