Latissimus Dorsi Breast Reconstruction
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Hi all!
I didn't set off any alarms at the airport, yay! All caught up now on your posts and I popped over to the picture forum to check out 2Tabbies and Artemis, you both are looking good!
I'm at work and reading up took some time, so I wanted to say hi and thinking of you all and jbokland, hope all goes well this week for you and you fight off that cold that's lurking.
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Hi, kfinnigan! Glad to know you didn't have any problems at the airport.
I have a couple questions for those of you who've been through this already. I posted this also in my thread on the picture forum just now so if you've been there very recently, you might have seen it. First, how long did the burning pain along the bra line continue after the surgery? I'm almost 3 weeks out, and it doesn't seem to be getting any better. I've never taken this much pain medication in my life. For previous surgeries, I always could get along with just ibuprofen after I'd been home from the hospital a day or 2. I have bottles of leftover pain meds to prove it! Not this time. I still wake up in pain in the middle of the night. I can't sleep on my sides only on my back which is a problem since I'm not a back sleeper.
My second question is also about pain particularly concerning the fills. I read what to expect from fills in the book the PS recommend. (Good book, btw. The Breast Reconstruction Handbook by Kath Steligo.) It said it might hurt during the fill and for a few hours or a day or two afterward, but it shouldn't be anything that Tylenol won't control. I've had the exact opposite experience. The fill itself didn't hurt, and I had no pain the rest of the day. I did wake up that night in pain, and have been hurting ever since. That's 6 days later. Have any of you had a similar experience - delayed pain from the fill? Is this because it was my first fill and only 2 weeks post-op? I sure hope I don't have this problem with all of the fills because I need to go to work! I won't be able to feeling like this.
Sorry to be a whiner! How are you all doing? I've been thinking about all of my LD buddies!
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Hi all! Missed you guys!
Ronqt1 I am so so sorry you are going thru such pain. Everything is tough enough without this relentless complication, I hope they figure out a way to take care of this asap...
Jbockland I love your beach bra burn and then year later treasure hunt, how hilarious and what a way to deal with tings..
fabulous idea with the poncho! Though I would indeed love to see a glittering goo ball! I had to go on a trip to one of the little fishing towns up north and my bouncing ball caused many an open stare... I told them it was my ultra modern liquor flask for my cosmos.. then I had to explain a cosmo.. sigh..I need to find a poncho too! Warrior Woman I think it's good to listen to body and get your rest! When my body is ready for a nap I swear I cannot keep my eyes open, so I don't! Thankfully my dogs are big nappers too..
Glad all went well with your travels kfinnigin!
2Tabbies, though I now have had the exchange done, I totally remember the discomfort of the TE's after fill. But my pain was not delayed .. it was worse during the fill, then subsided a bit but I actually was pretty much constant with the discomfort, I swear I thought that when the PS went back in there he was going to find a bent rib or something.. but your pain sounds more intense, not just discomfort. It certainly could be that you are so close to your operation. Your body has already been thru trauma recently and then you add this pressure.. still odd that it happens way after the fill.. What does your PS think? You did get a lot in there if I remember.. I hope they can go easy on you next fill, and still get the expansion they need.. remember they can always take some out (well with mine they said they could) if it is too much! Hugs hon and keep us posted on this.. :P
Thinking about you all too..
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2Tabbies, my first fill was 2 days shy of 4 weeks after surgery. He said he likes to wait about a month. I got 50 cc's that day. I would end up taking a pain pill the night of my fills, and they always caused spasms in my back on the opposite side, weird. I had that terrible sharp rib pain right at the base of my expander on my rib right up until 4.5 weeks out from surgery. I was MISERABLE! PS thinks TE was on a nerve, I actually got some instant relief upon my first fill, then wham, it was back. But its gone now. PS kept telling me to be patient, and I thought "bucko - you keep saying that and you will end up a patient" lol!
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2Tabbies - Ditto to what others have said regarding pain. I always have a level of discomfort for a couple of days after my fills (fortunately I am now done). I recall one particular fill where I had sharp pain around my lower ribs for about 4 weeks. I could have swore my ribs were being crushed. Think it was a combination of the T.E. sitting on a nerve, combined with the fact I had pretty much reached my max with my radiated side (this was the fill that pushed me over the edge and made me decide on a lat flap). Also, you are still going through some significant healing with the T.E. placement AND lat flap. I know it's hard to be patient, but give it time. Things will start to settle down a bit.
Right now my T.E. on my lat flap side is sitting up against a rib and rubs it periodically. I keep pushing it up hoping it will eventually settle into a different spot. T.E.'s are the work of the devil. I remember reading a post some months back where one of the ladies referred to them as feeling like "a small animal trying to claw it's way out". I couldn't agree more with that description. By the time I get mine out it will be close to a year of having them in. I will be in major celebration mode on exchange day!
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2Tabbies, I have that burning sensation every now and then under my breast and it is uncomfortable. My back scar stings too, though I think I have an errant stitch that's irritating one end of it. Raelan, my TE rubs against my rib too, and sneezing is still extremely painful. I have been doing the massages, but it doesn't seem to move much. Otherwise the pain isn't too bad, though I generally sleep -- or used to -- with my right arm raised above my head and I apparently tried to do that in my sleep last night, to a painful awakening!
My first fill is today and I am a bit nervous. I am not sure what to expect exactly, but I don't think he's filling it too much. I'll check in after my appointment. Good healing to all!
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Raelan, a year with the TE? ugh!
sharsalo, good luck with your fill!
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Thanks, everyone, for the information on pain with fills.
adove, my PS's assistant thought that as long as I didn't have signs of infection, which I don't, that nothing out of the ordinary was going on. She said that when I come in next week for my next fill, he might decide to postpone it if I hurt too much. I guess I'm just being impatient because I've never had pain for so long after surgery. I didn't expect it this time either. Then that book said, "Oh, just take some Tylenol before and after your fill, and you'll be right back to normal in a day or 2 at most." Um, no. Not happening. Maybe it works like that if you haven't had a lat flap.
Sharsalo, don't be too nervous. It's not torture. For me, anyway, the fill itself was a non-event. The aftermath has just made me feel like I did immediately post-op. You've had an extra week to heal though so yours might be better. Good luck! My back scar burns now and then too, but not too much. I have had errant stitches a couple times in the past. One was on one of my mastectomy scars then another one on the incision after they removed my port. They were actually poking out of the skin. One I had my DH grab with forceps and clip off. The other one my PCP took care of when I happened to be in to see her. I hope you bring yours to the attention of your surgeon.
Raelan, TE's - the work of the devil indeed! I'm going to tell my PS he needs to fess up to having sutured a strand of barbed wire around my rib cage.
I'm also in a catch 22 about wearing a sports or compression bra. It presses on my ribs below my pseudo-boobs right were the pain is and seems to make it worse. But if I don't wear it, I get some swelling under my arms. That makes me nervous especially under my right arm since that's where my one encounter with lymphedema started. So I've been wearing it some but taking it off when it starts to hurt. The PS's assistant said that I didn't have to wear one. When they said I could wear one, they meant if I wanted to not that I had to wear one.
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2Tabbies, could the burning be nerve pain? I've had it after all my surgeries and take neurontin for it.
I have to admit, the more I read about everyone's experiences, the more nervous I feel about the surgery. I worry that I might be exchanging one set of problems for another. I'm so tired of having surgery
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Question ladies: I had 29 lymph nodes removed on my right side and don't suffer much from LE...thank goodness. So my question is will LD surgery cause LE? I'm pondering reconstruction and forgot to ask the PS this question. Also, with LD, are expanders put in and eventually a permanent exchange? Anyone have fat grafting with their LD surgery?
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How do I gain access to the picture forum?
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Well, I got a fill of 30 cc's and it went fine. It didn't hurt at the time, but I'm a bit more sore as the night goes on (though it's not too much pain so far). 2Tabbies, I did have a few errant stitches on my back scar which my PS removed, and it feels so much better. I plan to return to work on Monday and work half days next week, so I hope that goes well. I get to finally wear bra too, though I tried one on and my new boob is still too far outside midline and higher than my natural breast, so I look a bit funny. More massages and baggy sweaters and scarves are on the agenda.
Andrea623, don't feel too nervous. I was really nervous before my procedure, and of course it does take a lot out of you and there are things to deal with. I think we all talk about the things that are bothering us because we've all been through a major procedure, but there is good, too. I don't regret having the surgery. Every day things improve and I feel less pain and more like myself. Six months from now I figure I will be all good. And no more ill-fitting mastectomy bras or prosthetics that slip out of place or lopsided/concave chest with ribs showing!
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Thursday is my final surgery. I've had these TE for nearly a year. The refill after Rads had been miserably tight, sometimes my arm goes numb. I'm looking forward to getting these out. My surgeon does a lat flap but does it through the Breast incision, tunneling the muscle through. It will be outpatient.
I do have trouble with a little LE. The surgeon said it should not aggravate it, but LE is a bit unpredictable as to what will kick it up.
Here we go
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Andrea, some of this could be nerve pain. I had that after my mastectomy. It was weird. It came on very suddenly one Sunday when I was sitting in church. It felt like my chest was on fire where my clothing touched it. Fortunately, ibuprofen helped some, and the worst of it only lasted a few days. It gradually went away on it's own. I do feel burning now, but it's centered on the areas that were sutured internally at least as I understand it. It's in spots under my pseudo-boobs and along my side to my back on the LD side. The nerve pain seemed to be more on the surface of my skin last year, but there certainly could be some involved here. This does feel like burning a bit, but is mostly a pinching or tearing pain like someone is either pinching me really hard or the suture lines are tearing. It's manageable with the pain meds. I'm just being impatient since I've not hurt this much this long after surgery in the past. But my previous surgeries didn't involve muscles as much as this one. Please don't let my comments scare you off! I'm still glad I had the surgery. I'm just so much happier when I look in the mirror despite the pain and the scars. I'll be able to wear any shirt that I want! I actually feel like I can already.
Hi, Peacestrength, and welcome! My PS told me that the LD surgery would not cause lymphedema, and everything I read backs that up. In fact, I even read that there's some evidence that this surgery helps lymph drainage. I had one little incident with lymphedema last year several months after my mastectomy, so I'm concerned about it too. But it was in the opposite arm (the side where I had a prophylactic MX) not in the side where I now have the LD flap. Since my surgery 3 weeks ago, I've had not sign of lymphedema on either side.
As to your other question, yes, with the LD flap, you get expanders which are later exchanged for permanent implants. In my case, I had the LD flap and an expander placed on my left side since that side had gotten radiation. On my right side, I didn't need the LD flap so I just had an expander placed. I have not had fat grafting, but the PS said it could be done in the future if it's needed to fix defects.
Sharsalo, I'm glad your fill went ok and hope you don't have pain sneak up on you in the middle of the night like I did. My PS told me I could wear a sports bra or camisole. I thought he was saying I SHOULD wear one, but he was only saying I could. I guess I'm odd because I really don't want to wear a bra. Ever! If I still had one breast like you, I would though definitely. Yes, scarves and loos shirts. That's mostly what I've been doing for 15 months. At least it's winter now so it's easy to layer up as needed.
jbokland, only one more day to go then out with those TEs!
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Today is Stage 2 in New Orleans. Yesterday at pre op appointment I was given the option of having yet another smaller flap done to better fill out my breast. That would mean more nights in hospital and a longer stay in New Orleans. Was not prepared for that option so sticking with original plan of lypo and nips and tucks.
Peacestrength: I do not have a TE nor will I be getting an implant. The addition of the Lat to a Gap flap has given me volume. I had 19 nodes removed and have not had issues with LE. At NOLA they wrap arms before surgery to protect arm(s) from sticks and bruising. The wrap also provides counter pressure if there is swelling.
Jana
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2Tabbies, the pain didn't really sneak up. About 5 hours after my fill it announced itself rather loudly! I felt nothing during the actual fill or for a few hours after, but then...ouch. Tylenol seems to do the trick, though.
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Hi Ladies -
The pain I feel is similar to the expander pain I had last time. It feels like they're pressing on my ribs. I don't think I can be of more help. My PS did say that nerve pain is quite normal but to report if I feel numbness or tingling in my hands as that would be a bad symptom.
I am now working from home for several hours a day. Frankly, it's exhausting. It is doable but not something I would recommend if given a choice. I started working from home 2.5 weeks post surgery.
I have 3 physical therapy exercises I do everyday that seem to help. This was surgery #6 for me. For everyone who is frightened by it, based upon my experience, the anticipation is far worse than anything else. All the horror stories I read have fortunately not happened for me (knock wood).
Ronna - They expect us to need less pain meds but sometimes we need more especially if a tolerance is developing or if other complications are making things worse. It is tricky to figure out how to manage the pain without becoming dependent on the medication. There are doctors who specialize in pain management. Maybe one can be of help?
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2tabbies - I dreaded my fills. I didn't experience any discomfort during the fill, but several hours later, pain would set in, both front & back. The lat muscle was pulled forward everytime my PS expanded. I would take a pain pill the night of the fill & the next night (ibuprofen in between); day 2 was worse than day of fill. I had a total of 9 fills, 60cc's each time w/ exception of last one, PS did 70cc's. However, it was either fill #6 or #7, it actually was less uncomfortable. Skin & muscle were stretching which made it easier. I was not a fan of compression or sports bras after surgery, so I wore snug fitting camisoles (w/out built in shelf bras) which provided support in front & back w/out cutting into incisions. They were so comfortable & easy to get on & off. Found a bunch in different colors @ Ross for about $5 each. I am also not a back sleeper, so that was challenging for me as well. But 3 weeks post op, my PS said I could start sleeping on my sides. I would hold a pillow close to me for support & help relieve any pressure. I actually still snuggle w/ a pillow. It's become my security blanket.
Well wishes to all...
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Well, it certainly sounds like I'm not unusual in having no pain until hours after the fill. Thank you all who have said that was true for you. This didn't seem to jive with what was described in "The Breast Reconstruction Handbook," but it's apparently not rare if several of you had it that way too. I had a rotten night. I woke up at 4 am with terrible pain on the rib under my left pseudo-boob and under my left arm. I got and took pain meds. It didn't seem to help, but I finally went back to sleep only to wake up a couple more times. I took another dose of pain meds at 8 am, and now I'm groggy. This stuff has never made me groggy before. Arrgh.
Sharsalo, you're too funny. See, the way I look at it is the pain did sneak up on both of us. It sat and waited for hours then it pounced! I wish Tylenol would control mine.
Warrior, yes, a lot of my pain is the feeling of the expander pressing on my ribs. I'm sorry you're having to struggle through working. I've been feeling guilty about not going back to work yet since so many of you have gone back. Last year during cancer treatment I took as little time off as possible. I think that may be one reason I still feel so beat up by this whole experience - not enough recovery time. So I vowed to take what I need this time even if I end up having to go on leave without pay. I feel a bit mislead by some of the "what to expect" descriptions of this surgery that said it has a shorter, easier recovery (as little as 2 weeks) than some of the other surgeries. I hope I'm not just being a weenie. I just don't want to run out of FMLA time because I'll need some for my exchange surgery in a few months. Arrgh.
Warrior, what are the PT exercises you're doing? I need to ask about PT when I see the PS next week.
Dpiggy, I've got a couple of camisoles. One is actually a compression camisole, but it's not really tight compression. The other is a Genie shapewear cami. They feel good when I first put them on but then start to feel like they're pressing on my ribs. Maybe I should look for something lighter like you have. I don't really feel like I need support, but I like that I have less swelling under my arms when I wear one of the bras or camis. My PS hasn't told me I can't sleep on my side, but it hurts to do so. I tried the pillow trick like you're doing, but it wasn't enough. I think my right side might be healed enough that I could do that now though. Definitely not on the left.
TedWilliams, thinking of you today! I'm still not clear on what each stage consists of other than my PS said the LD flap and TE placement was stage 1. Is the exchange stage 2?
Good to hear from all of you!
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Jbokland-Good luck tomorrow. You are in good hands. Please update when you can. I am three weeks behind you, so will be watching your progress. Take care. Im getting my ovaries out Friday-had my pre-op today. Fun fun.
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Thanks for your feedback
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I have a couple of questions. Does the TE/implant go under the pectoral muscle, or over it? Why do some PS go straight to implant and others go the TE route? If I already have an implant, would I still need to do the TE thing? I hated the TEs my first time around and had them for 10 months. I was hoping I wouldn't have to have them again. I don't see my PS till next year, so I can ask him these questions then, but I was wondering if anyone had some insight into it.
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Andrea, I can answer one of your questions at least as it applies to me. My left TE (the irradiated side) is on top of the pec but under my lat flap. The PS said radiation damages the pec too much for it to be able to stretch and accommodate the TE and later implant. On my right side, however, since there's no radiation damage and no lat flap, the TE is under the pec. I can only presume that some PS's go straight to implants in the case of a skin sparing MX where there's plenty of skin to accommodate it. I'm not sure if it still needs to go under the pec in that case or not. If it does, I'm not sure why they don't have to use a TE to stretch the pec. Just guessing here. I can't remember exactly what your situation is, but since you're having an LD flap, I think you're going to have to have a TE on that side (or both if you're getting the flap bilaterally) to stretch out the lat enough to accommodate the implant. My sympathies. Maybe this time it won't be for as long as last time. And maybe I'm completely full of B.S. since I don't really know squat and am just trying to draw a logical conclusion.
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Thanks, 2Tabbies. I've had 3 attempts at implants after radiation. My breast now has very thin skin,too thin for even fat grafting, and I can feel the implant easily if I touch it. That side is always uncomfortable, feels irritated, or feels like it's going to tear. My PS had wanted me to wait at least half a year from my last surgery in March, so my body could rest from the 4 surgeries I've had in the last 2 years. I wanted to try a diep but my veins are too small, so the lat flap is my last chance to get a decent reconstruction. I am so ready for this to all be done so I can move on with my life
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Almost exactly a year ago I had TEs placed during my BMX. I was filled to 800cc during chemo and prior to rads. I was deflated to 250 cc for rads. The refill after rads was quite uncomfortable on the radiated side! This morning I am going into outpatient surgery for the exchange and lat flap, bring done without opening my back , but tunneling the muscle through the breast incision.
I will post afterwards.....wish me luck!!
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Good luck, jbokland! Here's to being done with this business!
Andrea, same to you when you get there. I so hear you on wanting to be able to move on.
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jbokland - hoping all goes well!
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Whoever said it hurts worse the second day after a fill, I hear ya! Ouch! Tylenol didn't even last me through the night. Had my fill on Tuesday and I feel like I did two weeks ago re soreness.
DPiggy, I sleep with a pillow too -- a little travel pillow that's perfect for supporting my breast when I lay on my side.
Good luck to you, jbokland -- hope the surgery goes well.
Peacestrength, I have an expander and had the LD flap because I had radiation. Unlike (from what I've read) a lot of the ladies here, I waited over 10 years from my mastectomy to get reconstruction, so my skin was pretty taut and tight and I needed skin from my back to replace some of the irradiated skin, which I think is why I have a lot of tightness and pain in certain areas (more so in the area of the irradiated skin than where the skin on my back was placed). When I first visited the PS, he thought I could just get an implant, but he changed his mind and I think rightly so -- I don't think my skin could have handled it on its own.
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sharsalo - I'm not sure how many fills you're scheduled to have, but I can honestly say when I hit #6 or #7 (I had 9 total), they were definitely less painful. I waited 3 months after the last fill before having the exchange surgery, & I was amazed how soft & less taut the TE's were during that time period. A little tip - I would have a beer or a glass of wine the first couple of nights after a fill, & that would help me relax a little.
I didn't take any prescribed pain meds during the day, but on those two nights, I would take one percoset before going to sleep. By day 3, I was feeling more comfortable.0 -
Thinking of you jbokland! Hope you are recovering nicely right now.
I got the lat flap on my left side and will get an implant swap for the TE on left side and a small implant on right good side. No need for TE on good side, kind of like gals that get 'boob jobs', they don't need TE's...the skin will stretch to accommodate, as we are built to engorge with milk naturally - PS's words.
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