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Latissimus Dorsi Breast Reconstruction

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Comments

  • Diane509
    Diane509 Member Posts: 42
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    Hi Cindy....... It's been a while hasn't it?  So glad to hear you are post exchange and that it's finally working out for you.  Wow...800 cc's....makes me cringe!!  I'm bearly able to stand my 425s !!

    I always joke my husband about getting lipo...... I guess I will scratch that idea clean out of my head.  I'll try DIETING instead.... I have had enough pain.  

    My exchange was done on12/9/10 and they are sure more comfortable than the tissue expanders, but not without discomfort...I get a little bit of a raw feeling underneath from time to time, ususally after sitting in one position too long.  What a pleasure however to be able to roll onto my side and catch a few zzzzz's.  I could never do that with the TE's.  I had to wait 6 weeks to be able to get back in my hot tub after the exchange and I enjoy it so much (daily).... This Saturday we are taking a cruise and I am putting the "girls" into a bathing suit IN PUBLIC ......we'll see how that goes.  I'd feel better if I hadn't gained an extra 25 lbs last year from all my stagnant respose.

     Here's to the new glrls...and to a positve mental attitude!

    Diane 

  • justagirl
    justagirl Member Posts: 633
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    In 3 weeks I am scheduled to have a double mastectomy using the latissimus dorsi muscle on one side because of recent surgery.  I am doing this is to be proactive due to a hx of lumpectomy with a grade III aggressive invasive tumor and LCIS in the other breast.  I am sick and tired of worrying and having twice yearly mri's, u's and mammograms don't provide me any reassurance as I found the tumor 3 months after a clear mammogram.  MY BIG QUESTION IS: HOW DID YOUR DOCTORS MANAGE YOUR PAIN WHILE IN HOSPITAL? My last surgery was just with the breast surgeon and this time it will be the breast surgeon removing the breast tissue and the plastic surgeon doing the LD flap and reconstruction with 'A' size saline implants (one might not be needed on the LD side.  Anyway, when I had the lumpectomy last year all the nurses gave me was over-the counter tablets for pain relief.  Luckily I was only in the hospital overnight and upon leaving the Dr gave me a prescription for pain relief which worked.  I was so uncomfortable in the hospital I couldn't rest or sleep and the constant pain from the incision and lymph node biopsy was really bad and I just didn't want to move or get out of bed....which is not healthy!  I have an appointment with the plastic surgeon for measurments a few days before I am due to go into the hospital.  Would it be out of line to ask her what she will be giving me for pain relief while in hospital?  I just can't believe that last year the breast surgeon only prescribed tylenol for pain relief!  I would like to do surgery on one of those nurses and let her see how it feels!  Am I out of line or do I shut up and put up with the pain?  I just don't think taking the LD muscle and twisting it around to my breast and scooping out all my breast tissue to be a minor thing!  Sorry for rambling on..... any suggestions?

  • Shrek4
    Shrek4 Member Posts: 519
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    No, it wouldn't be out of line. You MUST talk to her, because she's the one to write the prescriptions for pain medication.

    Some surgeons put in a morphine pain pump, some go with just hydrocodone (Lortab, Norco) or oxycodone (Percocet, Endocet).

  • justagirl
    justagirl Member Posts: 633
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    Day,

    Thank you for writing.  I think at this point I would be happy with any pain med stronger than Tylenol!  And I will talk with the plastic surgeon before about pain management.  I just know as a nurse it's bad to stay inactive after surgery as that decreases your circulation and increases chances for blood clots.

  • Shrek4
    Shrek4 Member Posts: 519
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    I had after surgery those "socks" that inflate and deflate to massage your calves - ask if they are using those.

    Also, expect to be in surgery for quite a while. A LD flap recon lasts around 3 hours.

    It will take a while for the anesthesia effect to go away completely.My BS said that you need to count one week for every hour you were under general anesthesia.So when you start walking after surgery, make sure you have someone with you, because you can get dizzy very fast. And be sure to check with the PS about what exercises you are allowed to do, some routines can actually cause misshape of the reconstruction.

    You know, you could have asked for stronger pain medication when you were in the hospital if what they were giving you wasn't working. They are obliged to contact the dr. and get permission for stronger med. I remember when I had my first revision, the PS had forgotten that I had asked to not give me Lortab as it doesnt' have effect on me, and to prescribe me Percocet. Well, I raised a fuss in the hospital, they paged him, he contacted one of the surgeons on site and I got my Percocets in 15 minutes after I asked. Be firm, I know it's hard when you're in pain, but try. I am a "lucky" one as when I'm in pain I dont' get whiny, I get angry, and if I don't get to be pain-free, it's bad.

  • justagirl
    justagirl Member Posts: 633
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    Dear Day,

    Thanks for your advice on pain management.  If I hurt and don't get relief I will follow your example and demand something to get rid of the pain.  Plus I'm taking my mobile phone and if they won't call the dr. I will!  I do expect after 7 hours of surgery I won''t be steady on my feet so will be careful.  As all of my other surgeries have been less than two hours I realize recovery will be much longer this time, expecially since they are taking my LD muscle and twisting it all around.  I thought the plastic surgeon would be doing it for the other breast also, but she said if the tissue will support a small implant then she doesn't want to take the other LD and decrease my arm strength on both sides.  I know it's a big surgery but I am looking forward to getting this breast tissue out of me!  I just hop there is no nasty pathology results when they check the tissue!  That part fills me with anxiety and dread.  Thank you again.

  • Shrek4
    Shrek4 Member Posts: 519
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    Ok, also, make sure you have water with ice chips handy at all time after the surgery - ask the nurse to push the serving table/tray on the side you will not have the LD flap so you can reach it - 7 hours of having that tube in your throat will make your throat really really sore. Make sure you do not eat for at least 6 hours after you wake up from anesthesia. Don't drink anything else except iced water, and even that, not in big quantities, get just a chip or two of ice in the mouth at one time. Otherwise you will be very nauseous. You also might get a catheter if the surgery is long. Are you going to have direct implats or TEs?

    Check the first thread in the Surgery board, I can tell you, it helped me A LOT. The silky pj pants were an absolutely wonderful idea, as you will have a little bit of trouble getting up and laying down. Make sure they put those massinging "socks" on you after the surgery.

    Your PS is a very smart doctor, not to want to take both muscles.

     Good luck with the surgery, and keep us updated, please.

  • justagirl
    justagirl Member Posts: 633
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    Day,

     I will keep in mind all of your suggestions.  I am hoping they will only have to do the LD flap on one side.  The PS is hoping to only have to do a LD flap on one side but has to get in there and see how much damage was done with the previous lumpectomy.  The PS hopes to put in small silicone implants straight away to eliminate the need for another surgery and I am happy to be small...I just would like something there if possible.  As we live almost 2 hours away from the PS I don't want to be driving in or having my son drive me in all the time for fills.  As I am also a runner, small breasts are easier! All of your information and suggestions make doing this easier.

  • IllinoisNancy
    IllinoisNancy Member Posts: 99
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    Hi,

    I'm having neoadjuvant chemo for 20 weeks and scheduled for myLatissimus Dorsi Breast surgery on April 6th.  I'm scared to death!!!!  The chemo has been horrible and I never feel good.  I'm trying to focus on the chemo first but am curious how much pain will be involved with the surgery.  I'm a weird case and this is a recurrence in my left breast.  That's why I'm having them taken off this time because I am so sick of worrying about them.  My first dx was in 06.  The cancer has the exact same characteristics as the first time except it is just under the skin and you can see it this time.  It disappeared after the first chemo treatment so I guess it worked.  Because it was so visible on the skin, the BS is going to remove as much skin as she can from my front left side and the PS is going to take skin from my back to close the area.  Have any of you experienced this?  My right side will be a nipple sparing and I'm getting silicone implants.  My husband and I went to the first appointment with the PS and we both got the impression that I would only have one surgery and no expanders.  Maybe we were just not paying attention.  Does anyone do that?  I see all of you had expanders and wonder if the other is even possible.

    Sorry this is so long but I have so many questions and would love to hear from you ladies who have been through it.

    Thank you,

    Nancy

  • EllieD
    EllieD Member Posts: 14
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    Nancy,

    I had a mastectomy with immediate LD reconstruction.  They inserted a saline implant - no expander needed.  It was pretty big surgery.  I was in the hospital 5 days.  I live far from the hospital so I was hoping that having the implant would eliminate the need to travel back for fills.  As it turned out I had some healing issues that had to be followed up weekly anyway.  But I'm 4 years out and so far so good.

  • Linda54
    Linda54 Member Posts: 509
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    Nancy, I sent you a private message

  • Stanzie
    Stanzie Member Posts: 1,611
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    Nancy - I'm so sorry you are having all this again. I had immediate reconstruction no expanders and I was in the hospital only 2 days. Ask away with anything we can help with...

  • Adnerb
    Adnerb Member Posts: 727
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    Nancy:  

    My LD flap surgery happened almost 2 weeks ago.  It was not my first reconstructive surgery.  It was done to repair tissue expander reconstruction that did not work because or prior radiation.  I was in the hospital for 4 days.  Surgery was only on the left side.  I still have my drains, though I know I am feeling a lot better, no pain meds.

    I think you should have at least one month off chemo before you have major surgery.  Plan 3 to 6 weeks of time off work, depending on what you do.  

    Take care and good luck!

    Brenda 

  • Linda54
    Linda54 Member Posts: 509
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    Brenda

    good to hear from you and I am glad you are doing well.  I hope those drains come out soon!!

  • Adnerb
    Adnerb Member Posts: 727
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    Linda!!!  Our lat flap queen!!!  How've you been?  You need to post new pics, lady!

    Glad to hear from you too!

    Brenda

  • Cafelovr
    Cafelovr Member Posts: 75
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    Well, my surgery has been bumped...again! March 24. Ergh!

  • 1965sally
    1965sally Member Posts: 29
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    Hi all.  I had exchange last week and going back to work tomorrow.  Not much pain at all, yet.  No more muscle spasms at night, hallelujah.  One thing I learned since I last posted.  I misunderstood my PS talking about moving extra fat around to fill in hollow spots.  I was annoyed that he didn't take much fat from the back, which I thought was the main benefit to having the LD flap, but he had actually said (I asked the nurse to go back and read the notes) that the lat muscle would provide extra "padding" (I heard "fat") and give the implant a more natural look.  The nurse said the pec muscle is thin and when you put an implant just under that you can see more wrinkling of the implant, but with the implant sandwiched between pec and lat, that's not as much of a problem.  It'll be about 4 months before this all settles out and we see what we have.

    The other thing I learned in hindsight is I should have told the PS to go slower with the fills, because I got stretch marks!

  • westieluv
    westieluv Member Posts: 245
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    Well, the countdown has commenced to my bilateral lat flap surgery.  Scheduled for this Friday.  I am doing last minute preparations at home, packing my bags on Wed and going up to the city on Thursday. A special thanks to Linda for answering questions for me and for all previous post submissions that have been a great help.

    For the benefit of those that may not know me, I had BMX in Dec 2010.  Suffered complications on the operating table and woke up with radical mastectomy on left side and TE placed on right side.  Lost the one TE to infection 7 days later. I was back to square one minus alot of skin.

    I'm hopeful for a full B or small C, but will take what they can give me.  I'm still thinking about posting photos on the other site.  There aren't that many LD flappers as it seems to be more popular to DIEP or Tram, or SGAP.  I'm hoping for good results and no complications this time.

  • GG27
    GG27 Member Posts: 1,308
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    Good luck Westieluv!  I too am a bilateral lat flap, it was a good fit for me, I haven't had any problems & am very happy with my results.  I went home early from the procedure, with my PS asking if I was sure, but I was fine, more than fine.  I just had my nips done & am patiently (foot tapping) for my tats.

    Fingers crossed that it goes well for you this time.  Cheers, Dee

  • Linda54
    Linda54 Member Posts: 509
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    Beth

    You will be in my thoughts and prayers for Friday's surgery.

    check in when you feel up to it...

    the best to you

    Linda

  • Stanzie
    Stanzie Member Posts: 1,611
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    Beth- know you will do great! Thinking of you!

  • justagirl
    justagirl Member Posts: 633
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    Had my DM with one LD flap 17 days ago.  Didn't save the nipples as they could of been the making of an infection as they had both been removed and sutured back on twice before - you know, limited blood supply and all.  I know I can have nipples made in time.  The PS gave me plenty of pain meds.  I was in hospital 10 days until the last of the 6 drains came out. 

    I am so happy to have the surgery behind me.  The PS was able to put in the permanent silicone size (195 and 225cc) implants I wanted.  No infection so far, but I still have to take a strong pain pill and valium before bed and repeat it about 2am.

    I'm not as active as I thought I would be by now.  I can manage the laundry and cooking dinner most nights though. I did think by now I would at least be back walking a bit on my treadmill.  I know, all things will happen in time.  

    I am thankful to my PS and BS, husband and son for their support.

    Most of all, the high risk of reoccurring BC is gone from my life.

    Thank you, each and every one of you, for all your support!

  • Linda54
    Linda54 Member Posts: 509
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    justagirl

    You are active!!!!!!!

    If you are doing laundry and cooking most nights then you are doing great!!!!....I do not see any reason why you could not be walking on your mill.

    wooooo 10 days in the hospital....Austrailia must care more about their people than the US does....our insurance companies would send us right home if they could...I was in the hospital 2 nights.

    So sorry you are still taking the pain meds.  I did not take them for pain but to help me sleep the first week after surgery.

    so so sorry about the nips...

    take care..you are doing great

    Linda

  • Stanzie
    Stanzie Member Posts: 1,611
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    Just  a girl - Wow, you have been through a lot! So glad to hear everything seems to be going well.

     I think that was wise not to keep the nipples after having it come back. Gosh you were in the hospital a long time - so glad they were able to give you the implants you wanted. I had the regular Lat Dorsi surgery and it took a good three weeks to start being and do things "normal". And with grabbing more skin from your back I'd imagine your recovery will take longer but sounds like you are doing wonderful! I'm so happy all went well.

  • asr51
    asr51 Member Posts: 28
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    Stanzi, have you ever had anything done about the bulge under your arm?  I still have mine.  I think since I last posted to you, I've had my exchange in October.  Then two weeks ago, I had one of the implants replaced and had nipples done.  In about a month, my PS is supposed to do lipo to get rid of the bulge and use some of it for fat grafting.  I hope it works. 

  • FloridaGirl
    FloridaGirl Member Posts: 9
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    I haven't posted forever or been on the site in over a month.  Because, the less I think about BC, the better my frame of mind seems to be.  Actually, my bilateral lat flap surgery in December went so well and since I didn't have to do chemo or radiation afterwards, I feel like I am cured of BC, except for that annoying little Tamoxifen pill that gives me hot flashes.  Beth, I have been thinking about you and will be thinking of you especially on Friday.  I pray all goes well this time around with your surgery.  Wishing all the others well that have this upcoming surgery.

  • justagirl
    justagirl Member Posts: 633
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    Linda54 and Stanzie,

    Thanks to both of you.  My PS kept me so long in hospital because it wasn't until the 10th day that she had the last of the 6 drains pulled out.  I am just now hoping my private insurance doesn't protest the length of time I was in hospital.  I still need pain meds to sleep at night.

    All of you are inspiration to me!

    My incision where they did the LD flap still can really act up and ache.  Other than that, I think I am getting better every day!

  • Stanzie
    Stanzie Member Posts: 1,611
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    Justagirl - thanks for checking in!!!! hang in there it just gets a bit easier every day! Glad things are going Ok and glad you are home, at least I assume you are....

  • Linda54
    Linda54 Member Posts: 509
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    justagirl

    I think most of us come home with drains hanging out all over our bodies....to me the drains are the worst part.

    Glad you are home and recouping well.  It is OK to take the pills to help you sleep.  The rest will be good for your healing.

    take care and keep in touch

    Linda

  • Fearless_One
    Fearless_One Member Posts: 905
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    My surgery is in a few days, I assume he will do a LAT flap since I have a history of lumpectomy with radiation.   I am nervous, glad I found this thread.

    Justagirl, I think that is terrible she didn't give you painkillers.   Even after my lumpectomy,she gave me Rx painkillers and I never had to ask.