I saw Dr. Welk yesterday for a marking appointment. He took a blue Sharpie marker and drew a surgical incision map on my torso. (Tip: Remove any skin creams or oils before the marking appointment, especially if you’ve had a full body massage a few hours before your appointment. Otherwise, Dr. W your plastic surgeon will get annoyed with you and you will have to go to the restroom and clean up your skin.) I must be special because I got way more markings than are shown on the illustration, below. He also explained the procedure to me.

Here’s the first picture of a pedicled TRAM procedure I’ve found online that actually makes sense to me. My surgery is a little different. First, the picture below is of immediate reconstruction. That means that an onco surgeon does the mastectomy followed by a plastic surgeon doing the TRAM surgery all during the same surgery. I am having delayed surgery. I had a mastectomy last August. Dr. Welk is also not using any skin from the TRAM flap in the reconstruction. He’s only using the fat from my abdomen and discarding the skin. I am keeping all of my breast skin. That was the whole point of his putting a tissue expander (temporary implant, which is gradually filled with saline over a number of months) under my skin. He was able to expand my skin to make up for what was lost during the previous breast surgeries. This was possible because I did not have radiation treatment and I had a full skin sparing mastectomy.