I guess if I had had a double mastectomy in 2003 I would have elected to have two smaller breasts made from my "baby belly" rather than having the Lat Dorsi type of reconstruction. At the time I wasn't ready to make the decision to have my second breast off (I was 35yrs old). I wish I had and then I wouldn't have had to go through it all again - mastectomy and chemo this time too. Its all very well in hindsight though and I never imagined having to go through it twice! I think I was really unlucky.
I don't think you need too much tissue for the TRAM. My TRAM was actually delayed by 5 months as I had an anaphylactic reaction to the blue dye that they used to track the lymphatic drainage with my sentinel node biopsy and ended up in ICU - that sort of cut short the operation! I didn't have a great deal of loose skin where the breast was taken from. They used some skin from my stomach as part of the reconstruction.
If there is ever any chance of you having your other breast off as well then its probably a good idea to decide before you have your reconstruction - at least that way you could have both breasts reconstructed at the same time and make them even. If you have enough of a "baby belly" or stomach fat then a TRAM would be my preference, even though it is a bigger op and the recovery time is quite a bit longer. The breasts definitely feel more natural. I am not disappointed with the result that I got from the Lat Dorsi op but it definitely doesn't feel normal. Both breasts are more perky than they were before and both sit about the same. Whether the TRAM one droops over time, I guess I'll have to wait and see (although it hasn't over the past 7 yrs!).
I guess if I was you I would ask the surgeons whether a TRAM is possible based on your body shape etc. At least then you will have the information to make the right decision for you....
Louise x
