Latissimus Dorsi Breast Reconstruction
Comments
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I think I'm closer to 12 weeks out after a bilateral. I do have the elastic band around my ribs and back sensation still although I had it before the LD from the other surgeries. I have to stretch everyday. I start off rather tight and then I loosen up. I am not as flexible up top as I had been. It doesn't hurt or impair me but it would be nice if it went away.
jbookland -What instructions or restrictions do we give to massage therapists?
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We agreed on a light massage on my lat side ( I did not have an incision on my back for the surgery). That area she also worked on long, smooth strokes working from spine to side. It was heaven! Also, I think I still have some tendon issues in my left shoulder; sometimes raising my arm will 'catch' me mid-deltoid. She worked that shoulder for me too.
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Hi everyone,
Raelan, I was wondering how you're feeling a week from your exchange surgery. Mine is less than a week away. I'm only taking four days off (plus the weekend), so I'm hoping that's enough to recover, at least as far as the workday goes. My PS is not doing too much beyond the exchange; just some feathering and enlarging the pocket toward the breastbone for symmetry.
Hope everyone else is well.
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Hi sharsalo - Sorry I've been away from the board for the past week or so. I've been doing more posting over on the picture forum. I'm actually doing really well one week out. I took 4 days off work to recover (plus the weekend), then started back to work this Monday. I've been able to work from home all week, so that's helped significantly. My prophylactic side is great. Minimal pocket work needed there, and as usual it's performing like the rock star it's always been. My PS had to do more pocket work on the lat side, primarily in the IMF area, so that side is definitely much sorer. I'm having to be careful not to stretch to far to reach for something for fear I might pull an internal stitch. However, having said that, I was off all pain pills other than acetaminophen after the first 3 days.
Having the T.E.'s out feels wonderful. My breasts are squishy and soft. Even my husband can't believe how much they feel like the real thing. The lat side is a bit firmer, but not by much. Think the muscle provides some additional volume that gives it a little firmer feel to the touch.
Overall, very happy with the outcome on many accounts. I think once I'm able to get back to a normal exercise and stretching routine I'll feel 95% recovered. I still have a small amount of tightness under my arm area where the lat muscle was tunneled through, but that comes and goes depending on how much I'm on my computer. With time, I expect most of that to go away.
Good luck with your upcoming exchange. It was the most excited I've been in a long time for surgery.
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Thanks so much for posting, Raelan. Wow, it sounds like you are doing wonderfully! I'm glad the recovery time for you is what I'm told it will be for me; fingers crossed. I am excited, too. I can't wait to get this melon off my chest and have my right breast look something similar to my left (natural) breast. Did you go with a gel implant?
I have a lot of scars on my breast so it will never be a beautiful thing, but they have faded quite a bit and the PS is going in through the scar underneath the breast, so I'm happy about that. I'll post after my exchange and let everyone know how it went.
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jbookland - Thanks for the tips. I'll check with my PS. My back where the incisions are is still tender. I doubt I'm ready for a massage.
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Sharsalo, I'll be looking forward to your progress reports. I've got a couple melons, well small melons, that I'd like to get rid of. Come on May! I hope it all goes smoothly and recovery is fast like it seems to have been for Raelan.
Raelan, I was really looking forward to the original surgery in November, but I think the exchange will top that.
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Raelen-sounds like you are doing great. Soft and squishy, im jealous...mine have softened some but still pretty tight. I so hope to be soft and squishy again. Wondering if larger breasted woman dont get as soft since we are filled tighter-anyone know? I am 925cc right now....
Had to make an emergency trip to the PS again today, my drama never ends. Thought I had a leak in my masectomy breast implant. Clear fluid was seeping out of a gap in the incision that had not yet healed. 7.5 weeks out. She said radiated breasts just take longer to heal. I was freaking out-scared I was losing my implant. They said it was the fluid around my implant and from lat flap that was leaking out-so they gave me stitches to close the gap and put me back on antibiotics. I am okay with that-just happy to not be losing my implant.
Girls night tonight-dinner and 50 shades
Have a great weekend everyone 0 -
vettegirl, sorry you had a little scare but sounds like you are good to go now:)
I had girls night last weekend, dinner and 50 Shades:))
Have fun!
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vettegirl, I'd have been a bit panicked if I had something leaking too! I'm glad it wasn't serious. Enjoy your girls' night. I'm have a bit of one as well - wine and crochet with a friend. Then the rest of the evening alone since my husband has other plans. I like a quiet evening to myself now and then so it's all good. Have a great weekend everyone!
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I have another appt with the PS on March 27th - I didn't realize he was going to take a muscle from my back - hello drains again! I will get another 50cc's and we will talk about a surgery date!
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Yay!!!! No more drains! Last one came out today
PS won't let me stretch or lift my arm for another week and wants me not that active just to be on the safe side so fluid doesn't build-up in my back. Didn't have that problem before but don't want it now so I will definitely follow doctor's orders.It was a sad day as well, my grandmother passed away at the age of 90. I'm sad that I didn't get to visit with her this last year, I live in California and she is in Texas and it made it especially hard to travel through all this BC crap. Her services are next week and I was wondering how soon after surgery did any of you travel?
Hope everyone has a great weekend!
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Hi, Marney. My condolences on the loss of your grandmother. I didn't travel soon after surgery. However, since some women travel just to get reconstruction at one of the breast surgery centers, I'm betting your doc might clear you to go to her funeral. I'm sorry you weren't able to visit her this last year. BC does interfere with such a lot of the things we want to do. Congrats on ditching the last drain!
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It's exchange day! I check in at the hospital in less than an hour. I will try to post later tonight, depending on how I'm feeling, and let you all know how it went. A little nervous, a lot excited!
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I hope you ladies can give me some guidance.
As of today the only reconstruction option I have is the Latissimus Dorsi Flap surgery, and it scares me due to the use of the muscle.
How did you ever reach the decision to go with this surgery route and what has been your experience with recovery?
TIA
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Sam2U! HiI there. We know each other from somewhere else on these boards. I got to this LD thread before you. I'm sorry you're here. I was absolutely terrified of this surgery but everything turned out well. So well so far that I like how I look a lot more now than with expanders and implants. My first surgery failed and this was my only viable option. It's actually lower risk than many flaps because the muscle is never detached from your body. I got PT before and after. I recommend it. I also see a PS who is known for this procedure. I switched to him from my former PS. I have full ROM and no discomfort at all. I still have the elastic band sensation but I had that before the surgery. The only other things I find challenging are reaching heavy objects onto high shelves and my arms seem confused when I take off tight tee shirts. It is lessening with time. I had the bilateral and I am well. It is a major surgery on par with the BMX. I considered skipping reconstruction for fear of the LD surgery. However, I felt profoundly sad and cheated. I decided to go for it and I am glad I did. Sometimes there are complications but I've been following these posts for some time and I am not seeing complications with the LD at any higher rate than other surgeries. My best advice is get to a PS who does LDs all the time and a PT who works with LDs.
Sharsalo - I hope you're resting comfortable and lookin' good!
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Sharsalo, I hope all went well!
Sam2U, I think most of us had reservations about this surgery. I didn't want a flap at all much less one that repurposed a muscle that already had a job, thank you very much. All I wanted was expanders and implants. Unfortunately, nobody bothered to tell me that that was not an option after radiation because of the high rate of complications. I was furious when I found out because I had been specifically told by a PS that I could have any procedure I wanted at any time. Like you, it turned out the lat flap was my only option so that doc's definition of "any procedure" is a whole lot different than mine. If I'd been comfortable being flat, I would have stayed that way, but I was miserable. I hated how I looked and hated the prosthetics. So I bit the bullet and went for it. Unlike WarriorWoman, I only had the lat flap on one side - the side that got radiation. I had just a tissue expander placed on the other side at the same time. That was in November. I was really afraid of loss of strength on the lat flap side. I like to swim and didn't want to give that up. I have had no loss of strength or and easily regained my range of motion. There is tightness around the scar my back, but it is going away. I also have some of that feeling that Warrior mentioned of a band around my rib cage where a bra band would sit, but it is also easing. The only thing that doesn't seem to be going away yet, is that when I move my arm back on the lat flap side, the muscle, which is now part of my new boob contracts. It's a bit annoying but no big deal. I don't much like the look of the flap of skin surrounded by a red scar on my new breast, but there was no way around it. I'm hoping the scars will fade and the flap blend in better with time. I still have the expanders in. I won't get my permanent implants until May. But even with the expanders I feel so much better about the way I look than I did before this surgery. I can get dressed without having to think about whether my clothes will hide a flat chest or if I need to wear the hated prosthetics. That was a huge relief to me as soon as I had my first fill. Everybody has to choose their own path. Good luck, and please ask any questions you might have.
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Quote: "I didn't want a flap at all much less one that repurposed a muscle that already had a job, thank you very much. All I wanted was expanders and implants. Unfortunately, nobody bothered to tell me that that was not an option after radiation because of the high rate of complications. I was furious when I found out because I had been specifically told by a PS that I could have any procedure I wanted at any time."
This is exactly what happened to me unilateral mastectomy followed by radiation then I could have "any" reconstruction I wanted....why do these doctors do this to us? Do they think because we have cancer we are too dumb to comprehend the implications of treatment decisions? It's so infuriating, frustrating and sad all at the same time.
Enough of the whining...
Warrior-I think we were on the December surgery thread, I hate that your first attempt at reconstruction didn't work.
My fear is the use of the muscle, we golf, kayak and bike frequently as a family, and I would be even more upset if I lose that. Like you 2tabbies, I loathe the prosthetics but I have to wear them since my chest "cave" starts about 1" below my clavicle and is very noticeable in most of my clothes--it's not a lovely look to lean down and everyone can see my belly!!
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I learned the hard way, too. I was told I could do TE, then exchange for permanent implants 3 months after radiation. I was not fully informed about the risk of radiation fibrosis and infection. But that is exactly what I've been dealing with for the last month. I'd been on antibiotics for almost a month trying to heal, but by last week the infection was getting bad, and caused cording and lymphedema issues along with a lot of pain. So, finally convinced that I had no other choice, I had surgery on Monday, Feb 23rd to remove the implant and damaged skin. It was a very simple surgery, and I'm amazed at the immediate relief I got. By Tuesday, all the pain and most of the lymphedema were gone! I'm already off pain pills and don't even feel like I've had surgery-It'll hit me soon, as I'm about to remove the dressing and see my flat chest for the first time. Now I have to wait at least 3 months to let everything heal, and then I'll decide about a LAT Flap. I may postpone until fall so I can enjoy my summer. Or I may just live without reconstruction. I have to see how it feels to be flat first. I do have an implant on the other side. I have enjoyed following this thread so I know what to expect with a LAT Flap. Just nervous about the recovery and damage to my back muscle.0 -
Thanks Warrior and 2 Tabbies!
Things went pretty well. I went in at 8am and was home by 3:30pm. I did have trouble with the anaesthesia -- I was given more anti-nausea medication and then vomited anyway -- and there is soreness in my throat from the breathing tube. Otherwise, the pain isn't too bad -- nothing at all compared to the flap. I had only half a pain pill last night, mostly because I was still groggy and nauseated, but I did fine through the night. My PS went in under the breast, but most of the pain is near my breastbone where he did some pocket work. My arm swelled a little, but wearing my arm sleeve for a while should take care of that. I'm wearing a special bra so I haven't gotten a great look at how much my new girl resembles my old, but it feels pretty good and no more melon! I'll write more after my appointment on Friday, when I get to remove the dressing and bra and take a shower and will get a good long look. So far, so good though!
Sam2U -- I had your exact fears, which I too brought to this forum. I had the lat flap done on one side only, but it was my right side, which is my dominant arm/hand, so I was especially concerned. My surgery was in early November but I have most of my strength back and all of my range of motion; I don't feel like I'm blocked from doing anything because of the surgery. I may not be world class at anything (biking, etc.) but I can still do it. I don't regret the decision, which I think if you read back on the posts on this forum you'll see most of us don't. I went 10 years wearing a prosthetic and am so happy to have that over and done with. It is a big decision, though, so do all the research you can and ask all the questions you need to. Best of luck!
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Sam2U, I have no clue what these docs are thinking when they tell us, or don't tell us, these things. The only thing I can think of is that he forgot I was having radiation when he said that. Like you, I'm active. I swim, canoe, hike, bike, snowshoe, etc. Both the surgeons I consulted said this surgery should not impact those activities. I don't golf, but the surgeon I chose mentioned that he has done this procedure on women who golf and play tennis, and they were able to resume those sports. So far my experience has confirmed what they told me about not losing any strength. I haven't noticed any difference in strength between my 2 sides when I swim. My PS said that the only people who would notice a difference would be someone like a world class cross country skier. My concave chest was visible in clothing also. I'd have had to change how I prefer to dress if I'd have stayed that way and didn't want to wear the prosthetics. Knit shirts like I wear most of the time looked awful. Good luck with your decision.
1knightsjourney, welcome to our ranks. I'm so sorry for the complications you've been through and glad you're not healing. Regarding the recovery from the lat flap procedure, it was somewhat longer than from my BMX, but more tedieous than difficult. I think it takes longer to heal when they cut and sew muscles rather than skin, fat, etc, like with the mastectomy. What hurt the worst was the area where my bra band would sit around the front of my chest. That's where the PS sutured the bottoms of the pockets that will hold the implants. It wasn't constant pain, but hurt when I moved wrong. A lot of us had to sleep propped up for a few weeks. I had tried staying flat for almost a year and a half. To me, going through this surgery was worth not having to spend the rest of my life that way. I don't blame you for wanting to take the summer off from surgery and recovery though. I hope you finish healing from the infection really quickly.
Sharsalo, I'm glad to hear you're doing ok! I'm definitely going to ask for another scopalamine patch to avoid the post-anesthesia nausea. Worked great the last two times. I'm looking forward to your report on Friday. It looks like I'm stuck with my "melons," or in my case more like large navel oranges until the end of May. I'd hoped to have my exchange no later than mid-May. Maybe for my birthday on the 18th. But I realized today that I have a required training at work that I'd forgotten about. I knew I had training the week of the 11th, but I also have some on the 26th. That means the earliest I could do it will be the 27th. Drat.
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thanks 2Tabbies. I removed the dressings yesterday and was surprised at how concave my chest is. I'm not sure any of the clothes I like are going to work with this. Any tips on prosthetics?my surgery went well. It's the first time I didn't get sick with anesthesia, so there's one upside. Recovery is going well. No pain
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1knightsjourney,
My insurance covered prosthetics, I found a local store and checked with them to see if they took my insurance, I got 2 different kinds of prosthetics(one set for before reconstruction and one set(lighter) for after) plus 4 bras!! I also bought coobie bras which I wore if I didn't feel like wearing the prosthetics. The coobie bras make it look like you have some breasts, small...maybe size A or small B but at least they were comfortable and I didn't look concave:)
Best Wishes,
Kathy
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1knightsjourney, like kthielen, my insurance paid for prosthetics. Mine covered 1 set every 2 years. It also covered 3 bras. The silicon prosthetics are the most natural looking and feeling. I found them heavy and hot even though mine were supposed to be light weight. I know there's a type, I can't remember the brand, which is supposed to be cooler. In an effort to find something more comfortable, I tried microbead filled prosthetics and just the fiberfilled pads that came in the camisole the hospital gave me. I wore them with various sports bras that have a pocket with a removable foam cup. The pocket works well for holding the prosthetics. They were more comfortable, but with no weight to hold them in place the bra tended to ride up. The prosthetics also tended to migrate to the center. The Coobie bra that Kthielen mentioned is one of the more comfortable options. I also found this Anemone bra on Amazon that is identical to the Coobies I bought but a lot cheaper. I hope you find something that works for you. I ended up not wearing prosthetics and trying to camouflage things with my clothing as much as possible. Since I was not big to begin with, that worked ok with some outfits. Winter was easier than summer.
Kthielen, I'm curious about the prosthetics you got for after reconstruction. Are they just like padding to make you look bigger?
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I had the coobie but on me it made me look more like a C cup. They sell inserts to go with them.
Sam2U - Unbelievable that over a year ago we were in the Dec. surgeries thread and now here we are again. Anyway, I am athletic and I've found little that is a challenge for me. Some of my more elaborate stretching is more difficult but may improve. I will go swimming later this week. Based on how my body is moving I would expect to be able to kayak. From what I've read, the women who report impairments are super athletes. I've never been much of a rock climber and I've never done an unassisted pull up. That won't change for me now in this lifetime.
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Hi Warrior woman,Did you do the rounds before you did the LD? Did you have anatomical implants put in with the LD?
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Hi Raelen,
Did you have the anatomical implants put in or just the rounds. I just had the LD with anatomicals put in one month ago. I'm not happy with the results. They are very lopsided and just were not what I expected. It sounds like you had a good experience. It was an awful surgery for me. Any advice?
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amieclemens - Sorry to hear you are not happy. This journey is difficult enough without ending up with a less than satisfactory result.
My PS only uses rounds. He provided me with a variety of reasons for his position on this, but most have to do with the overall results he gets from them and the high patient satisfaction rate. He used Allergan style 20 on me, 550 cc's. They are silicone. It's my understanding they are softer than anatomicals.
If you are lopsided, it could have more to do with the pocket work and your IMF placement then your actual implant. Have you shared your concerns with your PS? If so, what was the response?
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amieclemens, I responded to your post on the Exchange thread before seeing your posts here.
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Have any of you had a lat flap prior to radiation?
I met with my BS on Friday and PS today. I will have Bilateral mastectomy with part of my right pectoral muscle being removed due to tumor invasion. Immediately following, I will get a Latissimus Dorsi Flap on the right and tissue expanders in both. That will be followed by fills. Then radiation. Then six months of waiting before exchange to implants. I would have preferred to not give up that muscle but with the radiation and loss of part of my pec, I would not have sufficient skin or muscle to hold an implant. thoughts
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