Latissimus Dorsi Breast Reconstruction
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9 weeks out from surgery, saw my PS for a 30cc fill (at 240 cc now), he said let's let the skin rest now...I think my next and last fill is September 22. Cleared to do push ups (start slow he said) and I asked if I could sleep on left side (lat flap side) and he said yes. Progress...
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kfinnigan, progress is good! I don't have a clue how big 240 cc's is. Can I ask what you're aiming for?
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2Tabbies - Keep in mind that everyone is built differently and the CCs for one may look quite different on someone else. When I had my implants before they were removed I had 535ccs. I am 4'11" and weight about 105lbs. This translated into a small C cup for me although I'd have expected more. Your PS will guide you through the fills. Be certain to make clear the size you're aiming for. I do assume with the LD muscle in the mix, the results will be larger with the same size implants. I do not want to go larger than a C.
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Warrior, thanks for the information. Yes, it makes sense that the same volume is going to look bigger on a person with a smaller frame, and I understand about a particular cup letter being a different volume depending on bra band size. I just learned that one recently. I only want an A cup. That's all I ever was. I'm 5'6" and currently weight 140 lbs thanks to the weight I put on during my treatment over the last year and haven't been able to shed. (I just love Tamoxifen.) I should weigh about 125. I feel and look good at that weight. Anyway, I've no clue what volume that would be, but I've made it clear to the PS that I don't want anything bigger than an A or at most A+ if you get what I mean.
I thought I was firm in my decision to go ahead with the LD flap, but now something else has come up. When I was in for a 1 year post-mastectomy check, I talked to my general surgeon about being dismayed that I couldn't just have implants due to radiation damage. He suggested I have a consultation with yet a third PS. (#1 was the guy I saw last year who told me I needn't make any decisions prior to getting the cancer itself treated because I could have "any procedure I wanted" at any time. #2 is the guy I've been seeing this year who is scheduled to do the LD flap on my in November.) Anyway, PS #3 is a young guy, and my general surgeon thought he might have some new ideas about what's possible. The general surgeon messaged me today that he talked to PS #3 who did indeed think it's worth my coming in for a consultation. I don't know what new tricks he might have up his sleeve. I thought I'd researched everything pretty thoroughly and had come to the conclusion that PS #2 is right about the LD flap being my only good option short of a traveling somewhere for a GAP which I don't want to do. So now I'm in limbo again after having thought I'd made my final decision. I know I shouldn't stress about it, but that's easier said than done. Stress is my middle name lately. I hope PS #3's office calls and gets me set up with an appointment soon. I don't want this to drag on. And did I mention he's in the same office as PS #1? I'm not really pleased with that, but whatever. In a smallish community like this one, there aren't tons of PS practices.
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I hope you find a direction you're comfortable with, Tabbies.
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2Tabbies - I did extensive research due to having both breasts radiated, & there were very few options available that had a decent success rate. I fully agree w/ another consult, but I remember my PS telling me that some surgeons, especially the ones right out of school, will try anything. I'm sure you've done your homework & googled him & his experience. Good luck!
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Thimbleberry - based on my research, it is crucial to find a PS who specializes in this type of reconstruction & has a specialized team that assists . I'm fortunate that my PS is close to home. Good luck on your journey.
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Dpiggy, I haven't googled him yet, but I will. Everything I've read backs up what my current PS has said about the failure rate of implants (without a flap) after radiation. If that's all this guy has to offer, I'm not going there. I'm really at a loss as to what he could offer me that's different. Some new material to reinforce the skin? I've not read about anything along those lines. If he wants to try doing a GAP on me, I'm also going to head for the door. That procedure sounds so complicated that I'd want somebody with lots of experience.
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Tabbies, the flap does give more volume. My radiated skin isn't too thrilled with the fills. I think I'm getting one more fill on 9/22 at 30cc and that's it. My PS is overstretching me prior to the exchange. I will also get a small implant on my good remaining breast so they will be symmetrical. I was always in the wrong fitting bras and Nordstrom started fitting me after a year wearing the wrong size prosthetic in the wrong size bra. My PS knew I wanted to fill out the bra I had on at my consult (34c, which fit my prosthesis but not the real boob),
I saw 3 PS's (#2 was a consult with an S-Gap specialist and she said she could only get me to about half of the volume of the remaining real boob). I had my first consult with PS #1 (which is my current PS) and he said the lat flap was for me, but he sent me to a specialist at my request. PS #3, a newer PS in the same practice as PS #1, mentioned she could "try" implants without a lat flap, if there was too much scar tissue in the way. I was like "Whaaaat????" I told PS #1 that comment, and he said that I didn't have to worry about scar tissue with a flap, and that it would work. He also has said numerous times after the surgery that doing an implant without a flap would have never worked on me, and also that my pec muscle (fried and thin from radiation) is protecting the skin (TE is behind the pec muscle).
It took me a few years (5 yrs to be exact) to come to the decision to get the lat flap done. Now I wish I'd done it years ago.
Best of luck in your decision process. Hope we are helping!!
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kfinnigan, yes, everyone's responses are helping me. I'm pretty certain I'll end up with the LD flap. I want to see what PS#3 has to say more out of curiosity than in hopes that he'll have something better to offer me. His partner who I saw last year (PS#1) had recommended an LD flap, but I had dismissed that recommendation because I didn't want a flap at all and at the time didn't know that radiation would be an issue.
I had a BMX so there's no original boob to match. PS#2 says he can match one LD flap and implant with one implant only (on the non-fried side) fairly well. I don't care that much about an exact match as long as there isn't an obvious difference visible when I'm dressed.
One thing I'm curious about. Why do so many of the surgeons do the horizontal incisions and say so proudly that the scars are hidden by a bra strap. I don't know too many women who walk around in a bra but no shirt so why should this matter? Or do most women want to hide the scars under a bikini top? My bikini days are long gone sadly. I prefer to be able to hide the scar under a one piece bathing suit. Fortunately, PS#2 does an angled incision which might make that possible.
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My PS # 1 did say that I will find surgeons willing to go with just the expanders again but it's too high risk. My issue was infection rather than radiation.
Ladies - I was studying the anatomy chart at the PT's office and learned that there are a number of muscles beneath the LD muscle in our backs. This is reassuring to me. It now makes better sense how the LD muscle can be taken for the flap.
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I had lat surgery 9/13. I have a very large seroma on my left back side. Has anyone else out there had this issue for over a year? My PS sent me to IR to have a tube put in so they can treat it with benidine. They have put the tube in 3 times over the summer. They keep telling me the seroma is gone. The last time I had it drained it was 140cc. It is getting more uncomfortable every day. Any suggestions?
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Bink, I haven't had that issue so I can't offer any advice. What a drag. I hope someone else can help you.
Tabbies, when PS #3 showed me her photos her first one was a vertical sorta scar. She said she would do it differently now, horizontal...I asked my PS right before surgery if he could hide the scar in my bra line and he said he'd do his best. When I woke up and saw the scar, its just below the bra but is covered by the band of the bra - he said "I know you wanted it higher but I had to go where the money was". I said that's perfectly fine. I wear exercise tank tops and you can't see anything.
Warrior, interesting on our anatomy!
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Warrior, my PS (#2), said the teres major and teres minor are the muscles that compensate for the loss of the lat. I keep meaning to look for an illustration of them in my old anatomy book or online. I also have a friend whose bicep popped loose from its insertion on his forearm. He decided not to have it repaired with surgery, and other muscles are compensating. Last I knew he was still lifting weights. I try to keep reminding myself of that.
Kfinnigan, the horizontal scar placement makes sense if you wear cropped exercise tanks. I doubt I'll ever do that any more than I'll wear a bikini. It's nice that your surgeon could accommodate your preference. Mine does what he called the "evening gown incision." It is angled like the edge of a low backed evening gown. I think it will be hidden by my bathing suit. But when it gets right down to it, that's the least of my worries. I have a whole collection of scars. All I need is one around my neck, and I'll be right up there with Frankenstein.
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Tabbies - my incisions are vertical, not horizontal. It's been 19 weeks, so they are starting to fade, but still visible. I had a challenging time finding bathing suits that would cover the top of the scar, but after a couple of hours of trying various styles, I found several that work. Agree - hiding them under a bra strap was not a concern for me.
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Bink, I hope you can get the seroma resolved. That sounds like the pits.
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Bink182 - I had bmx & double lat surgery 19+ weeks ago, & after my drains were removed, I had a seroma on my left breast. My PS aspirated a couple of times, had me wear an ace bandage for a couple of weeks, & it resolved itself w/in that time frame. I'm sorry I can't offer more help.
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Hi LD Sisters. I'm the proud owner of a successful LD flap that I had to deal with an infection I couldn't kick after my exchange. While I'm not thrilled at times I had to have the flap since my first surgery looked so great, I am grateful for this year with a healthy body. My flap is special for sure and I don't have symmetry despite being in the hands of a top PS. Regardless, it was the solution I chose at the time. I try to minimize bra wearing due to lymphedema. With my surgery result, if I wear a loose tank top - especially something linen or wrinkly - and a loose top over it - jacket, sweater, blouse, etc. I can pull it off. I was bold last week and wore a tank braless and open jacket to work - radiation tattoos showing and all. I'm challenged running because the whole deal pulls as I swing my arm. But, with patience and self-compassion I am able to get out and sweat too.
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Happy to hear some are able to run after LD. I'm finding it pretty tough because of the tightness. As long as I don't compare myself excessively to the pre-cancer podium grabbing me, I can enjoy getting in a little jogging along with my walks.
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Hi, Mariasnow. I'm sorry you had to deal with an infection and needed a re-do. Thanks for posting your experience with the LD flap. I hope you can eventually get the tightness stretched out and feel more comfortable running. I'm keeping my fingers crossed that after I get mine done, I'll be back to my swimming and other activities in time not that I was ever podium grabbing at anything! ;-)
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Hi Mariasnow - I'm here because I had an infection after my exchange and lost my implants. This is the first time I've heard an account of difficulty with running. I'm a runner. It's what I do. They're promising me I will be able to run around the 6 week mark. I'm having the flap on both sides. I'm getting PT now and I'll have it after too. I had better not have problems with running.
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No issues with double lat & running here, but have to work on swimming.
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What difficulties are everyone having with swimming? Is it the strength, speed, mobility, endurance?
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I can swim just fine with bilateral lat flaps.
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I tried running today with a looser bra - built into a tank top and it was slightly better. I'm thinking that with some patience, PT, and focus on the best form for my situation I can make some gains. But I want to tell everyone it is going to be OK. I really do. But it's tough right now.
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I'm interested in hearing about any issues with swimming also just so I can be prepared.
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I had lat dorsi reconstruction with TE's just about eight weeks ago. I was doing a good amount of cleaning in my house this weekend and my right breast (I'm right handed) swelled up pretty bad. At least twice the size of the other breast. It is swollen and quite sore but not red or hot. No lymph nodes removed that side by the way. The doctor told me it take aleve and a muscle relaxer and alternate heat and cold, and take it easy. Has anyone had issues like this? I don't know if it's normal or not. I kind of thought after eight weeks I could vacuum, clean bathrooms, pick up, etc. pretty easily. Thanks for your thoughts!
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Purplegurl - Did they tell you what is causing the swelling? I haven't had the surgery yet but I was told I can resume normal activity at 6 weeks. I would certainly hope I can house clean at 8 weeks.
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Purplegurrl, I had the same thought as Warrior Woman. It seems like you should be able to do regular household chores at 8 weeks. Did the doc think the swelling might be a seroma? From what I read, those are more common in the donor site on the back than in the breast after an LD flap, but who knows.
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I hope the swelling clears, Purple. Wishing you well. I got out and did some walk-run today and running with LD is VERY tough. My chest squeezes down with every swing of my arm. Sometimes I feel like there is pressure on these boards to say everything is OK because we are all so scared. I was brave and covered over 6 miles anyway so I am super grateful I could do that. But running is extremely difficult despite quite a bit of PT and other healing modalities. It may never be OK or easy for me to run again and I am an absolute badass who can take on suffering like no other! Sometimes I feel like all the Pollyanna stuff makes me sick so I'm not doing it. I'm grateful for LD but if I knew I wouldn't be able to run like before I wouldn't have done it. I would have gone with one boob while I looked for another solution. In face when I had one boob I would run with a boob pad for vanity and run like the wind.
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