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Latissimus Dorsi Breast Reconstruction

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  • Linda54
    Linda54 Member Posts: 509
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    justagirl

    WOW 10 days in the hospital...our insurance companies want us out of the hospital as soon as we can pee on our own....LOL

    I know we have heard this over and over but "we are all different" but I did not have any of the pain you are describing especially after 7 weeks. Not wanting to get out of bed!!! that is horrible. I remember I would wake up early and could not wait to get out of bed because I was so tired of laying in one spot.  I think some pain is normal but the kind of pain you are experiencing I would contact my PS about it. 

  • joiedevivre
    joiedevivre Member Posts: 47
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    Westieluv.. Thanks for the info. 

  • Linda54
    Linda54 Member Posts: 509
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    joiedevivre

    I have never heard of getting to the muscle under the arm.  Is this what you had done? 

    I had both sides done with the Lat flaps and after my exchange they did not look flat.  When I flex the muscles they will kinda flatten across the top and look weird. 

    Sorry I could not help you more.  Just go to the website that westieluv directed you to and maybe you can find some into there.

  • joiedevivre
    joiedevivre Member Posts: 47
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    What I had was a muscle sparing latimus dorsi..which means he took only part of the muscle and transported it to the front. It only covers the third lower part of the breast. I think there is a difference between that and the flap which also involves some skin being placed over the breast which I think is what you had done. The muscle is pulling tightly on the breast tissue and causing a flatness and widening of the implant.. In other words it is distorting the implant somewhat.I think they can go back in and cut the muscle under the arm and release the banding..since the blood flow is now established..I think that is correct but not totally sure ..Will get more info from PS when I go for my next post op visit..

  • justagirl
    justagirl Member Posts: 633
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    Linda,

    Thanks.  My PS insisted I stay in until all drains were removed and luckily our private insurance paid for it.  Maybe that's why they didn't pay for other things!

    I don't think our new breasts will ever look, forget feel, like our 'original' breasts.  Since I have had only one LD muscle in one breast and an implant, with just a implant in the other, they sure do look and feel different.  Right now, post 7 weeks, my LD flap breast hangs way down further than the 'just' implant breast.  My just implant breast sits round, perky and high.  Just don't know if the other breast can be pulled up or if I want to go through another surgery.  And, I still need nipples made!  

    Does it ever end?Linda54, I mourned with you on your third anniversary.  I guess the only saving grace is we are alive!?

  • westieluv
    westieluv Member Posts: 245
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    I posted a picture of the shoulder harness/posture device which is helping me rehab.  See the picture forum Latissmus Dorsi Reconstruction Story.  It's not the most comfortable thing, but it does the job of reminding me when I slump my shoulders.  I have no connections to the company or any representatives, so this is just something I am trying.

  • westieluv
    westieluv Member Posts: 245
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    Ok Lat ladies, I am having some swelling and I need to know if it is normal.

    My right side under the armpit just started to get larger and larger over the last week.  it doesn't feel like fluid build up but the tissue under the armpit is swelling and bulging more than on the left.

    Maybe I did too much activity with that arm over the weekend?  Could this be truncal lymphdema since it is on my right side where nodes were taken?  I'm not swollen down the arm, but I did have some minor truncal swelling after my BMX while I was waiting for the LD flap procedure to be done.

    Could this be caused by my posture support garment or could this just be the lat muscle tunneled through and still angry about being repositioned?

    I don't see the surgeon again until Thursday.  Should I try to apply cold compresses?  Put on a compression cami?  Need advice.  Sending an email to the asst at PS office for their advice.

  • Linda54
    Linda54 Member Posts: 509
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    justagirl, Thanks sweetie......I don't know why your lat side would be hanging. It should be perky and a little firmer than the other side. 

    Beth, I would not wear that posture support anymore until you talk with your doctor. I am assuming it is tight, right?  When you have lymph nodes removed you are not suppose to wear anything tight on that arm and I would think it would mean anywhere on that side upper body.  No compression for now but you might want to try the cold compresses.  I don't know if that would help but what could it hurt.  Let me know what you find out.

  • justagirl
    justagirl Member Posts: 633
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    Linda54,

    I thought my lat side was hanging lower due to the muscle relaxing.  The PS didn't put in as big of implant as on the other side and until two weeks ago they pretty much matched.  Now, without a bra, the lat side is probably an inch below the other breast.  I don't think I need a bigger implant as that wouldn't raise it up but a tightening up...  I have an appointment to see the PS next week and will ask, as the hanging has taken away the nice fullness at the top of my breast area.  Thanks for your imput.  I didn't think it was quite right either.  Hope you are feeling a little more positve now.  This breast cancer is a bitch but we just can't let it win!

    Beth,

    I agree with Linda54.  I don't think your harness is good pressing on those lymph areas.  I think gentle stretching exercises are better and trying to remember shoulders back and down - tits out to the front!  Heck, we have gone through so much for our breasts, we should think of showing them off.  My physio said NO WAY on your harness and to use my mind!  Hmmm  Good luck.

  • westieluv
    westieluv Member Posts: 245
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    Justagirl & Linda, - I think you are both right.  When I wear it, the swelling under there goes up.  I think I am going to sideline it for awhile and just keep my mind focused on the expansions and do the other PT.  Believe me, the stuff they have me doing in PT for this left shoulder is NOT gentle stretching.  I still can't get my arm all the way up and back.  It feels like the muscle tunneling has got that side in a bind and the shoulder will not function normally.

    I plan to talk to the PS about it tomorrow.  I'm generally impatient, so he will probably tell me to keep doing the PT and give it some more time.

    I'll post another expansion photo on the pic forum when I get back on Thursday evening or Friday morning.

  • justagirl
    justagirl Member Posts: 633
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    Westieluv,

    I hope you are going to a PT that massages the shoulder and scapula area before he/she tries to work that area.  Mine does and I think that's one reason why I do so well progressively with her at getting my arm on the LD side up and back.  The side that just had an implant put in has always been more flexible.  I am 8 weeks out from my surgery and just feel now like I am getting somewhere with greater arm movement. 

    Is there anyone at home who could give that area a little massage for you before you do the exercises?.....or use a mild heat pak for 5 minutes with a towel over it to keep the heat in or a warm shower or relaxing bath?

    I think we are a bit alike, impatient with ourselves and exacting....maybe that's why we keep in going!

    Also remember, if you are still doing expansions, that has to have some effect.  I don't know about expansions as I opted to have little boobs put in.

    Remember to be patient with yourself!

  • westieluv
    westieluv Member Posts: 245
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    justagirl & others lat flap patients

     They don't do any massages, just put me on a stationary bike with the arm poles and make me pull that back and forth to warm up.  I hate it and it doesn't feel good as it activates the lat muscles on the front of my breasts now.

     I have a shoulder pulley that I use at home and I do all kinds of stretching exercises on the left side.  Bottom line is that the lat muscle pulled down and around from my scapula is at such a pressure that it pushes my left shoulder socket forward.  I can't move it all the way back and get the shoulder out of impingement.  If I had impingement without this lat relocation, eventually an orthopedic doctor would probably recommend physical manipulation to relieve the impingement.  This means they rotate it for you (with extreme pain) either under general anesthesia or not.  They then keep it moving and rotating so you don't get frozen shoulder syndrome.

    This is really frustrating for me.  I am trying to be patient, but adding extreme shoulder pain to the expansion process is putting me on the ragged edge. I'm telling you, I can't put on a bra, shirt or a coat without help.  Now, I believe that to be a sign of real impairment.

    I've searched and searched the internet for rehabilitation studies for lat flap BC patients, and what I can find are all centered on how there is little lasting muscle strength loss.  I can accept the studies, but I can't find a single guide for proper rehabilitation of the rhomboid and teres major and minor muscles to take over the muscle loss from latissmus flap relocation.  Where do you find information on that? 

     Is there anyone on this forum that has researched this before?  I go to a sports medicine specialty rehab facility. These folks are serious about getting me back to my full range of activities which included tennis coaching, scuba diving, weight training and lap swimming.I knew that I would have impairment from these activities BEFORE I had the surgery due to the relocation of the muscle, and I can accept that.  What I can't accept is a chronic shoulder impingement that keeps me from doing everyday activities.

     Any suggestions would be appreciated.

  • justagirl
    justagirl Member Posts: 633
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    Beth/Westieluv,

    Beleive me when I tell you being put on a stationary bike with arm poles to pull back and forth to warm up is not a warm up.  As a RN, triathlete, a reader of all I can find on health and well being and a BC survivor with a DM with reconstruction, trust me that you need a soothing but firm massage from your neck to shoulders to lower back for 10 minutes before even thinking of getting on that bicycle!!!!!!!  Your scapula needs to be released so you will be able to eventually move your shoulder back and massage will help as it relaxes the muscle yet increases blood flow, therefore healing, to that area.  Then, any manipulation by your physio should be by degrees, not  full on.  I can see that where you are going is for sports medicine rehab but you really need someone who can do BC mastectomy/reconstruction rehab, which, at least here in my town in Queensland Australia eliminated most physios.  Here in Australia, in the major city closest to me (1 1/2 hour away) there is actually a big physio practice which only deals with breast surgery/radiation rehab and whatever directly related to breasts.  Search on the internet or ask your physio.  Even though you used to be very physically active in many disciplines and in superior physical condition, now your first goal should be to trying to get back to the basics before you strive for rehab to do your sports again.

    Having an impingement or frozen shoulder is serious and surely you don't need any more general anesthesia.....plus one manipulation won't fix you.

    I actually had to call like 20 physios to find one and then my BFF suggested checking the physio out that I now go to.  This physio is a real jewel!!!!!

  • westieluv
    westieluv Member Posts: 245
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    After consulting with PS, he encouraged me to stick it out and work through the pain.  We stopped doing any exercises that were weighted and engaging the lat muscle.  The swelling started to go down and I am seeing improvement in the range of motion.  I still have a way to go, but I'm keeping a stiff upper lip and moving forward.  It just takes time and work when it gets to this point.

    I need to listen to my body and speak up when the PT wants to do stuff that makes me swell up!  He was quite understanding and worked to help me resolve my problem, so I think he listens and cares.  That makes him a keeper in my view.

    Better days are ahead!  Onward with TE expansions.

  • justagirl
    justagirl Member Posts: 633
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    Beth,

    I was getting worried about you as you hadn't posted.  Yes, I was checking every day!  I am so happy things are settling for you, with the swelling going down and the expansions continuing.

    Having breast reconstruction using the LD muscle is not an easy in-out, one-stop deal.

    I think all of us women here have inner strength and determination, and I know I am my worst enemy as I just want to get in and get things done and do the best I can RIGHT NOW. I am not good at all at just waiting....and that's what I am doing until I hit the 12 week post surgery mark in three weeks and can start to run again.  This walking casually on the treadmill is driving my mind nuts, but it's what is good for my body. Both my physio and PS said no running or weighted exercises until 12 weeks, and then a verrrrrry slow progression. All this lack of running has made my dog gain 5 pounds and she sure doesn't need that either.

    Again Beth, glad things have turned around for you.

  • joiedevivre
    joiedevivre Member Posts: 47
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    There is something that I don' quite understand between what most of you girls have had and what I had.I see on the pictures that most of you who had a latismuscle dorsi reconstruction with implant also have a football shaped skin added to the breast. I do not have that. I have only the muscle sparing latismus procedure, and no additional scar on the breast or additional skin. Just the muscle was tunnelled to the breast. Can someone explain the difference to me as most of you seem happy with the ourtcome while I am not. I now have a flat wider breast than the other side. My PS had said  that  it would look better than before, but that is not the case. I am so disappointed and feeling sad about having agreed to this procedure.He said today that he could cut the nerve and it would allow the muscle to atrophy and relax more.Can anyone help me  with information on this.?

  • sarah1967
    sarah1967 Member Posts: 1
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    Hi



    Firt time posting on here..... I had lat flap reconstruction with small implants (no expanders) on both sides nearly 6 weeks ago. Did anyone have issues with differences in the upper area - above the actual boob I guess. My right side (which was the original mastectomy side), is considerably more raised than the other side. I'm not sure if it's swelling....... I guess it must be. Right now my upper chest area looks really uneven, and I wanted to know if any of you kind ladies had had anything like this happen.



    Thanks



    Sarah

  • Linda54
    Linda54 Member Posts: 509
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    justagirl,

    I started adding jogging with my walks at 6 wks and then kept building on that each week. By week 12  I was running for 8 mins with 1 min walk and kept doing this until I had done 8 miles. So most of the 8 miles was running.  My PS was fine with this as long as I felt good.  The only thing about the expanders was that while running by chest felt like a boa constrictor tightening up. Not a good feeling but I wanted to get back to my running.  Week 14 I started lifting light weights.

    Good to hear from you Beth and glad the swelling has improved.

    joi,  I thought muscle sparing meant that no muscle is used. I am confused by this.  I needed the the new skin (football flap) because of rad damage. It is difficult to expand the rad skin so the need for new skin. Were you expanded with TE's first then have exchange?  If not then that could be the problem.  I could have went with a tiny implant and skipped the expansion but I did not want to look like a girl in puberty.  So if you went with a fairly large implant and did not have expansion then the muscle could be flattening the implant.

    Sarah, My experience was that my prophylactic side (also LD flap) ended up hanging slightly lower than the rad side. Not a big difference but I had a revision to lift it up.

  • joiedevivre
    joiedevivre Member Posts: 47
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    Linda: Muscle sparing means only a small portion pf the muscle was used. Instead of covering the whole breast, it is only on the third lower part of the implant. And, I had been expanded before since I had the implant I wanted, but then lost it to infection. He did re-expand me, but only to 320..and my implant is 475cc. Yesterday, when I saw him, he talked about possibly cutting the nerve to the muscle, and the muscle would atrophy..and the breast would assume a more norlal position. ..Time will tell. He said I have to wait 6 months to see what it will do on its own.At least, it does look good in my clothes. They are the same height finally and that looks good, and I have nice cleavage now.. Yhanks for your answer..

  • Linda54
    Linda54 Member Posts: 509
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    joi

    thanks for the explanation...so glad the girls are looking better.

  • justagirl
    justagirl Member Posts: 633
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    Linda,

    Thank you for sharing with me your post LD return to running.  It sounds like a solid plan and I can tell from what you have written you think everything out and proceed with what is safe and good for you.  I do feel ready to start a run/walk program as I am at 9 weeks, but saw the PS a few days ago and she said to wait until 12 weeks to start any running or weight bearing on my arms.  She said I have made it this far without any complications with the LD flap and small implants 195 and 220cc I had put in, and she wanted to keep it that way.  I had thought the breast with the LD flap had dropped a bit, but she said the other sides implant had been drawn up due to me using the pec muscle.  Hmmmm, so I think, maybe I should do more with my right arm and chest to bring that side up but she says wait until the 12 week mark.  Then, the LD muscle would of reached it's maximum atrophy and she could put in an implant a bit larger to bring that breast in line with the other.  September.  I thought one 7 hour DM and reconstruction surgery and I would be done.  No way.  Plus I still need nipples!  Guess none of this is a one-shot deal.  Beth, I read what you have written and discovered your last journey of surgeries was a 1/12 year long journey.  Guess I have to start thinking that way....and I guess after already having 4 surgeries in the last year, what's one or two more in the next?  I think I have been putting my DH of 28 years through hell, and it's not him at all.  It's me.  I get mad at myself for wanting to do more and knowing I shouldn't.  I get ticked off at still getting tired when I used to be on the go from 6am to 11pm.  At least the tears and mood swings are almost gone.  Guess I have the Femara to thank for a lot of this too, along with the frequent hot flashes.  My 17 1/2 yo son made his first visit to a physchologist, for anxiety and depression.  This has been going on since I was first diagnosed last year.  He got better when I finished chemo in July but didn't recover completely.  My lovely GP finally said, teenage boys will be just that, but she was referring him to a specialist to see if it would help and get a second opinion if anti-depressants would be appropriate for a short time.  I sure could of used some anti-depressants last year but my GP felt my son and I had every right to be depressed and it was better to try and deal with it in 'real time'.

    I'm better but I would be much better if my son was happier.  He has his whole life in front of him while I'm 58you, more than half way through life.

    Beth, you are inspirational.

  • westieluv
    westieluv Member Posts: 245
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    Silly,

    I am making progress with the left shoulder and can't wait for my next expansion this Friday.  It seems like it has been a long time between the fills and "I want to get this show on the road!"  Here's to impatience!

    I discovered today that I really don't have much upper body strength after the last few months of surgery recovery.  I tried to dig in the ground to plant some summer flower bulbs & weed the rose beds, but I stomped off in frustration when I couldn't accomplish the job. All pulling and tugging motions feel very strange since they are still initiating those lat muscles.  After I messed around with that for awhile, I got all tight and the ironbra feeling got stronger.  I swear, these muscles are revolting at being relocated!

    Otherwise, I feel pretty good.  My DH says my back scars are really flattening out and I'm growing some new skin in the area that was so thin on the left side.  It's still thin skin, but doesn't look as fragile as it did right after the last surgery.  That's a positive!

    Sorry to hear that your son has been down.  It's hard on everyone in the family.  I also have a 17 yr old son.  He will be 18 in October.  He's very easy going and took my situation in stride.  He's alot like his Dad, lucky for me.  He sat me down one day after I had met with the BC surgeon and said "Mom, just tell me the truth, if it's bad, I can handle it, but I don't want to worry about whether you are hiding stuff from me."  His friend had recently lost his Father to a brain tumor and he watched that situation unfold in his friend's family.  The kids are not naive'.  All you can do is love them and give them the opportunity to talk it out, if they will.  I hope your son is better very soon!

    I'm set to see the PS next week for a small chat about things and to ask about starting different exercise programs.  We also have to talk about his ideas for my exchange surgery.  Can't wait for that!

    Beth

  • Linda54
    Linda54 Member Posts: 509
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    Beth

    I had trouble doing little things like raising a window. You are still in your infant stage of reconstruction. You are not suppose to be super woman.  I was thrilled when I was able to crank our leaf blower. I felt I was back to pre-surgery condition. 

    I can remember early on when I would be holding a pen writing notes and my boob would flex. It doesn't do it anymore.  That was a strange feeling.

  • Shrek4
    Shrek4 Member Posts: 519
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    I had problems for a year after the LD recon. Even now, more than 1 1/2 years out, my arms strength is far from what it was. But I'm getting there. I had the second phase of the LD detached from the pedicle, and at the end of March my PS gave me green light to work out. I am working with 2 lbs dumb bells.

     Beth,  I do not want to discourage you, but you shouldn't do much about trying to regain now the strength in your arms. For one, the LD is still firmly attached and with all the nerves there, so you will have lots of breast animation (it was freaking me out, honestly) and there is a small possibility that working out the LD will displace your implants/TE's. For me, once I got the LD separated (my PS did not cut the nerve, he practically cut the pedicle to the muscle, in two phases) I was able to do lots of things, without the animation (actually with a minor animation due to the pectoral muscle). 

    Did you ask for Flexeril or did you have it prescribed?  I had immediate implants put in, so the skin and muscle were very stretched, and the Flexeril helped tremendously. Also, give yourself some slack. I know my PS said that it might take a month or two for the whole thing to look healed on the outside, but the inside takes up to 6 months to be fully healed.

    Also, re. the upper pole - here you have to be very patient. There will be dropping and fluffing of the implants once you have them. With TE's you are only in the first phase, and how they look now has nothing to do with how your reconstructed breasts will look after the exchange.

    Hang in there.  It will get better. You just have to be very patient.

    Linda, I have the bra all the time. Not the "iron bra" anymore, but the feeling is like I am always wearing a bra. Not a tight bra either. Just a bra. I am wondering if once the nerves in my skin have re-grown, I don't feel the implants and the scar tissue and that is what gives the "bra" feeling.

    I did lots of stretching, that is for sure. But I think that either the fact that I used to be a gymnast, or the way my PS did the surgery, has something to do with it - I was able to move my arms all the way right after the surgery. Up, lateral, and even some towards the back. One thing is for sure, with the LD recon you will not be able to clap your hands  behind your back anymore.

  • Linda54
    Linda54 Member Posts: 509
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    Day...good to see you

    Re: the iron bra.....mornings are not too bad just feels like I have a "bra on" ...just tightness under the arms. I just tried clapping my hands behind my back and I can do that without distortion. Shrugging the shoulders really feels tight at the underarms.  I get tighter by the end of the day.  But as you say "not much of the Iron Bra anymore just the feeling of having on a bra when braless."  I have quit using the weight machines at the gym that work the pecs and LD's.  I felt really tight after working those areas.  I have quit stretching using the ball.  I feel that if my tightness does not get any worse then I can live with it.  At least it is not "pain"......I don't do any exercise that I support my weight using my forearms...those really distort my implants.

    It does get better but it takes time.

  • westieluv
    westieluv Member Posts: 245
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    Thank you all for the encouragement! 

    Linda, I believe you are right about being in infancy stage.  All I do is whine and cry!

    I know it will get better and I can look to you for support when I need it.  Thank you to all who have helped me during this stage.

  • Shrek4
    Shrek4 Member Posts: 519
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    Linda,

    What I noticed that helped a lot with the "iron bra", was certain physical activities that practically ripped apart the scar tissue on the former LD site.  That happened to me after I did some heavy gardening, i.e. shoveling, carrying and dumping garden soil and mulch, stuff like that. I hurt quite a bit after that (actually I thought I broke some ribs or something) but a week later the hard tissue that I could feel before on the former LD sites was gone, it's all soft there except for a few spots that are still tight, mostly along the incision scars. And no more iron bra feeling, just the bra feeling. If I shrug, I don't have any tightness, only if I lift my shoulders very much there is a little tightness at the incision scars site.

    Also, after the PS had cut the pedicle, I have no more distortion from the LD muscle whatsoever. Just when I do things that involve the pec I get some distortion but very mild. With the clapping behind the back,  I dont' get distortion, but on the right side it feels like it's a bulge around my underarm that doesn't allow my arm to go all the way back - but that is from the ALND I think.

    Another good thing - I barely have any problems turning on the side in bed. It used to be awful, I had to get up, then slam myself on the side, or grip the side of the bed and pull myself to lay on the side. Now it's much better and I can turn without doing all those gimmicks.

  • joiedevivre
    joiedevivre Member Posts: 47
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    Day: I see that you said that your PS cut the pedicle to the muscle.Can you explain if you can the difference between doing that and cutting the nerve. My PS is talking about cutting the nerve in six months. Then the muscle would atrophy and let the breast relax into its normal position. Right now, it is flatter and wider than the other side, and distortion in the shaping....I also heard another PS talk about cutting the tendon.  I don't know what the differences would be  between doing thedifferent surgeries. Was your breast distorted when you were in a relaxrd position before, and now it is better since he cut the pedicle? Undecided
  • Shrek4
    Shrek4 Member Posts: 519
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    No, my breast was not distorted when I wasn't doing anything, but was getting distorted with every move I would make. Now it doesn't. I only have a slight animation from the pectoral muscle.

    He said that cutting just the nerve is not always enough, and in people who regenerate nerves very fast (my case) the nerve can regenerate. So he cut the entire pedicle, not just the nerve (I guess that is right below the tendon), keeping the blood supply. He went by the fact that the nerves in my skin had completely regenerated after one year - I had skin-sparing BMX with immediate reconstruction, and now I have feeling over the entire area of the reconstructed breasts except for an area the size of a quarter where the areolas would be.

  • westieluv
    westieluv Member Posts: 245
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    I find this discussion on the nerves and pedicles very interesting. Wouldn't you think if doctors have been doing these surgeries for 30+ years they would have all this figured out and a solution to help atrophy and stop the animation?  They act like it's an old routine procedure, but I believe it is anything but routine.  My PS claims that his procedure for the surgery has changed over the years with newer surgical techniques.  He surely is faster at it.  The surgery time for bilateral with him was 1/2 the time.  Indy people told me 7 1/2 to 8 hours for bilateral.  Chicago team did it in just under 4 hours.

    I got a massage today.  It was heavenly!  I was explaining to my massage therapist that when I massage the flap, I feel the sensation in my back.  She said my PS must have been very good to have excised and tunneled the lat without losing any nerve sensation in the flap.  Now I'm not sure if that is going to turn out to be good or bad thing.