Knowing the options for breast reconstruction can make a world of difference to a woman when she is choosing her cancer treatment plan. It can help her make optimal treatment decisions and restore her sense of self. At Fox Chase, we not only strive to put more power in our patients’ hands, but we push the frontiers of new knowledge in an effort to continually improve the patient experience and reduce the impact of cancer on their lives. Below, clinical nurse specialists Deena Dell and Carolyn Weaver share findings from a recent survey they conducted among patients who have undergone a TRAM flap reconstruction. In their survey, they collected data regarding recovery, which now allows them to better address the needs and concerns of current and future patients. We applaud their ongoing commitment to setting higher standards for patient care.
“You’re not self conscious at all because you’re you, you are now fully attached, you’re fully normal . . . I feel, as far as the reconstruction goes, as I sit here now, I just feel like me, whereas without it I could never have said to you I feel like me.” Hill, et al. Oncology Nursing Forum (35)1;81-88
This quote sums up what many women feel about having breast reconstruction after needing a mastectomy. It makes them feel whole. Most women are candidates for breast reconstruction, with the majority eligible at the time of initial surgery. According to Sameer Patel, MD, a microvascular reconstructive surgeon at Fox Chase, two out of three women are never even told about the option.
In stark contrast, Fox Chase Cancer Center feels strongly that all women should be well aware of their options for reconstruction when considering their treatment plans. Fox Chase is fortunate to have two microvascular reconstructive surgeons who can offer women a number of options – including TRAM flap reconstruction, which uses tissue from the belly to create a new breast mound.
It is important to us, as clinical nurse specialists on the breast team, to make sure our patients are given the highest quality nursing care to support recovery. We keep up to date by reviewing the clinical journals. In this case, however, we found very little literature on instructions for patient recovery after a TRAM flap procedure.
Along with Jeannie Kozempel, one of our physical therapists, we therefore conducted a study on pain sites, pain intensity, and pain interference in 7 different areas of functioning associated with this procedure (published in 2008 in the Oncology Nursing Forum, Vol. 35, issue 2). We sought to determine the intensity and duration of pain and the level of interference with activities of daily living that women experienced at four weeks and eight weeks after the surgery. We also assessed patient satisfaction with a patient teaching tool we developed called “Activities and Exercises Following a TRAM Flap,” and found the following:
- Compared with how they felt before surgery, women still had higher levels of pain and interference with activities of daily living four weeks after surgery, but were almost back to before-surgery levels at 8 weeks.
- As might be expected, women with low back pain before surgery experienced exacerbated low back pain after surgery.
- Surprisingly, we found 40 percent of women reported pain in the reconstructed breast. It had been our impression that the reconstructed breast was numb and therefore would not be painful, but that was not the case. Most patients sought to treat the pain with opioid (such as Percocet or Vicodan) and non-steroidal inflammatory drugs (such as ibuprofen).
- Two-thirds of the women who worked full time and all of the women who worked part time were able to return to work at eight weeks.
- Women were overwhelmingly satisfied with the education they received from the clinical nurse specialist and the physical therapist.
As we use these results to continuously improve our support for patients, we would be glad to try to answer any questions or concerns you have about recovery after breast reconstructive surgery.
Deena Damsky Dell MSN, RN-BC, AOCN
Carolyn Weaver, MSN, RN, AOCN
Clinical Nurse Specialists, Breast Team
More information on TRAM FLAP Procedures at Fox Chase Cancer Center.