Latissimus Dorsi Breast Reconstruction
Comments
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I've never heard of doing the lat flap before rads. Wouldn't the lat muscle get fried also like my pec muscle did from rads? What did they say about that?
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The lat flap brings better circulation/blood flow to a radiated area. If you radiate the lat flap, aren't you negating the reason for doing it in the first place?
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Hi DLL66, did you get nipple reconstruction? I see my PS on 3/9 for my 8 week post op and we will discuss this.
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I did. It was a simple procedure done in-office.
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2tabbies, the prosthetics are clear, lighter and more hollow in the center if that makes sense?? They are Amoena Aqua wave....
Patty, I had surgery after radiation, sorry I can't help you!
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That's great! I will report back after my appt. I think my PS said (this is from my memory from May 2014) said he uses pig cartilage and skin graft from upper thigh...how was yours done?
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I did not have any skin grafts. My PS was concerned that the rads side might fail so he just did the reconstruction using my own skin (I forget the procedure name) where he cut skin on the reconstructed breast, twisted it & stitched it. My areolas are tattooed only. He was considering doing the skin grafts initially, but I had a lot of complications on my rads side throughout reconstruction, so we played it safe.
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Glad it turned out well and thanks for the info.
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Best of luck with your procedure, kfinnigan!
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Patty, I was wondering the same thing as some of the others about doing the lat flap before radiation. The radiation would be damaging to the lat muscle and other tissues that were used in the reconstruction. Have you asked your PS why he/she would do it that way instead of waiting until after radiation?
Kfinnigan, my PS does nipple recon the same way that DLL66 had hers. Just builds it from the skin on the foob. No grafts no pig cartilage.
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Thanks everyone. I will ask him more questions. I think he is doing it at the time of mastectomy because it would mean fewer surgeries. But I'll probe more0
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I hope everyone's ok. I've only posted here once or twice before, but I want you all too know I've taken great comfort in your stories and learned a lot. I had radiation for DCIS in 2012 then after finding another DCIS on the same side I had a double mastectomy. After an expander exchange due to capsular contacture on the radiated side and then cellulitis for over a month on the same side I sadly had the expander removed on the left, but the permanent round implant on the right in Sept 2014. The infection disappeared after the expander was removed and since then I've been healing and struggling mentally with whether I can face another surgery. As you all know, it's a huge surgery and a huge decision. Also, I'm a personal trainer. My body has betrayed me and I've allowed myself to become weak in my sadness. Though I do jave full ROM. I've just begun really exercising for myself again and it's pitiful compared to where I was. My mother died recently after a long illness--not cancer. But I am so sad. I'm also not ready to fade away and become a little old lady myself. I'm in my early fifties and my body that I used to love a lot about, definitely not all of it, but a lot, makes me even sadder. I want to feel strong and whole again. I apologize for this lengthy sef indulgent therapy session. I know that I am VERY lucky in the scheme of things. I have so much to be grateful for. I've been trying to focus on that, but I'm in a low place right now. Please forgive my pity party, but you're all invited to join.;) I guess my question is for those of you who've made it through this lat flap Odyssey: Do you feel strong and whole again? Do you feel limited in what you can do? Has it helped you with your self image? How do you feel about your scars? If it's been a while, how have they faded? Are you really glad you did it? I know I was so sad to hear that Tangled had an awful time, but how about the rest of you? Sending love, strength and many thanks to one and all of my virtual sisters.
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Honeybadger, I am really happy with my Lat Flap compared to all the other procedures I had. The radiated skin sabotaged all my efforts with implants. I just had my last fill and will wait until summer for stage 2 (implant). I have fallen behind schedule due to my husband having some health issues. It has not been overly painful and I am excited to see the healthy skin instead of the charred skin that previously covered my left side.
I have to admit.....my breast will never look the same and that is sad to me but I am thankful that reconstruction has come so far. My scars fade more everyday and many of these women have completed the process and look great!! I completely understand your feelings....we all have them!!! Good luck!!! Will be thinking of you!!
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amieclemens - I had rounds to start and will most likely get them again for my LD flap exchange. I'm leaving it up to my PS to do whatever he wants to make me look as good as he can. He did mention that after the exchange I may require minor tweaking to get them just right. Originally I was going to go with the anatomicals but I was hearing too many disappointing outcomes. Whippetmom stated that in breast reconstruction it makes little difference if we go with rounds or anatomicals.
DLL - It's good to see you. I want to thank you for all of your positive comments. On another thread, women posted all the LD nightmares and you were one of the few people who repeatedly posted that you're doing fine. It gave me hope that I too can get through this well and so far I have. So, thank you!
Honeybadger - I am very happy I had the surgery. I'm not done yet but I'm past the worst of it. Scars are scars. Oh well. I really don't have any limitations except a minor difficulty lifting heavy objects over my head. While not a personal trainer, I have worked out for a good 30 years. Cancer has been a cruel trick. Between the friggin' chemo, an infection, seromas and 6 surgeries, I have repeatedly been told I cannot exercise or had my muscles turn to mush. However, each time I get back on the horse and it feels so good. I went swimming for the first time in 1.5 years this past week. I swam so hard one of the diamonds came out of my wedding ring. (A small one...not a big deal.) But I swam. And I swam hard. And I was so glad that I can still do it. And while I am still building myself back, I am running and lifting and moving. I'm not back to 100% but I'm moving. With each trauma to my body I faced that pivotal moment when I needed to decide. Do I start over again (and again and again) or do I give up? We each know that moment when we have to decide. Frankly, I am not giving anything else to cancer. It has taken enough. At the same time, the trauma of this experience is depressing and it take its toll. I enrolled in an educational program to help me move beyond cancer and recover from the trauma. You know that you'll be disappointed in yourself if you give up now. You'll also feel like crap. There are some supportive threads here for exercise support. I like my appearance right now...boobs anyway. It is easier to find clothing and swimsuits and I'm making the most of it. Hang in there, Honeybadger.
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Jlow51 & WarriorWoman your words of encouragement have helped me tremendously. You have both been through so much yourselves.
Jlow51, Congratulations on your last fill! It's great to hear that you're excited by the new skin.I can't wait to hear from you after your exchange this summer. I hope you're husband is ok. Also, thank you for thinking of me.
Warrior Woman, you've been through so much in such a short time and here you are inspiring me beyond belief. My favorite line: "I am not giving anything else to cancer." Congratulations on your first swim in 1 1/2 years! I'm sure it's the first of many. Thank you for the kind hearted kick in the butt that I needed.
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Thank you too, Warrior Woman! I am happy that you are doing well.
HoneyBadger, I do feel whole again. I feel strong. I really don't feel limited; it is a bit awkward to lift things with my arms outstretched, but I can lift things just fine if I can hold them close to me if that makes sense. I do have scars, but I don't think you get to be my age without having a few of some sort. They don't keep me from wearing anything that I would like to. They have faded pretty well, but they will always be visible. I am very happy with my choice to go with lat flaps. I feel like I walked out of the whole ordeal looking better than I have in a long time. It is a big surgery, but I am glad that I did it and can move on
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Honeybadger, don't feel bad about having a pity party here as you put it. You've been through a lot of trauma between cancer and losing your mom. Who wouldn't be depressed? A lot of us have had our own battles with depression including me. I know only too well the feeling that my body has betrayed me. That said, I feel much better psychologically since having my reconstruction. I'm not even done yet. I still have the tissue expanders and won't have my exchange procedure until late May or early June. But as soon as I had my first fill so that I looked relatively normal in clothes, my self image was greatly improved. It's not perfect. I don't like the scars. But having foobs with scars is better than being flat with scars which is what I would have been without this surgery. I've had no problems with loss of strength. I'm not as much of an athlete as you and Warrior Woman, but I've always been active. I'm back to swimming 2 or 3 times a week. I feel like I can do everything I did before. I'm still working on getting my strength to presurgery levels, but I'd be there by now if I had worked at it a bit harder. I never wanted to have any of the flap procedures, but to my dismay radiation therapy meant I was a poor candidate for implants alone. I was very upset when I found this out after the fact. But bottom line is I'm glad I decided to go ahead with the LD flap. Good luck! Please post any other questions you have.
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I wish now that I had waited to have my reconstruction. I had a lat flap in March of 2013. If I had done my homework better, I would have not been in such a hurry. I was not pleased with the results from my surgery. I stopped right after this surgery and didn't have nipple reconstruction. I have also found a surgeon in New Orleans who is an expert in microsurgery. That is where I will go next time. That surgeon never uses a lat flap as an initial choice. In fact, he repairs many failed lat flap surgeries. He has a big practice in New Orleans.
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DLL66, it's so encouraging to hear that you are happy with your choice. Your description of lifting things does make perfect sense. Awkward, but doable sounds reasonable. I know everyone heals differently, but it gives me an idea of how it might be for me. Warrior Woman mentioned slight difficulty lifting heavy things overhead. Have you noticed that as well? Also, did you have radiation?
2Tabbies, it's great to hear that you're doing well too. I'm sure that "dismay" at discovering you were a poor candidate for implants is quite an understatement. I knew there was a higher risk of complications. I just never imagined that "epic fail" (my words not the Dr's.) would be the culmination of my complications.Though I'm flat on one side I can appreciate "foobs with scars is better than flat with scars." Congratulations on swimming 2-3x a week. That's terrific.
Nightnurse, I'm truly sorry to hear that you are unhappy. I have heard great things about the Drs. in New Orleans. What are you going to have done? Best of luck to you.
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Honeybadger - my only option was bilateral LD reconstruction since I had radiation on both breasts. Last year, I had a BMX on 4/15 & double lat on 4/16, so back to back surgeries probably made the recovery a little more challenging. For me, the first 5-6 weeks post op was tough, started feeling more like myself after that benchmark. I had TE's until my exchange last Oct, & experienced discomfort the day after each TE fill, but that too gradually improved. I had nipple sparing so no nipple reconstruction necessary. I am almost 11 months out, & when I look in the mirror, I am thrilled w/ the results. I still have some tightness, but stretching & normal activity helps work that out - my ROM is great & no restrictions whatsoever. It's been quite the journey, but one worth traveling. I wish you all the best.
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Nightnurse, I'm sorry to hear you weren't happy with the results of your lat flap. For some of us, there aren't any other options. I was not a candidate for other procedures that are done in my area, and traveling to somewhere like New Orleans just isn't an option for me. Fortunately, I've got a good surgeon and am happy with my results so far. I hope you have good luck in New Orleans.
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Honey badger,
I had the surgery January 20th and am doing great. I am very happy with the results so far. I am still in the expander/filling stage but am able to do everything that I did before. My PS used the same scar line that my breast surgeon did so I don't have a lot of new scars, except for the one on my back that I am sure in time will fade. I don't have anything to compare this surgery to because I had delayed reconstruction and this was my first surgery after the mastectomy(no expanders or anything)
Good luck with your decision!
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Dpiggy, back to back surgeries sounds like a LOT to go through, but how wonderful it must be feel thrilled!!! Congratulations on coming out the other side with flying colors.
Kthielen, three cheers on being able to do everything you did before!!!
Thank you both for your answers and for wishing me luck. I've thought of a new question: For those of you who, like me, developed an infection during your attempt with expanders &/or implants, did you get another infection while healing from LD surgery? If so, did you have expanders with your LD flap surgery?
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I have been reading your posts, trying to gather up the courage to do this procedure!
My PS is encouraging it on the side that had been radiated, thus causing problems, but I have been leaning towards having fat grafting and then a smaller implant put in because I am SO not looking forward to a long recoup time.
I know that 'reconstruction is a process', but I am running short of patience.
My husband and I finally retired, and had hopes of traveling this past year, but instead have been home and visiting drs. =/ I know that he is so disappointed, and I want to be well and able to go and do!
How long were you in the hosp for lat flap?
How was managing when you came home?
Thanks so much for your thoughts!
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Honeybadger - I got this one...
I developed an infection after my attempt with expanders to implants. The infectious disease doctor said it is highly unlikely I'd get another infection. They really are rare. We were just very unlucky. I did switch surgeons after losing confidence in the first PS. I have no signs of infection while healing from LD surgery. To be on the safe side, I was given antibiotics while I had the drains in. I still have expanders and expect to get the implant exchange in May.
AnotherNYCGirl - I've had 6 surgeries in a year and I'm heading to # 7. Had someone told me this from the beginning I am not certain what decisions I'd have made. However, I am very happy with my bilateral LD Flaps.
How long were you in the hosp for lat flap? Surgery on Thursday and went home Saturday.
How was managing when you came home? Easier than the mastectomy..much easier for me. It did take about 6 - 8 weeks before I was back to a fully normal routine. I had PT before and after and I'm still going. It has helped me, in my opinion.
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AnotherNYCG, I'll echo what WarriorWoman said. I was in the hospital for 2 nights for my lat flap. Some women only spend 1 night. I think it mostly depends on the surgeon. I took 6 weeks off from work, but could have gone back after 4 weeks if I had really needed to. Managing at home was no worse than after my BMX. The one thing that took longer was being able to sleep comfortably flat in bed. I slept propped up on the futon for a month after the lat flap. I don't remember how long it was after the mastectomy, but I know it was shorter than that.
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Hi All,
Just wanted to give some of you girls some encouragement. I had a bmx/lat flap surgery in the summer of 2012 and I'm happy to report that I had no issues. I had a relatively easy recovery (yes, it took some time) but I recovered completely. I exercize almost daily and have full range of motion. I was in the hospital for 3 days and used a recliner to sleep for the first few days. After that, I used a wedge pillow that was helpful for sleeping. I did arm raising exercizes initially, (as your PS to recommend some) and I was fortunate not to have had tightness or other problems. I even went to a birthday party for a good friend only 10 days after I left the hospital. Granted I took pain meds, and didn't stay long, but I was able to go, drains and all!! My surgeons were also able perform the surgery and access the necessary nodes through the incisions they had made in my breasts, so that they didn't need to cut me under my arms. Ask your surgeons if they can do the same.
As I was going through my recovery, I remember thinking it was not as bad as I thought it would be, I'm very happy I had lat flap surgery. Keep the faith....there is life after all this!! Good luck!!
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Warrior Woman, that is very encouraging news about the rarity of infection. So great that everything's going as planned. Thanks for letting me know.
Cgesq, it's so nice of you to check in here after having gone through it so long ago. Thank you. Just wondering: It looks like you didn't have radiation, so does that mean that you didn't have the skin moved over as well?
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Warrior Woman, 2 Tabbies and cgesq, - thank you for sharing your experiences with the LD flap.
I am going to post a question re reconstruction on a radiated breast to see if some PS have success with a less invasive procedure.
However, if I end up having to go the LD route, I will be less afraid! Thank you!
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another nycg,
I had my lat flap surgery as an outpatient...went home the same day!! Had 2 drains in for 10 days and didn't drive for about 15 days. The recovery was worse for me than the mastectomy, I feel I was in more pain. I only took 3 weeks off work but think I should have taken 4. I already love the results even though I am still going through the expansion process. Good luck on your decision.
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