Latissimus Dorsi Breast Reconstruction
Comments
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Ronqt,
Good luck today! I hope your back feels better!
It really sounds like you made the best choice for your situation. That's all any of us can do. I'm intrigued by the fact that you mentioned how young your second opinion doc was. My PS is very established and trains PS residents. I guess it's just having the microsurgical skills.
Again, I'm hoping things go well for you today!
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I've been following this thread since my last exchange. I wish I had gone with the lat flap instead of trying implants for the third time. Pilates, I asked my PS about the tdap, but he said in my case, where I have paper thin skin and damage from radiation, the thicker flap a lat would provide would be a better option for me. However, barring any complications, I'm done with surgery for a while. Both my PS and I feel I need to take a break from it and just heal.
Ronqt, I hope you get some relief from the pain soon.
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Hi just got home from first post op with PS. Still in tube top, and have to continue with the drain. he asked what hurts, I said the back, but he is more concerned with the pain I had the past years with the implants. I am praying all goes good.
Piilates My PS is an established dr. practicing over 25 years, does not do the new stuff, diep, TDAP and other good things. He is also one not to operate so fast, fought me for years when I said I was in agony. I respect him for his work, his knowledge and patience and willing to listen to me. The other young hot shot dr I used as second opinion is very young with all new techniques, but too quick to move to or. My one and only PS also trains the younger docs. (except for the new and improved microsurgical stuff) I have gone through enough, 5 years Oct. 30 wil be my 5 year cancer free celebration and hoping that I feel better then also. thank you ladies for all your support and I certainly enjoy this thread as it is my new home.
Andrea, I did an exchange of implant three times too. I too have paper skin. Was at a point of removal but I could not deconstruct so thank God I went for this procedure. Hope you are feeling well.
Hugs, Ronna
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Pilates4me, thanks for letting me know. Now that you mention it, I remember seeing your post on the picture forum. Well,at least I remember seeing your Strange Science name. I'll go back and check. It's interesting that ronqt1 mentioned that her PS is an older established guy versus the young hot shot with the new procedures. That sounds like the choice I may be facing. I'm seeing the young hot shot today. His office just called and asked me to come in early so he could spend more time with me.
Ronna, did your doc do anything about your back pain? You sounded so distressed earlier, but your latest post sounded like he didn't address the pain.
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Hi Two tabbies, he said everything was great, was my cheering section, and said to continue with percusset( sp). I did not know you could take two if you needed it. However, he was pleased and I am hoping that this is my answer. In addition, he removed most of the bandages, tapes and I have more freedom. I feel so much better today. Unfortunately still with the one drain, but that is ok. He also saved my nipple (fipple)? which I am thrilled.
Thank you,.
Hugs,
Ronna
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That's great news Ronna! I hope you keep feeling better.
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Two Tabbies,
The whole PS field is such a practice and an art. It's funny, cuz the "young hot shot" I saw, refused to look at my medical records (his office said not to bother to send them) and was adamant that I had only the option of a lat flap. I think a lat flap is a great option for a lot of people, but I have hyper mobile shoulders--I need every last bit of shoulder stabilizing muscles I can muster!! I put my pics and story up on the pic forum in Road less travelled.
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Hi Pilates: my young hot shot the first time I saw him in March this year, also had me in OR w/out looking at my previous med records before I backed out. When I went two weeks before surgery this time , he talked in circles, said I was a candidate for a tram, certainly not a diep, which my PS said I was not but I wanted a second opinion. He mentioned the tdap so my PS recommended the lat flap. The stories are really hysterical. Hope my journey and my sisters here all work out well too.
Yes, the new ps have it as an ART as well as the older guys.
Ronna
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I had a looooong conversation with my PS yesterday about bilateral LD with my near future mastectomy. I also talked to my BS today and told her "Let's do this!" I am penciled in for Oct. 1 - R. mx and bilat. recon. I have my mind right and ready to go and get on with it. By reading so many of your posts, I was really able to have a very detailed Q&A with the PS. So, 3 days after my biopsy results, full steam ahead. Wish me luck. Ready to be on the other side of all of this. Who isn't?? BTW, I am sticking with my orig. PS. She is more experienced than the 2nd opinion guy (who would also be a good choice), but orig. PS and I went into Brava/AFT hoping for the best. We are in agreement about this next step and she has been superb from day 1. We text a lot.She is confident that I will come through this well. She and I both feel that way.
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After 3 LONG weeks, I'm am drain free! Gawd, this last one, the one that was for the back, just before he took it out, I told him I was so scared, he said, yeah, this is a very long one...yikes..it felt so strange coming out, it didn't hurt but man the others didn't feel that weird, I was about to come off the table, then it was over. I won't have to have drains when he does the exchange, thank the lord. If I never have a drain again it will be too soon. :-)
I got my second fill too. My non cancer side is way up high, close to collar bone area, the ld is lower...please tell me these things will be balanced and symmetrical in the end??? I'm so lopsided. He's only putting in 50cc's at a time and says I'll have 5 fills, I hoping to get to a "d" cup, does that sound possible?
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InTheATL2014, I'm glad you've got a plan. It sounds like you have a great relationship with your PS.
2bluestars, hooray for getting rid of the evil drain! I hate those things. I can't help you with your question on getting to a D cup. Maybe somebody else can.
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Get ready for a long post. I hope somebody has time to read this and hopefully offer some advice.
I had an appointment with a third PS today for a
consultation. Even though I already have an LD flap scheduled in November with
PS #2, my general surgeon (who did my mastectomies) suggested I see this other
guy just to see if he had any other ideas. He’s more recently out of school
than PS’s #1 and #2. (As an aside, PS #1 is the guy I saw before my mastectomies last year. He told me I could have any procedure I wanted at any time so I did not do immediate recon. He neglected to tell me that radiation would limit my options. I'm not happy with him.)Anyway, PS
#3 has muddied the waters a bit. The procedure I have scheduled with PS #2 in
November is an LD flap with implant on the irradiated side and just an implant
on the "good" side. #3 says he wouldn't do that. He said it's hard to
obtain symmetry so he'd do an LD flap on both sides. I asked if I could have
the LD flap at a later date on the "good" side if the implant only
route didn't turn out very good. He said no, that once you decide on that
you're committed. The skin won't work for another procedure later. On the plus
side, he also said he thought I wouldn't need the back skin from the LD flap to
create part of the surface of the breast so he'd use it to build nipples and
areolas. This would also avoid that football shaped scar that you see in a lot
of photos of women who have an LD flap. I'd have just a vertical scar on the
underside of each breast.So now what
do I do? I liked both of surgeons #2 and #3. Either one of them can no doubt
improve what I've got, but just about anything short of an epic failure of
surgery would be an improvement. Here's a summary of pros and cons of both and
questions I still need to ask.PS #2 - pros:
* Lots of
experience with LD flaps (30 years worth). He said he's probably reconstructed
more breasts than anybody else in the state.* Comes
highly recommended. My GYN said "he does good work."* Said he
could achieve symmetry with an LD flap and implant on the left but just an
implant on the right so I'd only lose one muscle. (However, is this even an
issue? Both of these guys have said to just set aside any concern about the
loss of the muscle because it's just not an issue. They swear. So ostensibly
losing both shouldn't be an issue any more than losing one.)* Does an
"evening gown incision" which angles down the back in a way that
would make it likely an evening gown (or one piece bathing suit) would hide it instead of the horizontal incision that's "hidden by your
bra band." My bikini days are long gone, and I don't often
walk around with a bra on but no shirt so I prefer the incision a one piece bathing suit would cover. I don't know what kind of incision #3
does.* Spent a
good hour with me on my first visit then again when I had more questions.* I like the atmosphere of his office better. More like a doctor's office than a spa
where the stars go to have "work done."PS #2 - Cons:
* On my second visit, he started to sound like he thought I
was being what my mother would call a worry wart, and that I was obsessing over
this surgery. (Hey, information is power especially since I got
incomplete info last year and consequently made a decision that I regret. It's
also easy for him to say don't worry. It's just a day at work for him. For me,
it's my body.)* In trying to emphasize that losing the lat muscle wasn't a
big deal, he gave a bogus analogy of losing your appendix or tonsils or gall
bladder. The appendix and tonsils are a terrible analogy. Nobody even knows if
they have a function. The lat muscle definitely has a function. It moves my
arm. The gall bladder is a better analogy since it definitely has a function.
However, it's not a comforting analogy since there ARE consequences to losing
it. You've got to be pretty careful with your diet if you lose your gall
bladder.Questions to ask him:
*Can he
really achieve symmetry with an LD flap on one side, and an implant on the
other?*Could he do
an LD flap on the right side at a later date if the implant didn't work out?*Does he
think he can avoid the football shaped scar?PS#3 - pros:
* Studied
under a guy he called "The Master of the LD Flap." He said he did many LD flaps under this guy's tutelage.* My general
surgeon, who I really trust, recommended I see him. He (the general surgeon)
didn't necessarily recommend that I choose him over the other guy, but he did
recommend that I at least talk to him.* Said he
might be able to avoid the football shaped scars.* Possibly
less time in the hospital. He said that if my pain is under control, I could
get out in as little as 1 night. PS #2 said 3-4 nights.* Said he'd
do fat grafts if necessary to even things out. I need to ask him what donor
site he'd use. I can suggest a couple likely candidates. So, would I possibly
end up with a bonus liposuction?* Had his office
call me to see if I could come in early for my appointment so he'd be sure to
have enough time to spend with me.* Did not
downplay my concerns. Said it was good that I was educating myself and asking
questions.PS #3 -Cons:
* Partner of
the guy who led me astray last year by not mentioning that radiation would for
all intents and purposes rule out having implant only recon. He probably did so
inadvertantly, but he did lead me astray. I'd have had immediate recon if I'd
known. Yes, I'm still pissed off. However, I guess I can't blame #3 for what #1
said or failed to say.* The
general vibe of this office is that of a spa. They're the ones who showed
me a video last year that was more about a woman having breast enhancement than
a woman undergoing reconstruction due to breast cancer. I really hate that they
have that gorgeous woman in the bikini on the main page of their web site. How
to make the rest of us normal women feel like we don't measure up just when we
might not be feeling too good about our body image in the first place.* Recommends
doing the LD flap on both sides so I'd lose 2 muscles. Again, if I can believe
what both of these guys say, this isn't an issue.* He's
young. He graduated med school in 2007. He looks like my nephew! Not that
that's a bad thing. Is his youth an issue? Probably not, but I don't know.Questions to ask him:
* Does he do
a horizontal incision or an angled one on the back?* If he does
fat grafting, what donor site does he use, and how does it affect that site? Would I get a bit flatter abdomen?0 -
Two Tabbies,
it's really very frustrating to get so many opinions and then have to figure it out yourself. I'm sorry you are going through that. Have you considered talking to a Physical Therapist regarding these options? You've had radiation so your insurance should pay for an evaluation for shoulder issues as a result.
A consult might be able to help you decide whether a double or single lat flap makes sense from a functional stand point. I.E. some bodies respond well to having the same functional capacities on both sides of the body as opposed to one side doing things differently from the other. You may have relatively stable shoulders and that wouldn't be a consideration at all. But it may be worth a look.
From a purely aesthetic standpoint, you get better symmetry when you have the same procedure on both sides. Although, as you know, I've had two different procedures and have acceptable symmetry thus far.
In making my decision for a Tdap and NSMX on the prophy side, input from my PT regarding some shoulder/neck issues I have was critical. She thought that while many people do really well with a lat flap, I would have some challenges from it.
A PT consult won't make this decision for you, but it may help you feel like you've looked at all the consequences and are making a decision that is best for your body. And, don't let perfect be the enemy of good as you think about considering two different procedures on each side. Good Luck!
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Wowee…you're going to drive yourself crazy visiting 3 different surgeons. I had LAT surgery 2 years ago and went with the PS my oncologist recommended. I am the type of person who cannot "over think" these decisions. I had a mastectomy 20 years ago - R breast - and a recurrence on the chest wall (same side) 4 years ago. Underwent radiation, then the LAT surgery. Now I don't have complete symmetry, but with the right bra, it's not very noticeable. What is my point here? I guess I'd like women to be proactive in their treatment, but also leave the big calls to the professionals.
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2Tabbies: I feel for you terribly. Your truly are a warrior with your history. When I was first diagnosed my gyno called and gave me the names of the drs to call. People (all the experts with no bc) said to me go get a 2nd opinion, even a third. I delayed with the 2nd opinion with a ps until earlier this year, almost 4 1'/2 hrs into this. I was so mixed up, hearing this and that. What I firmly believe is and may be redundant to many, us bc gals and/or men now have an advocate immediately assigned to us. When we are in shock learning of our news that we have breast cancer we are making decisions changing our lives. I changed my breast surgeon earlier this year b/c I did not like his attitude when he spoke to me, although he did a great job in removing my cancer. So I went to the bc center at hospital . They advertise and want the business and surprise once cancer is out, physicians assistant is in. My original bs had a different outlook with me than my present bs, (pa) but could not take his arrogance. but I alwas preferred my original PS who I am glad I stayed with (the old fashioned guy) however I was upset with him too at times. However, never fast to operate, I would get annoyed, but he was always right. I know this is not the answer you were looking for but I made myself crazy trying to change drs. When I went to the lympademia clinic the staff would tell me of the different drs. but after going to the young hot shot, I was thrilled to stay with my orignal PS. I too have a dilemna, I had a mastopexy during my exchange in March 2010 when I just had the implants. I have not been able to see what the result is in symmetrical as of now but hoping that they are almost the same. Even with the implants, they were not perfectly same. I hope you can find the right answer. I guess I was lucky I did not have rads or chemo, just complications with the implant. Again, sometimes you can make yourself more anxious by too many opinions. Even at my pain management I was advised of this and that and it is only a decision that you can make. I was completely overwhelmed dealing with pain every day not knowing if and what was right and wrong. As to scarring, I am not a good healer and that is part of my problem as well. I have had quite a few surgeries due to implant problems and my age was a factor as well in this current surgery. (65) My PS did exactly the right move with me, knowing I could not accept the implant alone. (even did fat grafting a few years ago). In honesty, movement on right side is less than non cancer side and had been in pain management for three years. I also think I did not want to see too many drs. due to making all the decisions.
Tabbies, choose the path you want and take a deep breathe. Its hard with all the decisions, but where you are comfortable is it.
Today not a good day woke with severe pain, I pray for the good health for everyone on this site and bc.org.
I hope I made sense with this post.
Hugs, Ronna
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2Tabbies - you've done your homework & have volumes of information. I was fortunate that my surgeons, both PS & BS, were a go from the beginning & all has gone well. All I can say is trust your instincts, your comfort level, was it a two way conversation, did you feel like an individual & not the next scheduled appointment, etc. Nothing is a guarantee, but if you get to that place where you feel as though you did everything you needed to do to make an informed decision, then you know at that moment, you're doing the right thing & no regrets. This is all a moving target, & all you can do is take a quiet moment & dig deep to know what is best for you. I wish you all the best.
ronqt1 - some days are better than others, & you're only 9 days out, so be patient & listen to your body. I'm 22 weeks out from both BMX & double lat, & although I'm feeling really good, every once in a while, I get a twinge or ache that tells me it's time to stop what I'm doing & let it pass. Healing takes time.
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2Tabbies - I had the option of leaving in one of my implants and only having the LD on one side as the other side looked good. Both of the PSs I consulted with for the LD told me plain and simple - symmetry is easiest to achieve with the LD on both sides BUT it does require the surgery on both sides and it's big surgery as we know. At the time I made the decision to have both implants removed and do the bilateral LD. I had a couple months of asymmetry with size C cup implants and it was hell. I prefer being completely flat. No one notices flat. Everyone noticed one boob up high and the other low. This was my decision. It's important for you to make the decision that is right for you.
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2Tabbies, you have lots of info, that's great! My PS reminds me of your PS 2 but without the 'cons' part. I have my lat flap on left side and will get an implant on my 'normal good' right side at exchange. PS said they won't match exactly but he will get them as close as possible. I'm going with that hope.
2bluestars, congrats on the last drain being pulled, they are weird coming out aren't they?! What's up with the one side up to your collar bone? what did your PS say about it?
IntheATL2014, you're on the schedule now for Oct 1, the countdown begins!
Ronna, I hope you have some pain meds you can take and get some rest!!
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Thank you all for your replies. This is kind of frustrating. I just talked to my gyn who suggest I get yet another opinion to break the tie. Arrgh. There are no more PS's in my community so I'd have to go to the nearest bigger city. Not a big deal, but I'm sure tired of all this and wouldn't know which PS to choose there.
Pilates, talking to a PT is a good idea. I've just left a message for one who was very helpful a few months ago with a couple other issues. As far as I know, I don't have any shoulder stability issues so I don't think that's a problem, but you make a good point about being balanced functionally.
smass6, unfortunately, this isn't a matter of leaving the big calls to the professionals. I have two professionals offering me 2 different opinions. I'm excluding PS #1 because he's the guy who gave me bad, or at least incomplete, information last year. And that is exactly why I'm researching this to death. I would have made a different decision last year and had immediate reconstruction had he not told me that I could have any procedure I wanted at anytime. So now I'm not going to assume I've been told everything I need to know to make a decision. I could live with a small amount of asymmetry, but I never intend to wear a bra again. That's part of the reason for getting this surgery instead of wearing prosthetics. So I don't want to depend on a bra to even me out. It sounds like your choices have worked out well for you which is all good!
ronqt1, I agree that having an advocate as soon as we're diagnosed is a good thing. I'm past that initial shock now, but sure could use someone with experience on reconstruction options. I have fired doctors whose attitude I couldn't stand, but neither of these guys is like that. I like them both. I'm sorry you're in pain today.
Dpiggy, I wish I had a gut feeling that one choice was better than the other. With both of these guys, it was a 2 way conversation. I didn't feel like just the next case. I was a bit disturbed by #2's analogy comparing the lat to the tonsils or appendix, but I think he was just trying to find some way to convince me that we can get along fine without the lat muscle doing it's original job. A lot will depend on the answers I get to the emails I sent to each of them. Or if one fails to answer, that will tell me right there what I need to do. You're right that there's no guarantee. What #3 told me about not being able to go back and have an LD flap after having an implant on my "good" side disturbs me. I thought that was my ace in the hole. If the implant failed for some reason, I could do a lat flap on that side later. It will be interesting to see what #2 says about that. That's one of the questions I emailed to him.
Warrior_Woman, it makes sense that symmetry is easier to achieve with the same procedure on both sides. I think #2 probably didn't suggest doing the LD flap on both sides because he knew I wasn't even excited about having it on one side. That's another of the questions I emailed to him. I think he could probably get an adequate cosmetic outcome either way, but if it's really no big deal to lose the function of the lat (like both of them have told me), then why not do them both?
kfinnigan, when is your exchange? I'm interested in hearing how it all turns out for you. Did your PS say anything about not being able to do a lat flap later on the implant side if you had complications with the implant?
Thanks again, everyone, for your comments. I'll let you know what I hear back from these guys.
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Tabbies - I think it is a big deal to lose the function of the lat. We will need to relearn how to perform certain tasks and build up muscles that we relied less on in the past. Realistically I expect to be at about 80% of where I am now when all is said and done. I'm tired of looking and feeling deformed. I'll give up my 20% for breasts.
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Warrior, I was concerned loss of strength too, but both of the PS's I've seen told me that unless you're an elite athlete (international competition level), you shouldn't notice any loss of strength once you build up the other muscles to compensate. Maybe you're an athlete. I'm not. I stay active. Way more active than the average American. But I'm no athlete. I'm trying to get in the best shape I can before the surgery. Can't hurt. I'm right with you on being tired of looking and feeling deformed. I feel mutilated or like some androgynous alien from Planet Neuter. I mean no disrespect to the women who have chosen not to reconstruct. Before the mastectomies, I thought I might go that route, but this has hit me way harder than I expected. Sometimes, I'd like to crawl out of my own skin. Cancer has stolen most of my female parts. Ovarian cancer took my uterus and ovaries. Now breast cancer has stolen my breasts. I'm tired of it.
In other news, I got a reply to my email to PS#3. He even apologized for a "delayed response." Since I didn't really expect to hear anything before Monday, I wouldn't called it a delayed response. He said he does the oblique incision rather than the horizontal which is what I was hoping for. He also said he liposuctions the fat for the fat grafts from anyplace with excess like abdomen or thighs. So if I need fat grafts, I will get a little bonus. Score a couple points for PS#3.
Has anybody had an LD flap after a failed implant? I wish I remembered what PS#3 said about that not working. I guess I need to ask him.
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My second attempt at BR in 2 1/2 years...I finally had my LD sx April 2014 and it was a success...Three weeks ago I had my exchange LB only and it seems to be healing fine considering I have paper thin skin...My PS asked me if I wanted symmetry surgery on my RB by doing a mastoplexy/breast Lift and I agreed since I am mid 50's...Now I am regretting the breast lift because my incision has opened and is healing from inside out and it is very painful...This was my 7th surgery trying to feel normal again with breast...But 6 of these surgeries have had complications...I wanted to finish this whole nightmare of BC and surgeries by having nipple surgery but I can't take much more pain...If anyone has any tips, hints, or expertise on a breast lift complication or nipple surgery I would love to hear from you!!!
Thank you for your time and I hope everyone is having a wonderful and blessed day...
Susie
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Two Tabbies:
Susie R12
I hate to say this, I had major complications with my bc implant. 7 surgeries, if I remember (listed under my posts). Went for the LD Flap under suggestion of my ps and new hot shot. However, so in agony. I too am tired of the pain. However, after severe scarring healed on my mastopexy side (from exchange date) that foob has always been fine. I know from reading the posts this procedure takes time, Wed. 2 weeks, tomorrow I see PS again, I feel like someone slashed me with a knife in my back. I thank God my nipple was saved. Can't do this anymore. My drain is still in and the fluid is thicker than it has ever been. A little frightened with this. I was considering and had mentioned to PS doing the LD Flap on good side, I don't want anymore pain (all from scarring issues) not everyone has this. I will admit I made my mistake from the very beginning. Cannot look back. Just took a little pill and hope to be feeling well shortly. Hugs to all. One last thing, I was adament about tram or diep, so glad they advised it. At least from my waist down nothing hurts. Again, hugs and good health to all.
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ronqt1 and Susie R12, I can't help you with any advice on the pain other than take your pain meds before it gets bad. Otherwise, you're playing catch up. I'm sorry you're both in pain.
ronqt1, what was the mistake you think you made back at the beginning? I want to learn from your experience. Don't beat up on yourself for whatever it was though. We make the best decisions we can based on what we know at the time.
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Warrior, I just reread my post, and I hope my comments about being an athlete didn't sound snarky. I didn't mean it that way at all. I seriously meant that even though I'm not an athlete, maybe you are and will notice the loss of strength in your performance. I hope neither of us notices it! Fingers crossed.
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2Tabbies, my exchange isn't scheduled yet. I am nearing the end of fills but I don't see my PS again until 10/2. Will keep you posted. Also, we didn't discuss a lat flap on right good side, which I still have my boob on right side, I will be getting a small implant on that side at exchange.
Ronna, I was in pain for 4 1/2 weeks and then much better, but we are all so different. I hope your pain subsides pronto!! hugs
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Thank you keryl, 2tabbies, kfinnigan, sistagirl and everyone.... right after my post11 days ago I had computer problems and crazy, busy days...so haven't had a chance to get back on. And trying to get as much done as possible before my surgery October 10th. I am thankful to have you all to talk thru all this with. Thanks for the encouragement. I've read so much and gotten a lot of information from my doctors but your experiences are what really helps. I read somewhere that you can feel on your side where the muscle has been moved around from your back, but that you get used to it. Any one?
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Renee1008, I am totally getting used to the muscle being moved and working out slowly to gain my strength back, such as planks, girlie pushups, etc. and doing great at it! Still when I try to bounce around or slow jog (which I'm not a runner), the TE gives me grief for it, so I steer clear of those types of moves.
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kfinnigan, I had a prophylactic mx on my "good" (right) side so I need a total rebuild on both sides. If I still had one boob, I wouldn't do a lat flap on that side either.
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Tabbies - Not to worry. I didn't take your comments wrong. Everyone on here including you has been very helpful to me. I am athletic but I'm not a super athlete. I just hope to be able to continue with a quality life enjoying what I do today after the surgery. When I had the BMX it was a medical decision. This is cosmetic.
Anyone want to see my skydiving video? WW's Skydiving Video I hope to get certified next year and this had better not mess that up for me. BTW, I lost my ponytail holder and you'll see me freak out because my hair is so thin after chemo.
I had failed implant from infection. My PS said there is a 1% chance the LD could fail. It's not as if they can just return my lats to my back if this doesn't work out.
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