I don’t often get to see people before their surgery which is a shame, because a couple sessions of manual lymphatic drainage beforehand makes a huge difference on a number of levels …

  • the immune system is given a tune up
  • any lingering toxins are cleared out of the body
  • new pathways away from the site of the surgery can be created helping to reduce swelling or oedema more quickly once the surgery has taken place

I see R on a monthly basis to work on some swelling she has in her lower legs and feet.  She and other females in her family all suffer from this condition and while in her case it is not severe, it is enough to make buying shoes difficult, not to mention it’s just plain uncomfortable.

R was diagnosed with a DCIS (ductal carcinoma in situ) in her right breast in December.  She’s been having annual screening for over twenty years as she was considered high risk and after a couple months of deliberation she has decided to have a double mastectomy and a tram flap reconstruction at the same time.  This is a huge decision on many levels.  A DCIS is not usually considered an aggressive cancer and the recommendation is a lumpectomy, sometimes followed by radiation and one of the hormone inhibiting drugs if deemed necessary.  But R’s reasoning is that she has been screened for 20 years and she’d like to stop worrying.

The surgery is major but one of the main benefits is that there is only one (usually, of course there may be complications but hopefully not).   Muscle, fat and skin are taken from your abdomen to create a new breast using your own tissue.  The transverse rectus abdominus muscle is used to create a breast and later on, if you choose, there is another surgery to create a nipple and areola.  Or you can use a prosthesis nipple – a client told me today she bought one and wore it to bed the other day and woke up with a new nipple on her arm!  Probably best to take it off before going to bed.)

The surgery is long, eight hours or so.  As with any procedure there is a risk  with anaesthetic.  And the recovery is long and quite painful (think about it, you’re moving your stomach muscle up to your chest, ouch). 

The following excerpt is from About.com Breast Cancer, http://breastcancer.about.com/od/reconstructivesurgery/tp/tram_flap.htm

Moving Muscle and Skin

TRAM Transverse Rectus Abdominus Breast ReconstructionIllustration © National Cancer Institute
On the skin markings, your plastic surgeon will make an incision, and raise the skin and muscle flap. A tunnel will be created under your skin so that the flap can be relocated. This tissue flap will go through the tunnel to your mastectomy incision. Notice that this illustration shows a free flap — the skin, fat, blood vessels, and muscle have been cut.

Creating Your New Breast

TRAM Transverse Rectus Abdominus Breast ReconstructionIllustration © National Cancer Institute
The abdominal skin flap (still attached to muscle) will be positioned so that it fills in the skin that was lost during your mastectomy. If you’re having a pedicle flap, your plastic surgeon will close the skin incision to create a new breast. And if you’re having a free flap, your surgeon will use microsurgery to reconnect blood vessels first, and then close the skin incisions.
 

Post surgery there is hourly monitoring to make sure that the tissue is still functioning (there is a small chance of necrosis) and numerous drips which are gradually taken out over the next few days.  There are bandages for the breast and braces for the tummy.  The stomach will likely be sore for about six weeks.  But at the end of all that, there are beautiful breasts made from your own tissue.

After the surgery, as soon as she feels able, R will come in for some post-op lymphatic drainge to help her

  • eliminate toxins from the surgery
  • build her immune system back up
  • reduce the swelling around the surgery site

Extra care is taken and only superficial work is done in the abdomen, that is, if she’s able to tolerate any work at all.  With R I have to be mindful that her lymphatic system is compromised already but luckily she will not have nodes removed in the surgery so the main collections under her armpit should not be traumatised and I can direct fluid towards them as well as the nodes in her neck.

Surgery is next week, good luck R.

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