Latissimus Dorsi Breast Reconstruction
Comments
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I was so glad to read your post. I am scheduled for a LD and while my main concern is getting rid of the cancer, my next BIG worry is I won't be able to golf. I am retired and golf has become a major social and exercise factor in my life. Think if I have to stop exercising I might as well give up and die so you have given me hope.
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There are several golfers way back in this thread that have had lat flaps & were still able to play.
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thanks. I will go through them all. However, I am starting to wonder if that is good for me, as there are so many negatives. I want to be realistic but there is still hope I can have good quality of life after LD.
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Hi Ladies, I haven't posted to this thread before since I was either doing treatment or healing from treatment. It's been 5 months since I finished my radiation. Anyway, I am meeting with my ps on Tuesday to finalize my reconstruction plan and get on the surgery schedule. I'm HOPING to get on it right away. I've have been reading this thread but haven't found the info I'm looking for...maybe because I'm not exactly sure what I want/need to know. :-)
I know I will be having the LD on the right (cancer) side and TE's on both sides. I guess my biggest question is when do I tell him how I want or don't want them to look like, is that after, when they put the actual implants in? Do I even have a say or is it just whatever? I'm not making sense I know, I guess I'm just over thinking. When do you decide if you want high profile/gummy/silicone/saline type implants or whatever else? How does this surgery compare to having a dmx? The dmx wasn't pleasant, but I was up and around showering and such two days after surgery, drains and all, which totally sucked and hurt like hell when they came out, that is my biggest fear....those damn drains.
Of course I will be talking to him about all of this stuff. He always seems so rushed so I want to have everything laid out so to speak. Thanks for taking the time to read this....blabbering. :-)
PS...I thought of one more question...why do some ladies leave the TE's in so long...like a year or more? Is that personal choice or does it take that long to stretch the skin. I specifically asked him how late I could start recon and be done in December so I wouldn't have to pay another deductible, he said starting in August would work and I'd be able to get to my "d" cup size.
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2bluestars - I am preparing for the surgery too and it seems to be going the same way as my original surgery with expanders to implants. After agonizing over everything, I printed out photos of reconstructed boobs that I liked, showed them to my PS and asked if she can make me look like them. She did! I am sorry the exchange failed due to infection but for a couple weeks I looked like the photos. I am communicating what I want and what I don't want. I expect my outcome this time will be much the same. This is the job of the PS as I see it. I can guess all I want about implant size, shape, brand, etc. but in the end the PS knows their own work and what they can and cannot do.
As a side note, my husband added a photo to the line up. My PS responded with, "Those are not reconstructed. He found the photo in Playboy."
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LOL...that's something my husband would do. I have found a few pics on google, do's and don'ts to show him, hopefully that will help communicate my expectations with what I can actually expect.
Sorry about the infection and that you have to go through it again. That is my second biggest fear, behind drains. My skin seemed to hold up well during the radiation, but don't know about the inside.
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Drains suck but they're temporary. I've had them 4 times so far. I'm always happy when they're pulled. It's like being let out of jail.
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I had the same fears and questions as you ladies before my lat flap one month ago. I'm doing ok!
I wrote to my PS about the shock pains I am experiencing at times, and he assures me they will subside as I continue to heal. He also said to do shoulder range of motion exercises but does not recommend physical therapy as it will be too aggressive on the flap.
For what it's worth, I went through treatment six years ago, total radical left mastectomy, chemo, radiation, clinical trial, on Arimidex now...and without the lat flap my reconstruction would have failed. My PS keeps saying that to me now after the fact, since my skin was so thin. I wish I could have done the surgery years ago, but life gets in the way, no regrets!
I know it's a scary decision, it stressed me out for a long time! Glad I did it though, and as I heal I keep remembering the good advice from this thread along the way. And it's my way of saying "screw you cancer"! For six years of looking down down at my ribs and not much skin covering them, I can smile at this phase of the process!!
Good luck with your decisions and big hugs.
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hey everyone! I need your thoughts as well! I met with my PS this week. I thought I wanted DIEP until she told me that for Bil it takes about 12 hours! And a long recovery. After hearing that, I do not want to go that route! She recommended Bil lat flap with tissue expanders. Then once I was at the size I wanted, exchange out for implants. This surg would take 3-4 hrs and recovery 3 weeks. I am looking to see who has had this. How long were you out of work. Any issues? Are you happy with the results? My only choices are lat flap or DIEP due to radiation to one side.
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Hello All,
I'm scheduled for my Lat Flap surgery Aug 26th...I was supposed to have it back in May, but that area had issues - infection and sores exposing the tissue expander. So the doctor removed the TE and sewn be back up to allow for healing...Now, the radiated tissue is starting to break down again along the incision line again - ugh...I hope it stays closed until my surgery date. I was and still am a bit apprehensive - so, I'm glad to hear positive stories on this procedure...
My fear is still a lack of mobility, and skin breaking down again...I never thought to ask my PS if that has ever has happened...I know he's going to do a skin graft too, but after all I've been thru from the damage caused by the radiation - I'm not convinced it won't happen...
Andi
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I never had radiation but I developed an infection after my implants were in and the LD Flap is recommended for me because it is the "safest" of the procedures. Yes, I worry about mobility, ROM, strength and chronic pain / discomfort but I am being told that with PT most do very well. The reports on this thread range from highly satisfied without complications to horribly dissatisfied with serious complications. There is risk with every surgery. It is my understanding that this is a safer surgery because the LD is never removed completely from the body unlike the fat transfers. My options appear to be to try the expanders alone one more time (high risk for me), DIEP with concern that I may not have enough fat or LD flap. As scary as the bilateral LD flap surgery sounds, it may well be the safest of my options if I am to proceed with reconstruction. I'm still undecided. I'm enjoying the heck out of being flat but I think it will be nice to have something resembling my old body back again.
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I can't help you blossom, but DLL66 had bilateral lat flaps and did well, she may chime in here too.
I'm back from my second fill, he did 40 cc today and said If I feel discomfort later tonight then next week we will fill 30cc, he said this isn't a race. I'm cleared now to do ab work, cardio and lower body work, all shoulder range of motion work, just no exercises that would use the lat like Pilates or yoga or push ups...patience wins the race!
The radiated skin looks angry below the flap on the lower portion of the TE, when I get a fill, he said that's what radiated skin does and why it was necessary for the flap surgery and it will settle down. My shocking pain is gone now, PS thinks it was a nerve on my rib, like I thought.
Andi and warrior, hoping for the absolute best for you both.
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Hello I am not new to this site however I am new to this discussion topic. I was diagnosed with I.D.C. in January of this year and decided to be aggressive and go with bmx with reconstruction. I had my bmx in February and had the expenses placed at the time of surgery. I was told there were clean margins and no cancer in my lymph nodes therefore no chemo or radiation... I was a "lucky" girl and no need for tamoxifen! Yay right? Well all was Well until my final fill when blood vessels broke on my left side. Still we waited a month and Did the swap surgery in June. Dbring the surgery my PS noticed the skin where the blood vessels had broken had died so he tried a cadaver graft. It didn't take. I was then told I would have to have LD flap reconstruction. I was in shock, I still am. I had that surgery 3 weeks after my original surgery (the very same day they told me). They said if I waited and got an infection that it would no longer be an option and I would have to have my implant removed and wait months to heal and start the expansion process all over again. I couldn't handle the idea of that. I am now 2 1/2 weeks postop I had my drains removed 5 days ago. I have VERY limited use of my left arm and am in considerable pain, not to mention more depressed than I have ever been. I cry all the time (right now infact ). I am angry with all my doctors especially my surgical oncologist. My PS kept telling me during expansion that she went really thin on the left side due to that's where my cancer was but my cancer was way back in the breast near the chest wall. I see my physical therapist tomorrow to start that. My PS didn't put expenses in he put a smaller implant than what is on my right (which looks great Thank God ) and says that at the end of the year when all the muscle is shrunk we will put a new implant in to try to even out the breasts. He said they will look different bc there is now muscle etc on the left and none on the right. I am so stressed and scared. I don't know what to expect or where to turn. I guess I was just hoping someone on here would respond who can relate. My husband has been amazing but as much as he tries he really can't help with the emotional mess I am becoming. Can someone please help? Just talk to me about your experiences? I am so sorry I sound pathetic I feel pathetic I know I am lucky I caught it and I am grateful they got it but I am still angry, scared, and upset. Thank you to anyone willing to help.
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Blossom, I had my lat flaps done separately about 2.5 months apart & was able to return to work within 2 weeks each time.
I did have healing issues on my radiated side, but I am all recovered and am very happy with my results.
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Blossom - i had bilateral mastecomies w/ nipple sparing on 4/15 & bilateral LD flap reconstruction on 4/16 of this year. The LD flap surgery was every bit of 9 hours. My PS is adamant about her pt's being in the ICU following the surgery, so I was there for almost 3 days, moved to the floor for 2 days & then discharged. I was planning to go back to work 1-2 weeks after, but ended up out of work for about 5 weeks. It really does take time & patience to recover. I had radiated skin on both sides, so this was really my only option. About 3 weeks post-op, I had the first of nine 60cc TE fills, & finished up w/ the last one a couple of weeks ago. My PS waits 3 months before exchanging for the implants. I now see her on a monthly basis just to be sure all is still good & to discuss the exchange procedure. I do not like the TE's, but they have softened a little, & I'm managing. I can't wait for the implants! I am very happy w/ the results, although the first month was challenging due to the recovery. Someone asked me the other day if I would do it all over again, and I heard myself say 'yes' w/out hesitation. I'm not sure I would have responded the same way if I was asked w/in the first 4 weeks, but things do get better - just need to be patient.
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Kfinnigan....I am having the same sharp stabbing pain under my expander also! I had a fill last week and think I was a little too brave and had him fill too much (80cc). All last week I was in alot of pain...worse then ever. Yesterday, I started having the pains I described just when I took a normal breathe in! Emailed my PS and had a CTA of chest just to make sure I did not have blood clot which I didn't. The area where I am experiencing the most pain looks like angry swollen tissue but not sign of infection. I am due for another fill, hopefully my last in two weeks. I am so over this!!
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Thank you so much for your response. I will be having both done at the same time. Did you have TE's also? If so how long did it take to fill to the size you wanted? I am getting excited but nervous. But will be glad to look like a woman again!
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Blossom - yes, I have TE's on both sides. My PS evaluated what would be proportionate to my body frame, so she put in expanders that hold 600cc's. She only filled to 550 though because she was pleased w/ results. My PS filled weekly, with a few weeks off in between due to me being out of town or her, so from start to finish, I would say it was about 3 months. My last fill was 2 weeks ago, so now I wait 3 months for the exchange procedure. Based on previous discussions w/ my PS, the implants will be smaller, & my skin will be soft enough to mold around them.
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blessedbe - i completely understand your tears & frustration. I also cried all the time, very depressed & thought I would never recover. I can honestly say, it took at least 4-5 weeks before I started to feel more like myself. I am now 15 weeks post op & still have back tightness & some discomfort, but getting better every day. My husband has been phenomenal as well, but I felt the same way - he didn't understand what I was really going through. Keep telling yourself that you are strong & that you will get through this. I've been diagnosed w/ bc 3 times over the last 16 years. This surgery was the toughest of all to deal with, but you will turn that corner...soon. And, you are lucky that it was caught early. I feel the same way 3x's over. You're not pathetic - you're overwhelmed & scared & that is perfectly normal. Tears are good, they're cleansing & it's a way of letting go. Many hugs!
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DPiggy- Thank you! Did you have any/ alot of pain from the TE's? I am just waiting for the green light from my surgeon on the radiated side. It is looking really good. Can hardly tell the discoloration ! So I am hoping for beginning of next year to get this show on the road!! Can't wait!
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I agree with Dpiggy, i am at 5 weeks postop today and it took me about 4-5 weeks to feel really good and I returned to work Monday, so this is my third day back at work and I'm doing well. Back tightness/achiness that hits me later in the afternoon. But I'm back to my stretching routine and that really helps!!
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I hope one of you LD experts can help me.
I had a DIEP reconstruction in April this year but it got badly infected, so I lost most of it and spent several weeks in hospital on IV antibiotics, discharged with vac dressing and now just waiting for the wound to finally close.
I cannot have another free flap because there isn't anywhere to plumb it into. I used up the intramammary blood vessels for my failed DIEP and my armpit ones were too small to use.
My main options now seem to be an implant or a LD flap. After radiotherapy and now a big infection, I'm concerned about the implant failing (another infection or contracture), but at least implants are expendable.
If I go for the LD flap, I am worried about shoulder weakness and an uncomfortable and difficult recovery. The DIEP was a doddle if it wasn't for the infection, but LD sounds really tough - seroma, pain, shoulder stiffness.
If I go for the LD, which is better: the extended LD without an implant or LD with implant. I would prefer to have either an implant or an LD but not both as with both you have both types of failure risks, but there must be some reason by many people have LD and implant. I know there are size limits to flap only, but small is fine by me.
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Blossom - the first 4-5 TE expansions were uncomfortable between 24-48 hours following the expansion. A lot of tightness in the front & definite pulling from the back. Found it difficult to get into a comfortable position & had a tough time sleeping at night. After 48 hours, the discomfort would ease up & eventually felt ok. I had the expansions on a Monday, & by Thursday doing much better. By the 6th time, didn't feel that uncomfortable. I think my chest, back & skin adjusted & aside from some tightness, didn't have much discomfort. The TE's do feel heavy & when I bend down or move a certain way I feel some pressure & pulling, but have not experienced any sharp, unbearable pains & no issues w/ my ribs. My PS said implants will be very soft & very comfortable. Definitely looking forward to the exchange surgery which will probably be in October.
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Thank you Dpiggy and Kfinnigan. I went to PT tuesday and feel a little better today. Less depressed too. Still a little angry. But am taking it 1 day at a time. Ty for your honesty and support.
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Blessedbe, I had to respond to your post because I'm having a lot of the same emotions as you are. I'm new to this site. I found it because I was looking for information on the lat flap procedure. Like you, I'm angry, scared, and upset. As you said, an emotional mess. I hold it together most of the time, but inside I'm just churning. I'm so sorry you had complications with your reconstruction. I saw your later post and am glad to hear you're feeling a bit better. I can't offer you any advice or experience with the reconstruction process, but I can send you a virtual hug and tell you that you're not alone.
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Hi everybody. As I said in my response to BlessedBe, I'm new to this forum. My situation is very different from hers, but the emotional hit is the
same. I was diagnosed with invasive lobular carcinoma a year ago in
July. This is the stealth breast cancer. It doesn't show up on
mammograms. It doesn't feel like a lump. I didn't feel it. My gyn didn't
feel it. Consequently, it was a large tumor and stage III. I was, and
still am, so angry because I'd taken all the precautions I was supposed
to take (self exams, mammograms) and still had stage III cancer. Nobody
tells you there are kinds that don't show on a mammogram. I had no
choice but to have a mastectomy on the left side. Since there were
"areas that needed to be watched" on the right side, and I'd already had ovarian cancer, I chose to have a
bilateral. I had that last August then had several months of chemo and (play the ominous music) radiation.A year ago right before my mastectomy, I had consulted with a
plastic surgeon about reconstruction. He recommended the LD flap, but
since he said I could have "any procedure at any time in the future," I
opted to delay reconstruction and just deal with the cancer first. So,
for a year I've been planning on having only implants. I was not
interested in the flap procedures because I wanted the least
invasive surgery possible with no cutting on the parts of my body that
are still normal. Fast forward to last June. I had healed up from the radiation so I thought it was time to get started on recon. I consulted
with a different PS because he had been highly recommended by several
people, and I hadn't been really comfortable with the guy I saw last
year. Imagine my shock and dismay when he told me that since I'd had
radiation, I couldn't have just implants and my only options are the
flap procedures. He recommended the LD flap. I am so angry at the
first PS. Why did he say, I could have anything at any time? Did he
just assume that I'd go with a flap procedure? I'd told him I was
interested in implants. Why didn't any of the other doctors ever mention
that radiation limited my choices for recon? If I had known, I'd have
had the expanders placed at the time of my mastectomy. I understand there can still be problems after the radiation, but it's better than trying to expand the skin afterward. The idea of
cutting up a functional muscle to use it for cosmetic reasons sounds
just crazy to me, but I detest the way I look now. I also hate the
prosthetics. They're inconvenient and uncomfortable.So I'm stuck
between the proverbial rock and hard place. I'm so scared of losing
strength from the LD flap or having some other complication where they
cut my back. I don't need any more body parts that don't work. I already
have lymphedema in one arm from the mastectomy and in one leg from the
ovarian cancer surgery 12 years ago. I'm confident in the PS's abilities (the new one I saw in
June). He's done many of these procedures and gets rave reviews. My breast cancer nurse navigator had him for her recon. But I just want to cry when I
think about losing a muscle. I'm also afraid I'll end up with the 2 half grapefruit
look or some other ugly mess and it will all be for nothing. I don't mind a scar on my back too much, but don't want to have a big depression where they harvested the tissue. I know several of you have said you don't have that, but my luck hasn't been too good lately. I seem to get the rare stuff they tell me not to worry about. I have Waldenstrom's macroglobulinemia, for heaven's sake. Nobody's even heard of that. (It's a chronic lymphoma and my third, yes third, cancer.) So knowing a complication is "rare" doesn't comfort me much. At the moment, I have another appointment scheduled with the PS later this month so I can get more of my questions answered. I also went ahead and scheduled the surgery since he was already booked out until November. If I'm going to do this, the less time I have to sit and agonize, the better. I'm not even sure why I'm posting all of this since nobody can do anything about it. I guess I just needed to vent. Sorry about the long post.0 -
2Tabbies, I know what you are going through in regards to the ILC Stage 3 dx. Same thing happened to me, although I felt my cancer and my darned OB/GYN at the time said it was nothing and the mammo didn't show anything, so fast forward 2 years later and I had my mastectomy and ta-da Stage 3 breast cancer. I also was clueless about reconstruction being an issue until my Rad Onc told me it would be an issue, but from what I understand its better that you didn't have expanders in before radiation. I was saw different PS doctors and a specialist to try and figure out my only reconstruction solution, and it was the lat flap. I was DX 6 years ago, and I wish I would have done this 3 years ago. I can only speak for myself and had one side to reconstruct with the lat flap, but I'm happy I did.
Big hugs to you. vent away
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Thanks for your input, kfinnigan. Why do you think I'm better off not having had the expanders at the time of my mastectomy? From what I've read, there's at least a better chance of them being successful if placed and expanded before radiation. I talked about starting recon at the time of the mastectomy with the PS last year, and he said I could do it. If they'd ultimately failed, I could still have the LD flap if I wanted to. Even if there were reasons why it wouldn't have been the best idea to place the expanders when I had the mastectomy, I still should have been given all the information so I could have made an informed decision. Nobody mentioned the radiation issue. Not the PS, not the breast surgeon, not the rad onc. I hate being blindsided. There I go ranting again.
When did you have your reconstruction? If you've posted this already, just point me to the post. I've read through a lot of this thread, but it's very long so I haven't gotten through it all. I also can't remember who said what. I'm glad you're happy with your results. I only have to do the LD flap on radiated side. I can have just an implant on the "good" side. One of the issues I have with needing a flap procedure is that I can't take much time off from work to recover. How long did you need? How's your strength and function in your affected shoulder and arm?
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2Tabbies -
So very sorry for all that you've been thru - you have come to the right place for support...I had my mastectomy last May (left side) and had the PS put in an expander at that time. Unfortunately for me, I had to go back in to get cut on again to get clear margins. The expander remained and I was told to have radiation. Fast forward - the radiation caused my skin to encapsulate the expander which resulted in another surgery in Dec. My PS filled me too fast which caused my skin to break down exposing the tissue expander. In the meantime, he went on personal leave leaving me to deal with my open wounds. I decided to seek another opinion from UW in Madison...Wish I had chosen to go there from the get go...Anyway, at that point in time, all they could do was take out the expander and sew me back up to heal...In the meantime, I've visited my radiologist who did the therapy and said he had never heard of that before - skin breaking down from radiation therapy. I said that was funny as that's all I hear from ladies that have had radiation with expanders in place...I'm now waiting for my LD surgery at the end of this month...I'm very apprehensive about having it - but at this point, it's my only option. I sometimes feel all this is in vane...but, if I could do it over again, I wouldn't have had immediate reconstruction - or if at all...Good Luck to you and keep us updated...
Andi
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2Tabbies I had expanders placed immediately when I had my mastectomy, knowing full well that radiation could cause issues but wanting to take the chance just in case it would work and I could avoid the LD flap surgery. Turns out I didn't have problems with tissue breakdown but I did end up with a hard, very painful capsule forming around it after radiation. I am now scheduled for surgery in September to have it replaced. I had the choice of replacing the expander, with the addition of a product called alloderm (cadaver skin) for support and to give them extra tissue to work with inside OR a LD flap surgery. My PS advises that there is a relatively high (40-50%) chance of some form of complication if I go with expanders again, but I am taking that chance for the same reasons you are nervous about the LD flap! At least I still have the LD flap as a backup plan if this one fails... Keep your fingers crossed for me!! I'll do the same for you... There are lots of good news stories on here with LD flap, but we seem to focus on the negative ones when we are nervous!
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