Latissimus Dorsi Breast Reconstruction
Comments
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Keryl, you made my day, too -- congrats! I haven't had my surgery yet (it's upcoming this November), and activities and movement were a big concern for me. Thanks so much for sharing. Yay!
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Keryl, way to go girl!!
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Thanks, no one quite understands that sentiment but you ladies; thank you and hugs. we are in it together. hang in...
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Amen sista!
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Keryl - Thanks for the good news. I come here hoping to read good progress reports and not to see anything that frightens the heebie geebies out of me.
It looks like I am switching surgeons. I got a second opinion yesterday from Steven Copitt out of Jeff in Philadelphia. He does a lot of lat flaps. I found him to be more thorough than my former PS. I am also glad he does the circular nipples rather than the ellipse with the skin flaps. They'll be easier to disguise with tattoos. He was quite reassuring and while there are the cases of complications, he does expect I will fair well. They started me on physical therapy prior to the surgery and have not made a decision about doing the lat flap or going with just expanders again. He will see how I am after the PT. Regardless of the surgery, the PT should benefit me. I like this proactive approach. I don't want to wait until I am disabled to start PT. He also told me some things that I did not know. He said that while the human diagrams at the gym make the LD muscle look huge, it is actually narrow and not as big as it appears. He also pointed out that none of the machines at the gym use only the LD muscle and other muscles are always used for all of the motions. He told me that it is with very rare exception that anyone has chronic pain, immobility or weakness that effects their daily functioning and he doesn't see it in his practice. I should be able to return to my normal lifestyle post recovery. He also told me to stay off the internet but he knows I will go AMA on that one. I am slightly less freaked out than I was a few days ago.
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Warrior Woman, you and I must be joined at the hip via the internet or something. I also "come here hoping to read good progress reports and not to see anything that frightens the heebie geebies out of me." On top of that I had a second consult with my PS today and heard a lot of the same things you mentioned. He didn't tell me that part about the lat being smaller than it looks in the diagrams. I still have a hard time wrapping my head around the idea that it can be repurposed so that it's no longer moving the arm but there will be no permanent loss of function. But he swears by it, and like your doc, he's done a lot of them. He also explained that there's no point in doing the "muscle sparing" lat flap where they only use part of the lat, because what's left behind is mostly fascia and doesn't function to move the arm. My main concern was loss of function and not being able to do the activities I enjoy like canoeing, swimming, etc. He said he's never had that happen to a patient. He also swears I will not ever have to wear a bra much less one with underwires. (In another thread, some women have said their docs advised them to always wear an underwire bra to keep the implants from shifting.)
Besides, the LD flap is apparently my only option other than staying flat which is not an option that I want to live with. My other choice would be a GAP, but nobody around here does them. He'd send me to NYU for that. Since I live in Oregon, it would be quite a trip for surgery, and not feasible financially since I'd have to stay in a hotel during recovery. Not cheap in NYC, I'm sure. And I don't feel really comfortable doing that. I feel better about the LD flap now. I just wish I'd seen this guy last year instead of the guy I was referred to then. I feel like I got terrible advice from him. That guy made it sound like doing immediate reconstruction with expanders would be a bad idea if I was having radiation because the radiation could damage the expanders, and even more importantly, the expanders made doing the radiation therapy more difficult. I didn't want that because I was afraid of not killing all the cancer. Apparently, that latter statement isn't true. The PS I saw today has it from no less authority than a radiation doc at MD Anderson Cancer Center, that it's just fine to do a skin sparing mastectomy with immediate recon before rads. They might have had to do the LD flap to shore up the irradiated side, but I'd still have had a better result because of the skin sparing mastectomy. I'm pretty annoyed that this option was talked down last year so I didn't even consider it. I guess I'll just have to get over being mad because it's water under the bridge. I just hope I never cross paths with that PS I saw last year again. I feel like I got substandard advice. Maybe since I'm 57 not 27 or 37, they thought I didn't care how I looked.
Anyway, I'm on track with surgery scheduled for November 11, and I think I relax about it a bit.
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Tabbies - Copitt is the 2nd PS to tell me I will only need to wear a bra if I want to "for comfort". Aside from sports bras for running, I have no intentions of ever wearing one again. I do care about the aesthetics and if I did not I'd skip reconstruction. I told my PS I was really happy with my implants before I lost them and he said I will be even happier with the outcome from the LD. Based on the photos he showed me I am hopeful. I think the LD muscle is thin although it is long. We don't see the side views in the diagrams. I keep hearing the same thing from the docs so I am sure they're not conspiring to trick me.
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Warrior, LOL! No, I don't think there's any conspiracy going on. I'd skip the whole thing if not for the aesthetics too. I just want to be able to get up in the morning and put on any clothes that I want without having to worry about camouflaging my chest or wear uncomfortable mastectomy bra prosthetics. Not ever having to wear a bra again at all is a little bonus. I do like my new surgeon a lot better than the guy I saw last year.
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Has anyone done a Lat Flap as a second procedure after a partial flap failure? I had a tug that I have lost alot of volume on one side and my PS is suggesting a lat flap to fill it in.
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Marial,
I had a lat flap after a full diep failure on left side. Please Ask any questions that you may have.
V
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Two week check up post lat flap.
Still have side drains . Looks to be healing well. Righty is looking good as swelling decreases.
Back to herceptin, 15 left to go and was changed from tamoxifen to anastrazole.
V
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I am having a lat flap done in 2 weeks after 2 flap failures. The DIEP was completely removed. The SGAP has significant failure and parts will be removed during the procedure.
Jana
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TedWilliams - i had bmx on 4/15 & double lat on 4/16, so I'm 18 weeks out. It was a tough journey, but worth it. Wishing you best of luck.
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My husband and I are hoping to take a trip around New Years to the UAE. It's a long flight with a lay over in the EU. We missed our trip last year because of my stupid cancer. We missed a lot of things because of stupid cancer. I anticipate having my LD flap and tissue placement surgery mid October and it will be a little over two months later that we would take this trip. We're getting cancellation insurance if we book it. For those of you who have had the surgery, does this sound realistic or am I setting myself up for more disappointment?
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Warrior_Woman - You will still have your tissue expanders in at that point, but as long as that doesn't bother you, I would schedule the trip! I definitely was up to travelling after two months. Sometimes just having something to look forward to helps. I remember feeling like I missed out on a lot when I was in treatment too, but that has made all of the traveling we've done since then that much sweeter
Kathy
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Hi Keri, I am not done filling yet. There is too much swelling on the radiated side so I have to give it a months rest. Im scheduled to have exchange surgery on Sept 23rd but that might be moved depending on the fills.
Hope you are doing well.
Jackie
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Yesterday was my 8 week mark. I certainly would be able to take a trip at this point Warrior! Book it danno
I saw my PS yesterday at my request, I wasn't trusting the nurse I saw the last 2 weeks for fills. PS wasn't too thrilled with her either it turns out and he ended up removing a small stitch that was poking around and said no fill this week and that he will do about two more to get us where we want to be and space them out longer as my radiated skin isn't too thrilled but he said he's happy with the progress!
Jackie/turtle, interesting that your exchange date is scheduled already when the fills aren't done, but no worries if they can shift the date. My PS said this isn't a race, so low and slow on the fills. Keep us posted!
Vivian, glad you checked in...2 week mark is a big deal! yay!
tedwilliams, best of luck on your upcoming surgery, keep us posted!
I hope to never HAVE to wear a bra again
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KSteve & KFinnigan - Thank you! I know from before that the expanders aren't fun but I can live with them. If we do the UAE I will need to dress conservatively which will minimize how funny they may look. Next year we'll hit some islands.
It is nice to have something to look forward to. I haven't had much this year. Looks like my husband will be carrying all the luggage!0 -
Warrior Woman - agree, book the trip. You should probably take a few comfy pillows for the flight - the rest will all fall into place. I also had double lat, & by 8 weeks, I was able to start traveling.
My last fill was a month ago, & my PS, is not doing exchange until Oct. Her protocol is to wait 3 months after last expansion before exchange. So far, so good.
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Warrior
I can't speak for 2 months post lat yet, but I can for 2 months post diep and I could have definitely traveled . Enjoy!!!!
V
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2 Tabbies, I loved your response:
"I just want to be able to get up in the morning and put on any clothes that I want without having to worry about camouflaging my chest or wear uncomfortable mastectomy bra prosthetics."
Your words expressed why I am trying a 3rd time for flap reconstruction.
Jana
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I have chosen not to bother with a prosthesis. I went from having full Ds to walking around completely flat. People who know me don't say a word and the few who do mention how thin I look without boobs. My PS suggested I get one and wrote me a script but I never even tried them on. Just looking at them makes me squeal in discomfort. Still, I will be happy to have boobs again.
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when I lost diep flap . I had one side concaved and one side dd's. I could not stand the fluffy fill in. It was a big difference to camouflage without. But I got tired and just did without. Wore tank tops with a short sleeve jacket and it was much more comfortable . It didn't matter if people stared.
I am so much happier now that I have 2 flaps. Wear my tanks even though lefty is still pretty flat but I have bulk there and righty was made smaller so not too much difference.
We are having very hot humid weather in Miami . Multiply times my newfound hot flashes and I want to be naked.
V
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tedwilliams, I noticed you have had several flap procedures....you know first hand which ones work and those that don't. I have a failed implant reconstruction, and would like your suggestions on which procedure you think is the best. My failure is due to radiation compromised tissue. I was considering the Diep flap, what do you think?
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Jana, I hope the third time is the charm. C
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Warrior, walking into the fake boob store brought out all the anger I feel about having to deal with bc and especially the mastectomy. Also, the shop was decorated in frilly pink. I know they meant well, but that is not my style and made me even more uncomfortable. I only did it because I thought I should give it a chance.
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Thimbleberry - I had double lat flap 4 1/2 months ago, & my PS said it was really my only option due to having radiated both breasts from previous diagnoses. She was pretty certain anything else would fail, & if I chose to go a different route, I would have to find another PS. I knew right then & there, she was the doctor for me. And, so far, she hasn't steered me wrong.
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Dpiggy, my PS said pretty much the same thing. I only wanted implants, but since I had radiation on one side, that's not a good option. Previous abdominal surgery rules out DIEP or TRAM. I asked about a GAP or TUG just to make sure I was covering all the bases. My PS said no one around here even does those, and he'd send me to NYU if that's what I wanted. I know some women travel for these procedures, but it's just not feasible for me. That leaves me with the LD flap. It would have been nice to have choices, but so it goes.
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Thimbleberry:
I can only offer my experience for this journey of reconstruction. My first flap is the most favored by many women and doctors. I was unfortunate to be in the 1% failure group. And that failure was caused by several factors-human and damage caused by radiation. I was taken back into surgery the night of my DIEP to deal with a crimped/blocked blood supply. Two months later the flap was removed because it was dying from the lack of blood flow. My surgeon did not laugh when I told him I thought buzzards were following me or that my chest looked like a bad art project. I never blamed him for the failure; it was what it was. The GAP was not my favorite. The scar makes yoga a little uncomfortable. My current surgeon stated they do not take the flap from the same area that my was. The flap is more firm than the DIEP was. This flap too has had issues and some parts have died. The recovery was faster, but maybe I knew what to expect so was not so frightened to move and get around. The blood supplies have been compromised by the previous attempts and thus to try and do another flap from my other butt cheek or thigh is unrealistic. Doing the lat allows the blood supply to remain intact and hopefully provide the outcome I am looking for. I just want to be able to shop for clothing without thinking of what is not there and how to camouflage.
My journey has not been the typical and I truly wish I could have stopped after the DIEP. That was not my fate. I am neither bitter nor angry. I just want this finished.
My advice is to find the doctor you can relate too. One who listens and has empathy rather than one who looks at you as a project. Research the recommendations and find your zone of comfort and acceptance.
Jana
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tedwilliams, 2Tabbies, and DPiggy,
Thank you for all your advice and insight. I needed to hear from women who have been there, done that, before I talked to a PS. Travel is a huge consideration for me. There is no one in my home town who is qualified for any of the flap surgeries. I will be in the Arizona area in September, and will try to contact a PS in Phoenix....either the Mayo Clinic or JCL Hospital.
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