Archives for posts with tag: TRAM reconstruction

When I was still in my 20’s, I decided to give yoga a try. Maybe it was my age, but I had the idea that it was a bunch of gentle stretching and meditating. Yes, I’d seen photos of women doing challenging looking poses requiring great strength, balance, and flexibility, but surely beginning yoga would be a breeze. Plus I was young and strong. I signed up for a class at the student recreational center.

Oh, how wrong I was. Yoga, even beginning yoga, was hard! For one thing, it can be aerobic exercise! What????? I thought all of the deep breathing would be for meditation, not survival!!! It also required a great deal of strength. By the end of the hour, my arm muscles were in a spasm of fatigue. What was not surprising was my lack of balance. I am athletic but I am better at balancing while in motion than while still. I am also afraid of heights so the idea of doing a back bend freaks me out. That was true even when I was a much shorter and fearless kid.

The biggest surprise in yoga, however, was how incredible I felt at the end of class, lying in the corpse pose. Even though my body was exhausted, I felt a warm ease and comfort. I have returned to yoga a few times, but for whatever reason, I’ve had trouble making it a habit of more than 3 or 4 lessons, even though I very much enjoyed it each time.

I suspect some of my difficulty has to do with the fact that I need a class in order to get good at it and I am historically self-conscious about being “bad” at something for too long. Although I’ve flailed my way through many aerobic dance classes with my initial difficulties following choreography, especially trying to mirror a teacher whose right and left is opposite mine, I am able to get the steps eventually and by that time, I would be one of the stronger students in the class. Meanwhile, flailing is very effective at getting one’s heart rate up. Flailing will get you a good workout.

I don’t know what a yoga class would be like for me now that I’ve gone through cancer treatment. So much of it is flailing, trying to move forward, having everyone look at me in various stages of undress, and not knowing what the Hell I was doing except trying to follow directions and make some kind of sense. Everyone is different but I found having vulnerability and my body on display over and over as a person going through frequent and invasive medical treatments, I broke through some anxiety and self-consciousness. In clinical psychology, we call this exposure, meaning that I repeatedly put myself in anxiety provoking experiences, and each time with the world not coming to an end or anything, I learned to deal with it. But as I said, everyone is different and what is the appropriate level of exposure (literally or figuratively) for one person could be traumatizing to another person.

This is a personal blog and one of the things I try to convey is the fact that my life is highly fulfilling but also highly messy. My life is not an inspirational poster. I am not perfect and I am getting more and more okay with that. In fact, the more okay I get with it, the more okay I am with everyone else. So this is perhaps a very good time to give yoga another try. In fact, it is the latest practice in the Mindfulness-Based Stress Reduction (MBSR) program that I am doing.

Knowing what I know about MBSR, I did not expect the yoga to be super hard. I mean, after all, MBSR is used frequently with individuals with chronic pain problems. Also, I learned that yoga as a mindfulness practice is more focused on being mindful of breath and bodily sensations than on doing fancy poses. The video that accompanies my program is taught by a health psychologist and if you are keeping score at home, she uses Hatha yoga poses.

The poses are mostly stretching with a couple of strength and balance poses. The stretches are sublime, hitting every spot in my body that gets tight and achy. My favorite thing that the instructor says after saying that her motto is “No pain, no pain” is that we are to find “the sensation that is delicious”. That is exactly the way those wonderful stretches feel, too.

The strength and balance moves are a bit more challenging for me though not frustratingly so. A particular challenge are the poses that rely on abdominal muscle strength. Historically, I had naturally strong abdominal muscles. With my TRAM breast reconstruction two years ago, I lost one of my abdominal muscles. I haven’t done abdominal crunches since right before my TRAM surgery. I was instructed to a lot of walking and daily crunches to prepare for the surgery. I was already walking three miles a day and I got up to a pretty high number of crunches, at least for someone who does not hang out in a gym.

Imagine my surprise, when I was lying on my back with my knees bent and my feet on the floor, and I was unable to lift myself to a sitting position without putting my hands on the floor. My core is not working the same way as the yoga instructor’s core. My core got gored. By the end of the 30 minutes, I got that same delicious sense of relaxation and time well spent that I got at the end of the more rigorous classes of the past. I felt present, engaged, and exactly where I wanted to be. In spite of my flailing, my bobbling, and my imperfect strength, I felt great.

I may need to learn this lesson of strength, peace, and balance through imperfection, a million more times. And how wonderful would be? To learn this lesson a million more times is to live a long and mindful life.

The Tupperware hard plastic tissue expander is gone and so are the drains. My breast is nearly 100% human made from human materials. And the materials came from me. I am full of myself. I like it.

But in the spirit of “It’s more blessed to give than to receive,” let’s chat a bit about the donor site, which was my abdomen. I’m still swollen but literally shrinking by the day. A few days after surgery, my waistline was six inches larger than before surgery, even though a whole lotta tissue had been removed. The next day, I’d lost two inches. (Settle down, peeps, I’ve been keeping measurements to monitor any fluid build-up, which I didn’t notice after my expander surgery because I was too busy admiring the fact that I had cleavage again!) Today, I’m about two inches bigger than usual. This number will continue to drop, but it has been very clear since day 1 after surgery that my stomach is much flatter than it used to be.

Obviously, I expected this, in fact I relished the thought of having a flat abdomen. Even before becoming a mom, I’ve always had a little more than average size stomach, no matter whether I was at a healthy weight or not. I’ve had a few of those awkward, “Oh you’re pregnant, congratulations!” conversations. Ten years ago, I’d even lost 20 pounds and was greeted by my then hairstylist, “When is your baby due?” My response? “Four years ago.”

So you’d think I would be thrilled with development but I admit it looks a little foreign.

Some how, I will get over it!

So I felt much better this morning. That’s the good news. The bad news? The nagging thoughts that I should be doing something more productive with my time, like my business taxes! Oh wait, did I write, “nagging thoughts”? I meant to write “the nagging thoughts inspired by my nagging husband.”

John asked me two days ago when I was planning to do my part of our tax return, basically the part that covers my psychology practice. He was asking me before the surgery and I told him that it was a project that I would do during my medical leave. It takes about 2 days when I have a full tank of brain. I told John that I’d been out of the hospital less than a week and he needed to not ask me about it. He asked when he could nag remind me about it again and I told him he could ask again in a week.

Okay, so this is the same man who after I requested that we stop at my office to pick up my mail on the way home from my doctor’s appointment, asked, “You’re not thinking of WORKING are you?” He settled down when he realized that I was just planning to pick up the checks from insurance companies and patients that have accumulated in over a week since I’d been in. I am paid from many sources. There’s no auto-deposit option.

So, if you haven’t caught on by now, although I harbored those ever present feelings of love for my wonderful husband, I was also experiencing a wave of irritation. When I woke up this morning, I had a lot more energy than yesterday. I was happy and then I started feeling guilty. “Oh man, maybe I should stop putting off doing the taxes.” Then I talked myself out of it for a few minutes. Then I realized that I was really bored.

The days have been going by pretty slowly, after all, even on the ones when I nap a lot. So I started my taxes. And you know what? The time passed a lot more quickly and I have a feeling of accomplishment.

Does this mean I’m going to just push through this every day until it’s done? Probably not. In the spirit of mindfulness, I’m just going to take things as they come and make the plans that make the most sense each day.

And to cap it all off, I was able to walk a mile today and I felt good the whole time! I have now walked over 300 miles since I started tracking my walks at the beginning of December! Yay!



I had my first follow-up appointment with Dr. Welk, today. He was extremely pleased with how I am healing and how good my reconstruction looks. He told Marilyn, his nurse that my reconstruction may have topped the reconstruction he did for her. She was very happy for me. I guess she is happy with her 14 year run as having received Dr. Welk’s best TRAM reconstruction work. Anyway, he called me his “star pupil”, which is pretty funny. Just the crack to which a lady with a Ph.D. is addicted. I mean, up to this point, my breast has been getting low grades. It was bringing down my life GPA.

Seriously, it is so nice to have something go easier than expected, after so many things have not. I’m keeping my fingers crossed.

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.


Well, not exactly. My surgery on Monday will be at Swedish Hospital, founded by some Swedish-American physicians in 1908. Swedish Medical Center is pretty much a Seattle institution both literally and figuratively.

I asked John to stay with me in the hospital. He, being the wonderful hubby that he is, naturally said, “yes.” Then he added, “I’m looking forward to it. It will be like camping!”

Yes, like going on a camping trip and being mauled by a bear who rearranged my parts and hopefully supplies me with really awesome pain meds!

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George Lakoff

George Lakoff has retired as Distinguished Professor of Cognitive Science and Linguistics at the University of California at Berkeley. He is now Director of the Center for the Neural Mind & Society (


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