Latissimus Dorsi Breast Reconstruction
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I can't believe I've just read through all 9 pages of this thread - I feel like I know you all! Cindy, did you find a way to copy and save all your posts which you called your journal? Great idea.
I am going to have delayed reconstruction on one side in November, and I thought it was the "lat flap" operation but the PS never mentioned using a muscle, only fat, so now I'm not sure if I've signed up for the same surgery you all are talking about. The plan is that I'll have an implant and some back fat to fill in as there is quite a hollow spot on my chest that would still be noticeable if there were only an implant. I'll call and ask more questions, of course.
It's so helpful to see what might be coming my way - iron bra, linebacker feeling, bulges, pooches, etc. Most of you seem to have had it on both sides. I'm excited about losing some back fat but I hope it won't be too lopsided -- if it is I guess I'll just have to lose weight!
I'm trying to get all the way through to exchange by end of March, so that I can maximize my insurance benefits. I have an absurdly high deductible. I hope this will be a realistic plan. The PS said it just depends how fast and far my skin/muscle will stretch. His nurse thinks it could work. I'm also worried about keeping up with work during the post-surgery and fill period. It's a busy time at work but I really want it done and am also trying to save some money as I've already halfway met the $5k deductible. (It even makes me angry that I have to factor finances into this. American health insurance stupidity!)
If anyone else had a one-side, delayed LD surgery with implant, I'd love to hear more about your recovery - number of drains, limit in mobility, time to get back to work, time til exchange, etc. Thanks!
Sarah
edited to add: I had no chemo or radiation.
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OK Sarah, since you asked
I had three drains. No big deal, tho when we first heard about it, we were sooo grossed out. It turned out to the easiest thing. Zip, zip, and done, 4x a day. They were gone in three weeks.
Mobility, ah, that wasn't easy. After initial healing (3 weeks or so) I began to limp about. I was pretty much back to feeling well in around 8 weeks, driving was tough, so I didn't do it until about 9 weeks. I had to kick open the car door, of course, as you don't want to push pull. Invest in some button front shirts too, big oversize ones. You'll want the comfort. I used a Softee brand camisole over a sport bra for this time with a little insert that you could take stuffing out of as I got more inflated over time. Go nice and slowly with fills.
I had chemo before exchange. I had to wait thru the whole chemo (CMF, took 6 months) for the exchange and then 3 months after chemo ended to heal from chemo and get my blood counts up and all that jazz. It turned out to work in my favor, as I'd had previous rads on the boob and the TE really assumed a normal shape and comfort as well. In fact, I was worried I wouldn't be able to get as pretty a look as the TE had!.
Exchange was a breeze. It truly was. Tylenol only, stayed one night, had to remind myself not to pick stuff up. That is so important during this whole process. Do NOT lift stuff until you are healed up or when the PS says you can. He'll tell you what he prefers you wear, whether underwire, sport bra, etc. Mine said wear what you want but it was much more comfy with support so I did a sport bra. Champion makes great ones.
Anything else I can help you with, give me a shout. I wish to heaven's I'd done both now, and will have to go back and get a lift and reduce and a prophy. Grrrr.
xox
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Hi Diane - Yeah I have a skin bridge but the breasts are 3 or more inches apart. The PS said she can fix that. I'm more concerned that the 800cc implants are going to fit in the pockets etc....
I have to tell you with the little bit of exercising I am doing by the time I get home I just want to sleep and when it's bed time I go I'm out like crazy. Best sleep I get.
Cindy
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Cindy, I have nearly 3 inches too but my skin between is laying flat on my chest wall.. is yours raised? I don't know what my PS ordered as far as size goes for the implants..
Diane
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Hi Diane - there is a little stretch but thats because of how the pockets are made and how the skin was stretching with the fills. My expanders have started to seep and the skin is really loose. I'm concerned that the skin will start to shrink again before my surgery on the 17th of November. The PS says it won't and that she can put more that the 800cc that they were filled with. I was hoping for a full D close to a DD. I go to New Orleans next week fo work and I'm thinking of asking her for a fill before I go. I hope she says yes.
Cindy
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Hi Faythnme
I too am considering lat dorsi reconstruction after rads which have been strongly recommended by my team. Thanks so much for all the useful info on this thread it's been really helpful.
I have a different question but related to reconstruction ? - I noticed from your signature that your tumour was 6cm+ - Mine is approx 5cm and the Drs are pushing me to have rads because of this since it's the only risk factor. Drs are saying the chance of local recurrence is approx 22% because of size. I am a little sceptical of this but hey they are the experts. I,m curious to know if you were recommended anything similar because of size as a risk factor? I have noticed that lots of ladies have tumours around 2cm and still have rads.With the size factor as a risk I,m having a tough time deciding what to do about rads and would appreciate any feedback?? I realise with rads it will also complicate the reconstruction. I have visited the rads thread also and am gathering as much info before seeing my onc soon.
Best of luck too with your upcoming surgery
Kindest regards, susie
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Susie, when less than 4 nodes are involved, is controversial whether to have rads. Opinions vary among doctors. I had it, however. No problems.
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Susie, the difference may be in the type of cancer. I had similar situation to Cindy (DCIS, stage 0) and did not have to have radiation. I see from your signature that you had the invasive kind. I think they told me that though I had long tumors, they had not broken out of the ducts, and since I had a mastectomy and my sentinel node was negative, that meant radiation wasn't called for. I guess in my case the size of DCIS tumors didn't seem to increase the risk. I don't know if this helps, but good luck with your research and decision-making!
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None of the PS's that I consulted with would tell me "for certain" if they would be doing a lat flap, even though I just finished radiation 5 months ago. Am very confused about this. One doc said 70% failure rate on rads side if I have no lat flap - wth?? So I would think it would be a non-issue and she would just want to do it?
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I just had a BMX with TE's and Lat Dorsi on left breast last Tuesday (10/12). 8 1/2 years ago I had a lumpectomy/radiation due to DCIS. My DCIS this time was on the same side. I opted for the BMX so I would not have to worry the rest of my life if it came back. I am happy with my decision. My plastic surgeon did not wan to do without the lat flap on the radiated side due to the failure rate. I did see two Plastic Surgeons before making my decision and was defintely more comfortable with the one. I contemplated doing on both sides for the best symetrical outcome, but she assured me I would be okay with just the one for my situation. I recommend seeing at least two PS. Good Luck. Missy
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Rockyroad, if you work, may I ask how long until you were able to return to work? I, too, will be having BMX w/TE's and LD, so I just was curious. Am hoping to not need more than 3-4 weeks (desk job).
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Fearless_One, I had a BMX with TE's and LD at the end of June. I was lucky in that I work in a school and was off for the summer. I went back after six weeks. I think it will be difficult going back to work at 3 weeks. Depending on how you feel, you may be able to go back at the end of 4 weeks. I ended up having trouble with range on motion so I had to go to physical therapy.
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6 weeks? Yikes. I am really starting to worry that I might not be able to do this. Financially, I am just not in a position to lose more than 3-4 weeks. I don't have a recurrence yet, but I feel like i am going to for some reason.
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Hi Fearless, We are all different... some recuperate faster than others. I had my surgery 5-1-10 and returned to work part time on 08-02-10 part time. I am still only working part time. I could work more but sitting at my desk stiffens me and I go to physical therapy 2x a week to help my range of motion. I had bilat mx with te and lat flaps. I hope you have a quick recovery from your surgery. Take it easy for the first month. Doing too much can hamper your recovery ... on the other hand doing too little ... can make regaining your mobility and range of motion more difficult.
diane
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I just think when we have to we can. When my mom was a single mom and I was little, she had abdominal surgery and was back to work in 3 weeks. She said it wasn't easy, but she couldn't lose her job (I don't think they had FMLA back then).
At least I am hoping, because I really want this surgery.
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Fearless_one, I do work full time as a business manager at a school district, but I only had my surgery last week (10/12) so I haven't returned to work yet. My PS said approx. 4 weeks, so I told them 4-6 weeks at work. I got two drains out this week, and will probably get the other two out next week. I can't drive until then. Missy
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Rockyroad, 4 weeks sounds reasonable. I just remember when I had my lumpectomy w/axillary node dissection and everyone told me I would need at least 2 weeks. I had the surgery on Thursday and was back to work the following Wednesday, so I am hoping for the best with my MX. Hope you heal well and feel okay...
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I agree allow yourself at least the 4 weeks. It is more the tiredness. My sister came to town and wanted to go shopping. It was about 12 days after surgery and I thought I'd be Ok cause I could just sit in the dressing room and let her try on things. Well at one point I was feeling tired and looked in the mirror and I was so pale I looked dead and didn't even have color in my lips and I was wearing makeup. I told her I though we should go and she took one look and we immediately left. I was fine but I had just done too much too soon. There were not any bad effects from it just was too tired to handle that much. You will need to give yourself some time to heal not only from surgery but from the anesthesia.
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Tiredness I can deal with easier than losing my job. As long as the pain factor is under control, hoping to return to work in 3-4 weeks. I will go to wrok with drains, I don't care. I did that after my lumpectomy - it was annoying, but I don't care about that.
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Fearless One, I had almost the identical scenario. I only had a uni tho. Is your BM prophylactic?
I did feel fine during rads which was a lumpectomy 9 years ago now. With the lat flap, you are really not going to be able to drive or go back to work for at least 3-4 weeks. I would never have been able to do that.
You can do partial recon, wait til you could maybe do over the holidays? Combine your vacation time with that and finish it then?
Lat flap is different for everyone,but there is no way I could have done that. It's one rough recovery. Most need at least 3-4 weeks. If it is prophy tho, you might just squeak by at 4.
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Has anyone got any info on LD reconstruction for people who suffer from Lymphodeema? Am considering this as Tram flap not an option.
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SusieQ and others -
I did not need radiation as my DCIS was not invasion, it had not broken outside of the ducts yet. I had 3 nodes removed from the diseased side (left) and 1 from the right side. I opted for both breasts to go even though it was not genetic. I certainly wasn't going through it again. BS was not happy with that decision. In any case I am 2 weeks from exchange and I will have my new foobs and they better look closer to symetrical then they do right now with the expanders.
I can tell you that my lat flap recon has been much more manageable then the normal reconstruction using the pec muscle. That 1st go around last year had me crying for a week until it popped out of the muscle and I had them remove both, I decided to take 8 months to heal. Because of all this my only choice really was a lat flap. But I will tell I truly believe it takes both the PS and YOUR participation in making the best decision. As I always say listen to your body it won't fail you.
Fearless - don't push yourself too hard. You don't need a relapse and have to start all over. With my lat flap (no radiation) didn't go back to work for 5 weeks. My tubes were out however in 2-3 weeks. I had 6 of them ugh!! 2 came out the 2 week and the others the 3rd week. Did I understand your post about the lumpectomy? Did you have drains then? Just wondering never heard of that. I had lumpectomy and was out for a week.
Well gotta close for now, work tomorrow and exhausted.
My best to all!!
Cindy
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Not sure this thread is still running -- but I had LD Flap on Aug 25. I have in TEs until after chemo -- sometime in January or February. I still seem to swell up under my arm (I did not have axillary removal but had 9 nodes removed) and around my back scar. Does anyone else experience this? How long does it last? I am active -- still working out and walking 4-5 miles -- but can't lift my nephews without getting swelling -- it been 11 weeks.
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Hi Lmflynn -
You really shouldn't be lifting anything more than a couple of pounds, that is probably why you are swelling up. I had my LD in May (my exchange in 7 days) and my granddaughter was born in August and I can't hold her for very long. Are you lifting weights? I know my PT said no more than 5 lbs each side and to not do anything that makes the pecs work. They are already being strained to their max.
You will probably get a few more responses. This thread comes and goes.
Cindy
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Hi there! I am three years out from uni lat flap, this december. I do notice that the "pooch" at the base of my back incision used to swell with exertion. Vacuuming made it do this.. it went away after about 2 years or so. It can still swell and nurt on occasion.
I second faithinme's advice. If you use your pecs to work out by lifting weights, you will have a rebound effect. Usually the iron bra. Women post about it, and when I hear that they lift weights, I say to myself "well, cause and effect". Women that do this, do not want to hear this, so they continue to work out and continue to feel these effects.
I have not lost a bit of strength but beause of this, I don't baby it and I probably should take it a little easier on it. No more than 5 lbs or yes, you will feel the iron bra and swell.
I had my TE in for a good nine months as I had to go thru chemo before exchange. 11 weeks is FAR too soon to be lifting anything at all, let alone toddlers or weights! In time, if you work up to it, it might be OK. Your PT should have good advice for you on this. In general, it takes 6 months to a year to get back to where you were and good common sense will let you know when you have overdone it and what did it. Usually you'll find that out pretty quickly.
good luck to you!
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Hi ladies,
Thank you so much for all the insight. I am 47 and newly diagnosed with stage 1, grade 1 invasive ductal BC in right breast. I immediately made the decision to have a double mastectomy, then last week found out I have it in left breast (found in subsequent MRI- NOT in mammo). In any case, I am opting for double mastectomy with double lat flap. I can’t seem to find anyone in my area who has done this (double double). I have a couple of questions: Would you do it again if it you had the choice (or would you just do expanders w/o lat flap)? How long did you have to sleep on your back (ugh)?BTW- what do all the abbreviations mean :TE, BM ,MX, LD, CMF, etc…I am so new with all this (only diagnosed 2 weeks ago ) I cant figure out all the posts!! My surgery is scheduled in 2 weeks- this is all happening so fasssssssssssssst!
Thanks!
tropical jill0 -
hello all i am having a latissimus dorsi flap with implant soon and i would be greatful to hear from any1 that has had this op to tell me about it and how all went for them please
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me too Kathleen56. when is your surgery? mine is Nov 26th. I am having both sides done (immediate reconstruction after mastectomy), and am curious as to what to expect :-)
tropicaljill
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hello i have not got a date for the op yet but hope it will be soon i have had reduction done on the other breast 6 weeks ago and that went great hope all goes well for u on the 26th please keep me informed on how things go for u best of luck
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Hi Jill and Kathleen. I'm having a unilateral lat flap with tissue expander (TE) put in on Nov. 18th. I can't tell you anything about it but I'm sending you good wishes! There seem to be a lot of people on here who've had bilateral mastectomies (BMX, MX for just one), but not as many who've had the latissimus dorsi reconstruction.
Sarah
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