Reconstructive surgery
Post Operative Restrictions TRAM Flap
Because this operation removes a segment of the rectus muscle from the abdominal wall, which then has to be reconstructed, activities stressing the abdominal wall are to be limited for three months. This would include such exercises as sit-ups and the so-called tummy-tightening exercises often used in aerobics programmes. Also restricted for 3 months is heavy lifting, i.e. weights more than about 10 kilograms and remember that this includes lifting up small chilMren! Light exercise after the surgery is encouraged, especially walking and swimming, although you shouldn't swim for about three weeks after the operation, and then, start slowly.
Breast Cancer
A common question from patients is whether breast reconstruction increases a risk of recurrence of breast cancer. Studies from the Cleveland Clinic in the U.S. and other respected institutions indicate that breast reconstruction has no adverse effect on the course of breast cancer.
There have been some concerns in the past about reconstruction disguising a possible local recurrence of breast cancer, however newer diagnostic techniques such as CT and MRI scanning allow such recurrences to be detected fairly early, even underneath the new breast. In any case, local recurrence is uncommon after the application of modern surgical mastectomy techniques.
Pregnancy
Studies in the US indicate that women who have TRAM flap reconstructions may successfully undertake pregnancy with little risk to the baby. However there may be reasons to do with management of breast cancer that limit this option and you should discuss this with your Oncologist. It is also not advisable to fall pregnant for about one year at least after TRAM flap reconstruction to reduce the risk of hernia formation, which is greater if pregnancy occurs, even years after the reconstruction.
The Other Breast
As a general rule, plastic surgeons try to match the reconstructed breast to the normal one. However, some women with very large or floppy breasts often prefer the reconstructed breast to the normal one. In these cases it is possible to reduce, uplift or reshape the other breast to create a better shape. This is usually done at the time of nipple reconstruction. Some women have had their opposite breast enlarged with an implant, as in some circumstances, the reconstructed breast is larger than the normal one. In certain cases, your surgeon will indicate that he might not be able to make a breast the same size or shape as the opposite one and will recommend surgery on the other breast. Figure 5 illustrates the results of one patient who had the opposite breast reshaped and lifted to match the reconstructed breast.
Additional costs will be incurred for these extra procedures, but Medicare rebates and Health Fund cover usually apply.
Medicare and Medical Fund Coverage
Post mastectomy surgery qualifies for a Medicare rebate and Hospital Fund cover. Health Fund cover applies when you have been in a health fund for longer than 12 months, according to Pre-existent Condition rules.
Note however that not all the costs of the surgery will necessarily be met by Medicare and your fund, depending on the level of fees charged by your surgeon, anaesthetist, assistant surgeon etc. Discuss this with your surgeon or the practice manager before your operation. Implants are usually covered by your Health Fund, but you should check this in advance. Some Health Funds have exclusion provisions, or up front payment rules for these types of operations, although most will agree to cover hospital costs according to their policy rules. That said, forewarned is forearmed, so check with your fund first.
Empathetic Advice
Most surgeons will be happy to introduce you to a patient who has had breast reconstruction.
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