Latissimus Dorsi Breast Reconstruction
Comments
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Aren't we the lucky lottery winners? Any time I'm told that "there's only a small chance..." I now assume that small chance will be me. After all, I did get BC, NF1 & developed an infection after my implants were in and looking good. My PS claims I'm only the 10th patient to get an infection. Lucky me.
Anyway, from what I was told by my PS, the incisions on my back should be completely flush and that the big indentations are seen in women who are heavier. This makes sense to me and seems consistent with photos I've seen.
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You have really been through the ringer, Andi. Your original PS sounds like an idiot. So does the RO who never heard of tissue breaking down with expanders and radiation. You mentioned possibly not doing recon at all. Before my mastectomy, I thought there was a good chance I'd go that route. I really didn't think I'd care that much about being flat. Surprise! I'm seriously depressed over it. I feel like I want to rip my chest right off. I know that sounds awful, but my moods are really up and down due in no small part to the fact that I can't have estrogen supplements anymore. Add a year of stress, and I find I'm often angry or depressed. When I'm down, I'm pretty far down and can't stand the sight of myself. However, if the LD flap fails, I'll be out of options and have to adjust to being flat. The only good part is not having to wear a bra if I can hide under enough loose layers. I've told that PS that I don't want to wear a bra ever again, and he said I shouldn't have to with my new foobs. Do you call the fake (rebuilt) boobs foobs in this forum? I'm in another forum, and that's what they call them.
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I hope the expanders work for you this time. Was the other option an LD flap without expanders? I'm having an LD flap with expanders. I don't think there's enough tissue on my back to build me a boob without an implant. Best of luck! I hope this time it all goes well for you.
Yes, I do tend to focus on the bad news stories. I guess since I've landed at the wrong end of the bell curve a few times, I'm paranoid. Before my hysterectomy I was told, "We're confident you don't have ovarian cancer, but there's no way to tell for sure except surgery." I had ovarian cancer. Before my bone marrow biopsy, I was told I'm sure you don't have Waldenstrom's macroglobulinemia. It's very rare. Only 1500 people are diagnosed with it every year in the US, and it mostly affects older men." I'm one of the lucky 1500. So talk of how rare problems are with the LD flap doesn't comfort me much. I won't be comfortable until it's over, and I can still swim and do anything else I want with my left arm.
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No kidding about being lucky. I'm going to have to start buying lottery tickets. Although I weigh a bit more than I did before starting to deal with this mess a year ago, I don't think I'd be considered heavy. So maybe my back will look ok. Speaking of weight, I thought normal people lost weight during cancer treatment. I gained. What's up with that?? I'm going to rejoin the Y and try to beat this body into shape before my surgery in November.
Are you having the LD flap on both sides? I'm just doing a straight expander/implant on my non-nuked side.
And one more thing. Can you point me to the photos you've seen? The ones I've found are just of the boobs. None of them show the back.
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Yes, 2tabbies, mine would be LD flap with expanders as well, using the entire LD muscle... There isn't enough flesh on my back to make even a tiny little mound, apparently, so I wouldn't have a choice but to use expanders and then do a swap for implants. I know what you mean about being in that rare few... I had no risk factors whatsoever for breast cancer and did everything "right" but still ended up with stage 3, locally advanced breast cancer. The most important thing, I keep reminding myself, is that the cancer is GONE! I can't see myself not having reconstruction done, but if it comes down to no reconstruction or just LD flap I will be going through the exact same anxiety as you!
Oh, my other side would just be expander with implant. And, to answer your question about weight, lots of women gain weight during treatment for breast cancer. I'm not sure why, but they do! Oh and I have read somewhere on this thread someone referring to reconstructed breasts as "foobs"!
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for the ladies with no other options but LD have you considered Fat grafting/stem cell transfer? The procedure is done 2-3 times. Fat/stem cells from a donor site (like lipo) is harvested and injected in to the radiated breast. My friend had this done and did expander to implant and she is great. No complications. This is not standard of care but many PSs are doing the procedure and successfully
Im not going to bore everyone with my experience with this surgery (bad) but you can read back on my prior posts - or PM me
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I am almost four weeks out now from my bilateral mx and LD with TE surgery. This reconstruction option was the one recommended to me by two PS's due to prior left breast radiation and being thin (not enough fat/tissue for other alternatives.) The skin on my left breast is having trouble healing up in some spots but it seems to be slowly improving. Right breast and back on both sides is healing just fine. My PS has not done any fills (other than during the original surgery) as she is waiting for the breast skin to heal more first. And no starting chemo until the skin recovers more as well. So far, I have not experienced any significant pain or muscle weakness in my back.
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That's one of the things I intend to ask my PS about when I see him on the 20th. He didn't mention it so I assume he doesn't do it, but maybe he knows someone who does. I live in a small city. I imagine I'd have to travel somewhere for that procedure which might make it out of the question.
An account of your experiences wouldn't bore me, but I'll look for your earlier posts.
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Thanks for your input. Am I correct that you had the LD flap on both sides? If so, why did you choose that over just TEs and later implant on the non-irradiated side? Or did you have radiation on both sides? I was planning on just a TE/implant on my good side. I want no more extensive surgery than absolutely necessary.
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2Tabbies - There are plenty of photos on Google that show the front and back. Here's a link: LD Flap Photos
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Thanks. I'll take a look.
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Does anyone have experience with the following activities after an LD flap? Any weakness or pain when trying to do these things?
- swimming
- canoeing
- kayaking
- hiking with trekking poles
- climbing ladders
Thanks.
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Hi, my my posts are earlier on this site but I was one with double mastectomy after similar experiences of it sneaking up after good check ups, also was told positive prognosis of just a little DCIS to all of a sudden, nope it's a tumor, lymph nodes and then YEARS of interventions after chemo and rads. I had an initial implant in my radiated side after expander; my PS said it was worth a try initially; but I had nothing but issues, including the skin breakdown. Soooo, after numerous implant revisions, I had LD flap on that left side in May with a new PS. Saving a breast form was definitely not the only driver; when you have weakened and destructed skin and tissue, it is unhealthy and multiple infections. PS said even without LD flap, that was an issue. The skin and tissue needed to go.... I needed to get that out.....and I did. The LD flap seemed like my only option. I am now I am 11 weeks out and finally able to do more. I can tell you a few things -- it was the hardest physical thing I've ever done - harder than other surgeries or chemo treatment. It's too early for me to say on what my final physical ability will be, but I am not terribly optimistic that I will be able to do those vigorous sports or activities needing heavy arm/back strength. If I CAN get to the point where I have mobility and can do most things, pain free and can keep up with life, I will be happy. I am not there yet but doing more every week. I am confident that I will get to that point. I've been in the pool (since I was always a swimmer) but I can't do a decent stroke yet. It feels great for movement and flexibility. I am going to PT 2x per week for manual mobilization and lots of exercises at home; I have not been able to begin much strength training yet. My front looks great, my back scar is long and vertical. When I see folks say it's hidden by bra line or bathing suit, I don't see that for me - but then that's not important to me. I walked 3 miles today and saw my best friend for lunch who I hadn't seen for weeks. She said "OMG you are sooooo much better. You are moving like a champ." I had to chuckle because I still feel so limited, but it was nice to know that I look and feel better. I guess my point is that going into this surgery takes some preparation for a hard road. I made the decision in a matter of days due to skin that was opening up; I thought ok, lets do it! I had no idea what I was in for...... Soooo, for those of you contemplating, that's good and you will be better prepared. I don't mean to be a bummer, but do know that one doesn't just pop up on the other side of this. It takes time, patience, strength and perspective. My back remains very tight and incision sometimes sensitive. the most sensitive part is in my arm pit area between the back and breast. My pec muscle is very confused and tries to dominate, causing all kinds of bad domino affect with other parts of the shoulder area. Anyway, after saying all this, I am glad I did it ...and I am confident I will be in a much better condition overall. It's going to take work and patience and maybe even acceptance of some things. I am going to Hawaii in September, I don't know if I will be great, but I will be there!!!!!
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Hi 2tabbies - I opted for LD with TE on both sides for what I hope will be a good result from reconstruction. I want both to look as similar as possible and I felt using the same technique was the best option for me vs. LD/TE on left (where I'd had prior radiation) and TE only on right.
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Thanks for the input. It's interesting how differently the procedure affects people. I was talking to a person locally who is only 3 weeks out and has been gardening already which really surprised me. Of course, I don't know her exact procedure. Perhaps she had the muscle sparing one where they use only a small part of the LD. Was the whole muscle used for yours? I can see how manipulating a muscle that big would take quite a bit of recovery time. I'm glad you're making progress and hope you doing cartwheels by the time you go to Hawaii!
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2tabbies, I am able to swim just fine after bilateral LD flaps. Haven't tried any of the other activities on your list yet.
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Thanks. Good to hear. I'm most worried about canoeing in kayaking since my PS mentioned something about rowing being an issue. I didn't think to ask him about canoeing at the time. It's not something I get to do frequently, but I don't want to give it up. I short canoe trip has been the nicest, most relaxing thing I've done all summer.
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2Tabbies - I had Uni LD (2011) on the left side and kayak and swim with no problems. I also continue to work out, do yoga, etc. I really feel it after mopping the kitchen floor so I try and avoid that. LOL Overall I think your body makes an adjustment, at least that's how I feel.
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Thanks for your reply. What is this mopping of which you speak?? LOL
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I had bilateral mastecomies w/ nipple sparing on 4/15 & double LD flap on 4/16 due to having rads on both breasts. Totally agree w/ Keryl - this surgery is no walk in the park. I am almost 16 weeks out, & it has been quite a journey. Incisions on my back are still sensitve (but getting better) & tight (also getting better). I have TE's, finished expanding 3 weeks ago & exchange will be sometime in Oct. Just got back from Gulf Shores, AL, & realized I need to work on swimming. I had been in our pool once or twice before we left, but didn't attempt to swim. Oh, well, it could be worse. As far as range of motion or strength, don't seem to be affected. First 4 weeks post op, I was depressed & didn't think I would feel good ever again. But, I can honestly say today that I am glad I had this surgery, & the results are impressive. I'm not a fan of the scars on my back (mine are vertical), but I'm sure they will fade in time. My PS is wonderful, my husband is awesome & family/friends support pulled me through. I just pray that the cancer is finally gone! Hugs to all!
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2Tabbies, I thought if you had the expanders or implants in
before the radiation it would have damaged them/make them hard and damaged the skin. I didn’t know anything about the LD flap
procedure at that time either. I hear ya
on not wanting to be blindsided, that’s how I felt.I just had my LD flap on 6/25/14, only on radiated side and
will also get an implant on my good side (PS said no expander needed on that
good boob). I took off 4 ½ weeks, and
last week was my first week back at work.
I left early a couple of days, it was tiring. I’m glad I took off that much time, as I was
having shocking, stop me in my tracks pains on my rib at the bottom of my TE,
which magically stopped at 4 weeks and 3 days after my surgery. My PS kept telling me the pains would settle
down in time and they did! I’ve made
terrific progress in my shoulder function and strength. I listened to my PS avidly, and he was right
on with everything he said. I’m still
now allowed to do certain exercises, like push ups or pilates/yoga, anything
that will really engage the lat right now.
My back looks good (I am thin), but still gets tight and feels weird at
times.0 -
I'm glad to hear you're doing well overall. You had a big surgery especially with LD flaps on both sides. That's got to be a big hit to your body. But you're progressing! It's great your strength and range of motion were not affected. I hope I'm that lucky. I can get through anything in the short term. It's long term complications l hope to avoid.
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From what I understand, radiation can damage the expanders, but putting them in at the time of the mastectomy was offered as an option. I think I was told at the time that it made doing the rad therapy more complicated. Since the PS I saw then assured me I could have whatever procedure I wanted at any time in the future, I didn't see the point of complicating things then. Little did I know.
It sounds like you have a great PS and are doing well. Happy healing!
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2Tabbies,
Love your pix by the way - I love animals
- I have to have expanders put in place at the same time as the LD surgery. At first my new PS wanted to do the LD than go back in to put in the expanders - but, I don't have a lot of skin to work with...times like these - it's not a good thing to be skinny. I do understand your emotional roller coaster...I feel like crying everytime I look down at myself since the left side of my chest has so many scars...Not only from all the cutting, but scars from the drain tubes too...ugh!!! I think that coined term 'foob' is cute though I've never referred to my future boob that way...You mentioned you like to kayak and canoe - my new PS assured me that by next year, I will be able to continue to do those activities too...He said one of his patients that had this surgery went back to playing volleyball about a month after surgery - I can't imagine that - but I guess if one is already athletic - that could happen...
Good luck with your decisions,
Andi
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Hi, Andi. Thanks for sharing your experience. It's good to know your PS says your strength will be ok when all of this is over. Some days it's hard to believe it will eventually be over. My scars aren't too bad relatively speaking. Just 2 horizontal lines. I don't think I have any from the drains. If I remember correctly, those came out of the ends of the mastectomy incisions. I do have a scar from the port they used to administer chemo. It's still pretty red since the port was only removed in May. They left it in a few months just in case they needed it for something else.
I don't have a lot of excess skin either. If I do this, I'll be having expanders put in at the same time as the LD procedure also. I wouldn't say I'm skinny since I put on some weight during treatment, but I'm still in the healthy range. From what my breast surgeon said, being relatively slim was an advantage for the mastectomy. He said it's harder for him to make the scars look decent (relatively speaking) on women who are heavy, and they are more likely to have problems healing. They do have a bit of an advantage when it comes to building new boobs though.
I'm definitely not an athlete, but I'm active and hope to remain so in the future. I doubt I'll be playing volleyball month after surgery though! Dang!
Cinnamon Cat thanks you for the compliment. I'm an animal lover too.
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Hello all, 8/6 is my lat flap day. Left side. This is after diep failure. Right diep will be made smaller to match.
Excited and nervous. I have spent weekend cleaning and tomorrow will get kids their supplies. School starts on 8/18.
I have in my mind that I will be able to attend a work conference on 8/14-16 in Orlando. It's about a 31/2 hr trip. I would not be driving. My PS says maybe he'll let me know on 8/12.
I'm sure I'll be on with lots of questions soon.
Vivian
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Good luck! I hope aall goes well.
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Vivian - best of luck. Please be sure to listen to your PS as to what you can & cannot do during the healing process. Be patient, & most of all, take care of yourself. Many soft hugs!
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I'm just about a year out from my latissimus dorsi recon. It has been a long slow road but as others have said above it sure as heck beats the uniboob status I had after my first recon failed due to radiation impacts. Although I am quite non-symmetrical - it is easier finding undergarments and clothes to adjust to uneven boobs than one boob. I went for a second opinion hoping my current situation could be improved upon. Ultimately I decided to walk away from any more surgery at this time and just get on with life with my one C cup boob and my one B cup. I had hoped the ONE good thing that might come out of this was a bigger better looking rack! Alas, that wasn't really the case. I've learned the best padded bras for me. I don't wear a prosthesis and I look uneven in lots of clothes. Oh well. I'm uneven with my one lymphedema arm anyway. My right side is the side that has been through hell left with a bigger arm and smaller boob. My boyfriend took a nice pic of my left side recently and on that side I am looking quite good with my skinnier arm and C boob. I'm hoping that some weight training and physical therapy will even me out the best I can. My body told me not to go under the knife again - that my immune system and blood counts need to stay strong.
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Vivian, big day for you tomorrow! Will be thinking of you. I think the conference sounds a bit ambitious, but we all heal differently. I hope you can attend.
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