Gaining weight after TRAM flap?


Question from BJW: If you have a TRAM done and normally gain weight in your belly, will you then gain it in your new breasts? Or is this an "urban legend" of the breast cancer world?
Answers - Maurice Nahabedian Actually, because we are transplanting skin and fat from one part of the body to the other, if you gain or lose weight, the reconstructed breast will also increase or decrease in size or have the ability or potential to increase or decrease in size.
Marisa Weiss, M.D. What role does liposuction have in terms of building up soft tissue or removing excess soft tissue from an area of tissue reconstruction?
Maurice Nahabedian Liposuction is a very effective means of contouring a reconstructed breast in order to obtain better symmetry with the opposite side. It is a safe and relatively easy technique that can be performed with minimal patient discomfort.
Marisa Weiss, M.D. Can it be used to bring softness to the area?
Maurice Nahabedian In general, liposuction is only going to be effective if the fat being removed is soft. If there are areas of firmness within the breast, then liposuction will not be as effective in removing those firm areas. Those areas must be surgically excised. The fat that is removed from liposuction can be used in other areas of the body. However, it is not used in other parts of the breast routinely because of the potential for additional firmness. Fat grafting is not successful in the breast.
Marisa Weiss, M.D. Can you explain what fat necrosis is and how it can affect the way the tissue-reconstructed breast can feel?
Maurice Nahabedian Fat necrosis occurs because of insufficient blood supply. This insufficient blood supply causes the fat that is starved of blood to become firm or hard. This is known as fat necrosis. This can occur spontaneously; however, it generally requires a few years to occur.

Fat necrosis can be palpable and a source of dissatisfaction. When it does occur, one option is to surgically excise the areas of firmness. The incidence of fat necrosis generally ranges from 5 to 10% of patients and usually involves only 1 to 2% of the actual breast tissue. In other words, it's usually the size of a marble or walnut.
Marisa Weiss, M.D. Your doctor will follow you over time and is usually able to easily distinguish a lump from fat necrosis vs. a lump from a cancer recurrence. Fat necrosis stays the same or gets better over time in terms of size and consistency, whereas recurrence after mastectomy is likely to get bigger without treatment.
Maurice Nahabedian An easy way to distinguish the two, if there is some ambiguity, is to do a fine needle aspiration.

On Wednesday, November 19, 2003, our Ask-the-Expert Online Conference was called Breast Reconstruction. Maurice Nahabedian, M.D. and Marisa Weiss, M.D. answered your questions about different techniques in breast reconstruction, the pros and cons of implants and body tissue transfers, when you might want to reconstruct, and many more issues related to rebuilding your breast/s after breast cancer surgery.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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