Latissimus Dorsi Breast Reconstruction
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Grandmother always said if you don't want to know the answer maybe you shouldn't ask the question---that's the lesson I learned today.
The ps I have seen is going out on maternity leave until August, so I thought it would be an excellent time to see another ps for a second opinion with the hopes of scheduling surgery earlier. The answer was a flat no. This is a reputable surgeon in our area, one that both my mo and the lymphodema pt recommend. Ps#2 says I am not a candidate for any surgery at this time. He says being overweight is an issue to do the DIEP, te's to implants would likely fail because my skin is too damaged for fat grafting to help. Then he drops his opinion that I am not a good candidate for the lat flap because of the radiation damage on my back. He did measurements and said there is no way to get adequate skin from my back to match the non-mastectomy side--he would be taking radiated skin which in his opinion would fail upon expansion.
He offered that his hospital has an excellent bariatric surgery department--I am amazed at the irony in suggesting weight loss surgery in order to qualify for reconstruction surgery.
Now what do I do?
Go for a 3rd?
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Myleftboob - Although not a popular choice, the LD Flap is far safer than DIEP as the muscle is never cut off from the body. Welcome to this thread. The women hear have really supported me through this. BTW, I am not permitted nor desire to wear underwires. It was suggested for me to wear a genie bra for the back compression. Stretchy bras should be fine.
Shorfi - Unless something changes, I will go to Vinnie Myers for the tats. When I compare the photos of his work with Jersey's it seems a better choice for me. I like Copit a lot! How do you like the outcome?
Tabbies - If it's any consequence, I will likely need a tweaking surgery after this one.
Sam - What the heck! Nothing in this whole mess ever goes as planned. My PS went on maternity leave and left me with an infection. I changed PSs. We all know how important it is to have confidence in the surgeon. When in doubt keep looking. When you decide on the surgery make certain to have it done by someone who does that surgery all the time.
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Sam, FWIW, you might want to get a third opinion. Someone I know on another forum was told she had to lose weight before reconstructive surgery. She went for another opinion at an excellent facility (Stanford, I think) and was told she did NOT have to lose weight to be a candidate. Do you mind if I ask why you have radiation damage to your back? Your diagnosis and treatment are very similar to mine. My back was not irradiated.
Warrior, let's hope you don't need a revision. But for all I know, I'll need one too. I won't mind that much if I do, but I'd really like to get rid of the TEs ASAP. I sleep on my side, and they're pretty annoying in that position. Whine, whine, whine! :-)
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Curiously-has anyone ever had their lat flap area lippo-ed. I am having what I hope is my final revision on April 30. Getting about 100ccs more added to my left side for symmetry, getting my nipple made and the ps said he was going to lippo my back since I have a hump where the lat flap was done. Just wondering how sore that is going to make me-it is already tender there (lat flap surgery originally on dec 29).
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WW--it never seems to end, nothing goes as planned.2Tabbies--I assume the damage to my back is from the lymph node treatment, but I was never given precise info by the ro. The actual team that did the treatment reminded me daily to put aquaphor on my back because the beam left an "exit tail" out the back. It's an area that is visible and about 6" in diameter. They also treated under my arm and that area extends on to the back. My skin is discolored and both areas are visible.
I guess I need to talk more to PS1 after she comes back, and in the mean time search out a 3rd opinion.
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Sam, interesting about the exit beam. I had treatment to my lymph nodes too, but nobody mentioned that. My skin is only discolored in a square on my chest where they put that gel square (can't remember what they called that) to concentrate the rads near the surface.
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2 Tabbies. Thanks for the feedback, now I know I'm not nuts not wanting the DIEP LOL. I will have someone to drive me no problem for a couple of weeks after surgery and I remember very well having stuff within easy reach after my MX. . I have a lady that will pick up prescriptions, groceries whatever and will get a cleaning lady in while I'm recovering. I'm seeing the PS this coming Wednesday and going to book the appointment. I really hope I can have it done by fall or earlier. I had to laugh at the TE Stripper boob comment.
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MyLeftBoob, sounds like you have things all organized for your recovery. I hope you can get a surgery appointment soon.
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My surgery on 5/4 will be more involved than first thought.
I will need fat grafting in addition to the skin graft/nipple areola reconstruction. The fat grafting is usually done in stages, but at my urging, my PS will combine the first fat grafting session into the same surgery (2-3 hour surgery). He's going to take fat from my thighs. I asked him if he was only going to do one leg and he said he will do both, he said I earned it and it will be fun (psycho, lol), so I said can't you do my tummy too? He said there WILL most likely be a need for another/future fat grafting session(s), as these grafts don't always take (and this step would come from tummy). I am taking 2 weeks off May 4-May 15 (he said it will be a 2-3 week recovery, but 2 weeks off should be ok).
Fat grafting surgery is a one week recovery, so in the future (don't even have a clue when that would be scheduled) I will need to schedule this.
No exercise/physical therapy and no picking up granddaughters for a few weeks. Just rest (it's going to be uncomfortable).
He told me to buy "shape wear", I found Jockey Skinnies brand that were pretty comfortable.
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kfinnigan, I'm sorry to hear your surgery is going to be more involved than you thought. I might need some fat grafting too. I'll admit to kind of hoping I do so that I get a bit of liposuction as a little bonus. Is that sick of me, or what? I like your PS's attitude that you've earned getting both thighs done. I've seen photos of women after liposuction. Be prepared for some nasty looking bruises. I hope it all goes well.
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Have to admit 2Tabbies, I'm thinking of it as a bonus too, that is covered by my insurance to boot! Yeah, I need to prepare myself for the bruising.
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kfinnigan, we need all the silver linings we can find! Right now I'm pissed off because I just found out I have osteopenia. My mother had to go into assisted living because of spinal fractures due to osteoporosis. I don't want to go down that road, but there doesn't seem to be much that will stop it except estrogen. Which, of course, I can't take because my bc was estrogen sensitive. My GYN, who did the bone density test, said just to keep taking vitamin D and calcium. Well, gosh! I've been doing that for years, and it's apparently NOT working! I consulted my PCP and she recommended some other supplements. I hope they work, but it really seems like nobody has found much that really helps.
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Warrior...I loved the outcome, but I am scheduled to see him on May 19th because I want to talk about revision surgery. My left breast had the radiation 10 years ago with the first cancer and he did an excellent job. It's just a little bit bigger than the right side (which was a new primary) and it needs to be lifted a little. I want my breasts to appear symmetrical, which they do when I wear a bra. But 99% of the time I do not wear a bra and i love it.
I love the way my tats came out and was very pleased. I went from a DD to a nice sized B cup. Will keep you updated.
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Well I've booked, sort of. PS says by the end of the summer for sure and that I'll get a call from her assistant to confirm. She was still hopeful I would go with the DIEP but understand my reasons for not wanting too. At least it's an option down the road if need be. I finally feel a bit excited that's an actual plan is in place. BTW @Tabbies, she was explaining how the expander would sit higher that my natural but that she would do her best at symmetry etc. and I said "Like a Stripper Boob?" She got a chuckle out of that LOL
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Myleftboob, too funny! I'm glad you both got a chuckle. My PS says I won't have stripper boobs when I get the final implants. He better be right!
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2Tabbies, what other supplements did your PCP recommend? I'm curious. I also have Osteopenia, and my BMD (bone mineral density) got worse after being on Arimidex for a year. My Onc even put me on Fosamax for a year, but I told her no more of that drug. My Gyn didn't agree with my Onc putting me on Fosamax or even having the bone density test, says almost everyone has Osteopenia and my fracture percentage is 2% and recommends no further bone density test until I'm 65. I turn 53 May 11th.
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kfinnigan - Here is a stupid question and I should probably know this by now. What is the purpose of fat grafting? Is it to fill in sections of the boobs? Funny how a few weeks of recovery seems so simple after all we been through.
Shorfi - I too went from having too big boobs to being pleasantly perky. Even with the scars I like how they're turning out and if I never wear a bra again all the better.
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Kfinnigan, my total fracture risk over the next 10 years is 6.2%, and hip fracture risk is 0.3%. I'm 57, but had surgically induced menopause at age 45. I did use an estrogen supplement until I was diagnosed with bc. That probably saved my bones at least a little. Here's what my PCP said. I linked to the multi-vitamin she recommended. I'm going to have to ask her about the amount of strontium because the Osteo Prime only contains 6 mg not 100. She's talking about "magnesium as tolerated" because when I was taking it before, it started giving me diarrhea.
Take strontium 100 mg a day, with vitamin K2 25 to 45 mcg a day. There was a study in the Netherlands done on people who drank milk vs people who ate cheese and yogurt vs people who were dairy free. Those who drank the milk had the highest fracture rate, those who were dairy free were next, and those who had the fewest were eating cheeses (hard cheese) and cultured dairy like yogurt but not drinking milk. I would recommend moderate intake of cultured dairy. We carry a multi vitamin called Osteo Prime which has both the strontium and the vitamin K that I can recommend as well. Magnesium is also important, I would just take what you can comfortably, to bowel tolerance, remembering that malate and glycinate forms are better tolerated.
Warrior, my goal is to never wear a bra again also. Right now since my foobs have an obvious boob job or stripper boob look (there's that term again, Myleftboob!), I'm resorting to a sports bra if I have on a clingy shirt in an attempt to squish them into something resembling a more natural look. TE's do not squish well. Fortunately, not many of my shirts are that clingy. I was never big and never wanted to be. I'm actually a bit bigger now than I was naturally, but I think I'll go down some when I get the permanent implants. If not in volume, at least in projection.
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Hi Eveyone
I had my recon surgery on the 9th of April and I still have the one drain that comes from the back. The other two barely produced anything so they came out after one week. I go this morning and I doubt it will again come out due to the fact I have to produce only 20cc's per day for two days and it's been like 45 -60 ccs a day! How long for those of you who are done did it take to get this last booger out?
I also have fluid build up in my back and side along with what appears to be a lump at the bottom of the affected area on my back.
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HomeMom...not trying to discourage you, but my last drain was with me for over a month. My PS removed it because I actually split the tubing trying to clean it out. I went into the office and the nurse just removed it. I was so happy. Those drains are a pain in the butt.
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I HATE to be a "Debbie Downer" but my fat grafting left me with large lumps ( fat nercoisis) the size of a quarter. I was hoping to notice a slimmer mid section where he took the fat from but didn't notice anything. BUMMER!!0 -
2Tabbies, thanks for the supplement info, I'm on Tamoxifen too. For now per my MO. I tolerate it pretty well but MO wants to switch me to Armidex which I really don't want. One thing to be on estrogen blokers and quite another to be on estrogen suckers. I'm 52.
Question, how long do you expect in total to get the swap out surgery?
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Warrior, never a stupid question in my opinion. I asked my PS about fat grafting months ago and he said he does it in cases of divots on the chest, and I never brought it up again. This visit, after I signed consent forms for nipple/skin graft surgery, I asked him what he thought of my chest area of left lat flap boob, he suggested fat grafting he said my tissue is thin from rads. But he did say at first when he was looking at my bony chest area, that sometimes more work to the breast may end up looking worse. I immediately said if its going to look worse, forget it. He then kept examining the boob/chest...moving the boob around and really studying it, and said Let's do it. He was really thinking, then thought he might change up the whole plan and do fat grafting first...then said he could do it at my nipple surgery. I kept asking him Are you sure? he said yes. I feel good about it.
2Tabbies, thank you for the supplement info! Do you still take calcium supps? My calcium pills have Vit D and Magnesium, but I take an additional Vit D3 pill.
Tangles, dang girl, you have not had a good experience...
Myleftboob, I had a 7 month wait in between lat flap surgery and exchange, because of surgeon scheduling.
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Kfinnigan & Tabbies - Thank you for the supplement information. I will talk with my MO on Monday. Nobody tells me anything. I wish I was given a procedure manual at the time of diagnosis. If not for this site I would be totally clueless.
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Myleftboob, I'll end with about 7.5 months from the lat flap procedure and TE placement to my exchange. My PS's standard is 6 months because he says it takes that long for the skin and muscle to completely lose it's elasticity and relax. Scheduling issues pushed it out another 6 weeks. Not all surgeons wait that long. I asked him if the longer wait meant it wouldn't take months for the "drop and fluff" to occur. he'd never heard of the term "drop and fluff." So maybe with his protocol the tissues are relaxed enough at the exchange that there isn't a lot of change afterward. We shall see.
HomeMom, my PS warned me the drains could be in 3 or 4 weeks. Sorry you're having trouble! Drains suck.
Tangles, so sorry to hear you've got fat necrosis. I hope you can get it fixed. No worries about being a Debbie Downer. If we can't gripe here, where can we?
Everyone, your welcome for the supplement info. I hope it works for us.
Warrior, I feel like nobody has told me a lot of things I need to know too. The bone density thing came up just because I went to see a new GYN, and she thought it was time for a bone density test. I wish my cancer center had a post-treatment program where they'd help you with all the long term side effects and just general adjustments we need to make after active treatment is over.
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On a Happy note I was sooo worried that my back pain from this surgery was so unusual I demanded a PET scan to make 100% sure it was not cancer. Thank the LORD it is not. Just major pain from the Lat surgery. As for taking care of the fat necrosis it is the least of my worry. My main concern is getting mobility back in my arm, being able to work full time, getting strength back, getting rid of the severe back pain. As for the foobs. Yup it would be nice to have symmetry and not have one high and rock hard and one saggy, maybe get nipple tattoos someday, but hey that is pretty low on my priorities list right now.0 -
You know you're a cancer patient when you say...
Tangles - Hooray. I am so glad to hear that your pain is from the surgery.
I wonder if a day will come when I don't think every twinge I have is a recurrence.
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Warrior, oddly, I don't tend to think every twinge is cancer. Maybe I'm going to the opposite extreme and ignoring things I should pay attention to.
Tangles, glad to hear your PET scan didn't show any cancer. Great news.
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Hello all...I had bilateral skin sparring mastectomy with tissue expanders in Nov 2014. I had a small area that wasn't healing on the left breast (cancer side). PS said it was the tissue expander pressing against thin skin. It did not break through the skin but did cause scabbing.I did not do chemo or radiation but was a light smoker. I quit right before my recon surgery and the dr was aware of this. I had recon done on 4/22/15 ..right side just implant and left side latissimus flap and implant. First day of recon seemed that all went well but second day the latissimus flap side skin turned black and purple. has anyone had this happen? PS wants to wait a week to see if any color comes back and then will decide what he can do to fix this. He said he never saw this before. I am freaking out. He said something about debridment? Also what other skin can they use if this skin flap fails? I am very thin and not a candidate for other flap procedures. If anyone has experienced this or knows about this please share with me. I've been crying for days and am very nervous that I will not be able to have implants at all. Thank you
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shorfi - My PS won't let me keep it in more then 4 weeks. It looked yesterday it was finally slowing down - the total was 28cc and then today it went back up to 40. I have my next appointment on Thursday but hope I can call them before that and go get it taken out. It's tough trying to hide it under my clothes for work and I keep worrying about infection.
I had implants put in in 2004 and always felt I was made too big for my frame (34D). I had to talk my PS into making them smaller, and while I'm not sure of my size, I'm guessing I'm a cup size smaller - and perky!
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