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Latissimus Dorsi Breast Reconstruction

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Comments

  • tropicaljill
    tropicaljill Member Posts: 3
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    Hi 1965sally,

    Thank you SO much for your reply. May I ask why you chose latissimus dorsi reconstruction over expander to implant? I have to make up my mind by Wednesday and i am starting to doubt myself. I'm under the impression lat flat looks better.  I am 47. I am having BMX and worried about the healing time for a double lat flap AND BMX at the same time. Any input is appreciated.

    ~Jill

  • 1965sally
    1965sally Member Posts: 29
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    Gosh Jill, I'm just seeing this, hope you have the chance to read my reply!  My surgeon said using the fat from the back would help improve the shape of the implant (I'm having both implant and lat flap), make it look more natural.  As I have a couple of really deep depressions where they dug in right to my chest wall, and high up on my chest, the fat can help fill those in.  I also have a remaining breast to try to match (I know it will never really match), so those are the two reasons it seemed worth doing, to me.  I've read that the implants often look like a "hamburger bun" under the skin, kind of abruptly rising cleavage, and the left breast certainly doesn't have that!

     I'm having delayed reconstruction.  I didn't want immediate.  I wanted to heal from one thing first and my surgeon recommended that too.  Also, I was thinking, I want to make sure they get all the cancer before I go building something back over that spot.  I don't know if that was logical, but it was part of my thinking.  I used a prosthesis for 2 years and it looked fine in clothes.  I wasn't bothered by being flat on one side, but when I started swimming this summer I got self-conscious and decided I was ready to be able to wear whatever I want again.

    Each of us has to decide for ourselves what feels right to us, but since you asked, I would also be concerned about the long healing of being cut up on both front and back at the same time.  On the other hand, I can see benefit in getting it all done under one round of general anesthesia, which I don't like.  I'll send you a private message with my phone number in case you want to talk more.  Remember I'm just one viewpoint, but I hope this helps and that it reaches you in time!  Sorry, I've been so busy I haven't been back to check the boards.

    Sarah (Sally)

  • 1965sally
    1965sally Member Posts: 29
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    The other 2 advantages of doing tissue reconstruction (pure lat flap) vs implant is that your breasts would gain or lose weight with the rest of you, and that assuming all goes as planned, you would never have to have them redone.  Implants have to be replaced - approx every 10 or 15 yrs.

  • Faythnme
    Faythnme Member Posts: 92
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    H Everyone -

    I had my Bilateral MX(mastectomy) last year 7/21 and few surgeries following it.  One was the 1st attempt at reconstruction using only the pecs.  It failed and by that time I was exhausted so when the TE (tissue expander) popped through because the stitches broke I stopped and took 8 monts off to heal emotionally, mentally and physically.  Still workong on all of those too.  So in April I intereviewed a new PS(plastic surgeon) and she knew immdiately that the LD (latissimus dorsi) flap surgery was the one for me.  So on May 4th (the day before my birthday) I had my surgery.  It went pretty well, I left with 6 drains but they came out pretty quickly and I was back to work in about 5 weeks. So in may the 3rd week they started my fills in the TE(tissue expanders) first a 60cc in both and then I went back every week there after and had 120 cc filled in.  In July every other week until the end of the month I had 120 cc put in until I reached 800cc.  After that I went 4 months before doing the exchange for my foobs (fake boobs).  Well on Wednesday the 17th I had my surgery and came home on Thursday.  I'm doing quite well with the exception of the bruising caused my liposuctioning of my tummy (not my abdomen area), sides and little on the upper butt sides.

    So to answer a few questions:

    What do they  mean:

    TE, (tissue expander) BM (bilateral mastectomy, both breasts) ,MX (mastectomy or Mexico :) ), LD (latissimus dorsi), CMF (I think it has somthing to do chemo) DH (dear husband)

    Always keep a positive attitude befor going in because I truly believe it works.  Listen to our body it won't lie to you.  .  I also have the word Faith with the pink ribbon tattooed on my right inside wrist.  It's a great belief.  I tell my friends that it can also serve as a medical bracelet. Wink

    My favorite poem

    Peace, Faith, Love and Hope. poem please read
    The Four Candles, Author Unknown

    The Four Candles burned slowly.
    Their Ambiance was so soft you
    could hear them speak...

    The first candle said, "I Am Peace, but these days, nobody
    wants to keep me lit." Then Peace's flame slowly
    diminishes and goes out completely.

    The second candle says, "I Am Faith, but these days, I am
    no longer indispensable." Then Faith's flame slowly
    diminishes and goes out completely.

    Sadly the third candle spoke, "I Am Love and I haven't the
    strength to stay lit any longer."
    "People put me aside and don't understand my
    importance. They even forget to love those who are
    nearest to them." And waiting no longer, Love goes out
    completely.

    Suddenly...A child enters the room and sees the three
    candles no longer burning. The child begins to cry, "Why
    are you not burning? You are supposed to stay lit until the
    end."

    Then the Fourth Candle spoke gently to the little boy,
    "Don't be afraid, for I Am Hope, and while I still burn, we
    can re-light the other candles."

    With Shining eyes the child took the Candle of Hope and
    lit the other three candles.

    Never let the Flame of Hope go out of your life.
    With Hope, no matter how bad things look and
    are...Peace, Faith and Love can Shine Brightly in our lives.

    I will be checking in periodically and if you want you can also send me a private message.

    Lots of love and faith to everyone!!!

    Cindy

  • FloridaGirl
    FloridaGirl Member Posts: 9
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    I had a skin sparing BMX with LD flap surgery with silicone gel implants on 12/10.  I am one week out and was not really told what stretches to attempt at this point.  I am just keeping pretty still and using my arms as needed.  I have such friction under the arm with the bulges rubbing on the arms.  I feel very tight (I guess what you ladies call Iron Bra symptom).  I return to the Dr. on 12/21 and hope to get the 6 drains removed because the output is very small.  I took a nice long shower today and from reading some posts, it seemed some ladies did not do this in the beginning and took sponge baths.  Overall, I think I'm doing well being one week post-op, and have weaned myself to two percocet per 24 hour period.

  • Diane509
    Diane509 Member Posts: 42
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    Good luck Floridagirl.... you are doing great. Do you have your implants already?  Many of us went into a tissue expander first.   Advice on exercising is to stretch as much as you can stand it... stretch and hold not stretch and bounce...itsy bitsy spiders in the shower type of thing... the more you do the better you will be.  i had to have tons of physical therapy after because I was very tight...had to postpone my fills because of my lack of range of motion,  

    6 months later i just had my exchange.  boy are they comfortable in comparison...something to look forward to.  I still have that rubbing feeling on my sides but not nearly as much as before the exchange.  

    Good on you for the drugs.... i was on the narcotics nearly 6 weeks and it was hard getting them out of my system.

    get a pully system than hangs over a door so you can sit in a chair and pull down with one arm and reach up with the other.  

    the drains are a pain but they feel good when they come out.... i had 8 and the last two came out on week 5 

  • FloridaGirl
    FloridaGirl Member Posts: 9
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    Diane509 - yes the implants are already in and the nipple reconstruction is done.  However, one nipple is nice and pink and the other is black.  The medication I am to be putting on the nipple, CVS and Walgreens do not have - Povidone, so will have to wait until next week to get the proper medication.  That part is frustrating.  I probably did not do enough research prior to the surgery, but the Drs. never really told me about TE's.  I'm not sure if that is because it was skin sparing, but regardless, I am happy to already have them in and not have to do another surgery down the road.  I get so confused when I read some of the forums because so many different type procedures are done.  It sounds to me like TE's are the most common before getting the implants and it also sounds like they can be very uncomfortable.  Thanks to all you ladies posting on the forums for the newbies like myself to learn more.

  • walker2222
    walker2222 Member Posts: 442
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    Here is my story I was diagnosed with Breast cancer in March 2010 and had a bilateral mastectomy with reconstruction.  Everything was fine until after two weeks and I got a post operative infection on the right side so the TE had to be taken out. Due to tumor size and lymph nodes (took 10, 5 had cancer, 1 was stage 3) my tumor was stage 2 but 5.5 cm.  I started my chemo in June and ended October 1st.  After talking with my Oncologist and PS we thought we could fit in the reconstruction between radiation treatments (my radiation oncologist did not agree).  I opted for the surgery, on November 9th.  Everything was fine until after I got back from the in law for Thanksgiving.  Noticed some seepage and a lot of redness.  When back to PS and found I had cellulitis.  Took major antibotics and things were healing or I thought.  Found a dark spot on the breast skin that started to leak and then got bigger. It became a hole and the expander was exposed.  Had it removed Tuesday and tomorrow take the drains out.  Last week in talking with the PS he said we could do the Latissimus Flap later and go directly to implant.  I have to heal for a couple of weeks and then start radiation treatments, heal and then finish recontruction.  I am half done since we did both and the left side is waiting to be done.  Wished I found this forum to talk to you all.  I am trying to say encourage through this all but at times I get depressed.  I have faith and I know the Lord is looking out for me.  My special scripture is Philippians 4:13 "I can do all things through Christ that gives me strength."  Send me words of encouragements and what to do in the mean time to prepare.  What to look at to know what to expect.

  • dawney
    dawney Member Posts: 136
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    Hello Ladies - I saw my PS today to talk about reconstruction.  I went in hoping to have a TRAM flap procedure but he is recommending the LD.  He said he did not want to do the TRAM flap because of my weight, that I would probably end up with a hernia after losing all the muscle.  I was really hoping for no TE's or implants but it looks like that's where I am headed.  I could see another PS but he is the best in town.  Has anyone else been told not to have the TRAM flap?

  • susieQ610
    susieQ610 Member Posts: 2
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    I am scheduled to have lat dorsi reconstruction in a few weeks time. I had axillary clearance with mastectomy and so far no probs with lymphadema. I do have some concerns about the lat dorsi surgery and the risk of lymphadema from further tissue moving around in the armpit area, ie when they pull the muscle through. Has anyone noticed problems with new or existing lymphadema from this type of reconstruction?

    regards, susie 

  • 1965sally
    1965sally Member Posts: 29
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    Hi everyone.  I had lat flap and TE done Nov. 17th (unilateral) and am slow getting back to the boards to report.  To answer the last question, I have not had any trouble with lymphedema, didn't have it before either ( just one node removed).  So far no trouble in armpit, not even much swelling.  My back has hurt terribly though, just got better in the last week or so.  It hurt when I slept, I guess from being still too long or something.

    To answer the next to last question, I wasn't told not to have a TRAM, but I decided not to after learning about all the trouble a friend had with hernias.  She had had 2 c-sections 20+ yrs ago, then the tram flap about 5-10 yrs ago, and has had several surgeries for hernias in the past 18 months.  And she's not very big.  I just decided I didn't trust my abdomen - it's always been weak, and I gain all my weight there.  So the lat flap procedure seems (so far) to be perfect for me.

  • Stanzie
    Stanzie Member Posts: 1,611
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    I had the lat surgery and no trouble with lymphedema but I do have swelling or it is the muscle under one arm that is awful. I still have a great deal of pain in my back and my surgery was last March. I also noticed in the last few months the muscles make the "new breasts" move weird and it is even doing things like driving or pushing a grocery cart. It doesn't hurt but just feels creepy and is uncomfortable. I'm supposed to go back to my PS but I'm dreading it. He was so excited and pleased with everything and now I'm not. Especially after having the nipples and aerola done - it didn't turn out well at all. Sorry I don't mean to be so down on everything. I had just hoped by now things would be feeling better not worse. Anyone else have any of this? Thanks.

  • elmcity69
    elmcity69 Member Posts: 320
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    hi dawney,

    My PS advised against the TRAM flap; he feels it is too much surgery to heap upon a mastectomy. I did the immediate reconstruction with latissimus dorsi and I couldn't be happier (well, you know what I mean!). My back still tingles 14 months later, and I've had some lymphedema, but that is due to the lymph node extraction (19 total ).

    Most folks can't tell I even had surgery - I was a double D before surgery and the PS did a fabulous job matching.

    I would highly recommend the LD.

  • elmcity69
    elmcity69 Member Posts: 320
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    stanzie, i have noticed my breast moving as a muscle - particularly during exercise! it is weird to feel the "ripple" when doing yoga, but it usually makes me chuckle.

    yes, my back still tingles sometimes, which is bothersome but not much else.

     i'm sorry you're having a hard time. it is mindblowing to really think how much our bodies have to change because of this ridiculous disease!

  • Stanzie
    Stanzie Member Posts: 1,611
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    I know it is hard to actually get your mind around it all. How long has it been since your surgery?

  • Stanzie
    Stanzie Member Posts: 1,611
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    I know it is hard to actually get your mind around it all. How long has it been since your surgery?
  • elmcity69
    elmcity69 Member Posts: 320
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    october 15, 2009...wow! writing that date makes me realize how much time has elapsed. I still remember thinking I would never finish my "to-do list" of cancer treatment...and now I have only three Herceptin doses to go --although I am unhappy and afraid about that!-- and then just the left side mastectomy (prophylactic).

    some of it is, mercifully, a blur. other moments are crystal clear.

  • dawney
    dawney Member Posts: 136
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    Ladies,  thank you so much for the info.  I have scheduled an appt next month for a second opinion and I will take all of the info in to account before making my decision.  I was just looking forward to the TRAM flap and the idea of getting new boobs and a flatter stomach at the same time :)

  • Cafelovr
    Cafelovr Member Posts: 75
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    Hello all!

    I was a frequenter of the DIEP board, but my PS is saying that if I had a bilateral Tram, the surgery would last 20 hours. No thank you! So...I will be having a LD flap with TE on cancerous side and TE on non-cancerous side.

    I have a question. I have gained a bit of weight. I guess I've given myself free reign to eat what I want since I was having a tummy tuck. Didn't work out that way. My surgery will be in about a month. Should I go to the gym now and try to lose a little weight and build some muscle, or should I just wait until after the surgery?

  • Stanzie
    Stanzie Member Posts: 1,611
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    I know I had been going to a trainer and my surgery was 2 1/2 hours shorter than expected because I had good muscle tone. Now because I say I went to a trainer no I'm not talking major workout queen or anything. I went for balance training and she worked on the core muscles but she did  used gym equiptment and I do think that did help. Of course haven't done much since and would like to get back but now so little energy it is hard. Oh, not from the surgery.

  • Catrenae
    Catrenae Member Posts: 572
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    How long was everyone's hospital stay. I'm scheduled for exchange surgery on the left and a LD flap with exchange on the right side. I've called my surgeon's office but I haven't gotten a reply yet.

    Thanks,

    Cat

  • GG27
    GG27 Member Posts: 1,308
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    Catrenae, I didn't have the same surgery that you did.  I had LD on both sides & stayed in hospital for 2 nights, 3 days.  But surgeon asked me if I was really ready, he said usually 3 nights, but I was fine going home early.  My exchange was done 8 months later & was 1 1/2 hours, we went for lunch after, before going home.  HTH, Good luck! Dee
  • sdstarfish
    sdstarfish Member Posts: 38
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    Hi, Linda,

    So sorry, just noticed your post now...oops :)

    Yes Linda, my flaps are a different color, and thicker.

    Stanzie, I feel the same - to me they look too low on my chest.

     Oh, and I am almost 3 years out and still have the tightness/iron bra thing if I skip even a day of stretching.

    Lisa

    www.pinkkitchen.info

  • Stanzie
    Stanzie Member Posts: 1,611
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    I was in the hospital two nights and I was very glad to go home that following afternoon. It was so wonderful to get home and into my own bed. My PS kept telling me this was a really big surgery and that it does take a while to recover. Afterwards they will tell you to walk- it is very hard but any little bit you do helps to much. Even though it is hard to do it your recovery will be quicker with it so try and remember that. Also just listen to your body and rest when it tells you to - healing does take time but the physical healing is quicker and easier than the emotional healing so give yourself time on both.

  • Adnerb
    Adnerb Member Posts: 727
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    Hi dear ladies,

    I am new to this thread, but not new to reconstruction nor breast cancer.  My LD Flap Surgery was Wednesday 7:00 A.M.  The flap is pink and is viable!!! Everything is going well, 4 drains, but I may go home with less!!  Ill be here in the hospital till Saturday or Sunday.Thanks for all your good thoughts and prayers...

    Brenda
  • Stanzie
    Stanzie Member Posts: 1,611
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    Adnerb- Glad things are going well. Hope you do get to go home with less drains.

  • Cafelovr
    Cafelovr Member Posts: 75
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    Quick healing Adnerb. I'm right behind you on March 9.

    May I ask if you had a single or a double mx?

  • Faythnme
    Faythnme Member Posts: 92
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    Hello Ladies!  I've been gone for sometime and it looks like everyone is using the forum,that is fabulous! Well to update everyone, I am 2.5 months post exchange.  I now have FOOBS!!!!  The DXLF (double lat flap) worked real well. The surgery went very well, but the liposuction sucked!!!  OMGoodness!  However out of that I found 2 home remedies for it.  For bruising Apple Cider Vinegar compresses (applied to my torso), helps the bruising go away faster and I did a comparison between that and Arnica which is supposed to be good also. The vinegar won out.  For topical analgesic and inflammation castor oil mixed with olive oil or safflower oil for easier spreading (this if for liposuction only).  I had the liposuction done for fat placement in my chest above the implants.  I can see now since the swelling has gone down why she wanted to do it.  I think if I didn't have the liposuction I would have been back to work within a couple of weeks.  I didn't need the pain pills except for the lipo pain.  My next surgery will be later in the summer for a revision on the right side and the nipples. Because I have the largest implants that can legally be implanted (800cc) and my skin stretches so well that the right side droops a bit, but I have a wonderful PS and couldn't have asked for more. Oh and that iron bra effect it's going away slowly.  I have that feeling of wanting to actually take a real bra off (which I am wearing) and I can feel the difference.

    So for those who are going in for surgery, listen to your PS and your body, they won't lie to you.  Take the time to heal and don't be in a hurry to try anything too soon.  It gets better and better!  I know I have had 8 surgeries in 2 years with 1 more to go all surrounding my cancer and I'm feeling good and cancer free!!  When I went in for my 2nd attempt at reconstruction in May the day before my 53rd birthday I stated an emphatic everything is going to go right this time and it has. The power of positive thinking as hard as it may be sometimes really does work.

    You are all strong and wondeful women!!!

    Cindy

  • Adnerb
    Adnerb Member Posts: 727
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    So I had my LD flap surgery (left side only) last Wednesday.  I have something very good to tell you.  I have very little pain.  My PS said he injected my ribs with pain killers while they were exposed.  He said that since my body never experienced that kind of pain, it did not remember it.  It's kind of wild, isn't it?

    I go see PS today - my first follow up.  

    Take care. 

  • Adnerb
    Adnerb Member Posts: 727
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    Linda J:  I had a bilateral mx, prohy on right side.  My ld flap was only to remedy the complication created by my radiated skin.  So the ld flap is only on the left side.  

    Brenda