Hi Heidi
I didn't have a TRAM reconstruction the second time because my tummy didn't grow back! I've got a lovely flat stomach now, which is a huge bonus :)
I kept the majority of my skin with both mastectomies - all except a little area on each side where the nipple was. My surgeon said that it is rare to get any BC coming back in the skin of the breast unless there was a tumour very close to the surface. He simply feels the skin over my reconstruction every time I go to see him and I look out for changes (which I am not expecting to get).
I scar pretty badly too with quite lumpy dark scars. My TRAM scar is very low down (similar to where a caesarian scar would be) and I really don't notice is. I can still where a bikini if I am feeling brave LOL. The one on my back hasn't scarred badly at all. I rubbed it daily with Bio oil after the op and it certainly helped a lot :)
My surgeon prefers to use a muscle when he does a tissue expander type reconstruction because he thinks it gives a better result. He doesn't like to put the expanders straight under the skin. If you have a TRAM flap reconstruction you don't need to take muscles etc from elsewhere in your body.
For the nipple, the surgeon "creates" a new nipple from the tissue that is there. I am not exactly sure how he does it but, other than the lack of colour at the moment, you wouldn't know that it wasn't real! Sooooo lifelike!
Anything else that I've forgotten or you need to ask, I'm around :)
Louise