Latissimus Dorsi Breast Reconstruction
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The surgeries techniques HAVE improved. True, mostly in what concerns survavibility of the flap - that is the most important part in the surgery. With the development of the micro-surgery, they are able now to connect flaps to blood vessels better than in the past. As for the atrophy - well, in this it's on a patient by patient case. I doubt they can help the muscle atrophy at the same time they are doing the best they can to make it survive. That is the primary concern in the first 6 months.
The nerve sensation is probably referred to as the skin sensation. Those are different nerves from the thoraco-dorsal nerve that brings the signal from the brain to the LD to move.
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I guess if it means that I have a good blood and nerve supply to that flap, then I should be thrilled that I have the animation!
Have any of the ladies on the forum that had lat flap surgery also had truncal LE? I have an area under the arm pit that continues to swell if I wear anything other than a sports bra. One of my mastectomy bras still fit, but it swells up under that arm pit everytime I wear it. I can't decide if it is just post surgical swelling or LE. Obviously, I quit wearing that bra. Does anyone have experience with this?
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Beth,
Hope your fills are going well. Sounds like you and Linda are kinda like me - wanting to get going, get strength back and into doing things.
Unfortunately, I think this is one time in our lives when going gentle and easy will make us the winner in the end.....and there are ends. We all have tissue, nerves and muscles that are cut and shoved around. We have sleepness nights, non-productive days, pain, disappointment and anxiety over if all is EVER going to settle down and IS LIFE EVER GOING TO BE LIKE IT WAS BEFORE BREAST CANCER? No, life will never be the same but better because we have perservered through and not given up.
When I had my first surgery - the lumpectomy in March 2010, I thought all I had to do after was chemo and radiation. It wasn't on my radar to have three more surgeries, including this DM using my LD muscle and easily two more surgeries in my future, one to maybe redo the permanent implant on the LD muscle boob and make it equal the other breast in size and one to make nipples. I thought DM in March and nipples in June. Ha, the joke is on me. I used to feel like a failure because I couldn't do things because of my lack of muscle strength or lack of stamina. I got mad at myself. Now, I'm happy to wake up in the morning, see the blue sky and hear the birds. I'm satisfied with myself at being able to do the grocery shopping by myself and being able to walk 22km during the week.
I too, have that ironbra feeling, but it lessens as the day goes on. I also feel better not wearing a bra (unless gardening or walking), which I do as my implants are small. I do massage the area under my breasts twice a day as I have scar tissue there from other surgeries. I try to get lotion on my LD scar and even beg my son and husband to assist me. I think it helps. As a RN, I know scar tissue isn't very flexible and have found that an elixir of herbs called Swedish bitters has really helped to flatten and lessen the tightness of my scars.
Nerves can be really frustrating. When you want them to work, they don't and when you want them to not react, they do. My pec muscles and LD seem to have minds of their own. Just in the last few days they have once in a while just been contracting on their own - more like a spasm. Kind of funny....guess I better not wear any form fitting top when I go out among others.
Westie, I am amazed how fast your surgery was. My DM and reconstruction using only one LD flap took 7 1/2 hours. I don't know how long it took the breast surgeon to clean out the breast tissue versus how long the plastic-fantastic surgeon took to do her part.
I think we are are strong, determined, beautiful women!
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the surgery has actually been around for more than 100 years. but I'm sure it's changed a lot in that time (at least, I hope so!)
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justagirl, it took me almost 2 years to get back to my full pre-surgery activities. Of course for 1.5 yrs I was having surgeries then having to recover from each one and start over again but once everything was finished I was able to build myself back up.
My bi-lateral MX and bi-lat LD flaps with expanders inserted took 8 hrs. It took about 30 mns to remove my natural breast and 7.5 hrs to build them back.
Beth, I do not have any problems with LE. I am so sorry you are dealing with this. There's an active topic call "GRRRRRRRRR LE" or something to that effect. You might want to ask your question there.
One problem that I am having (I guess not really a problem) is that when I am braless and have on something kind of slinky I can see the outline of my football shaped flaps. Even with my sports bras I can see them. I recently bought some new sports bras that have some padding so that helps with the flaps not showing when wearing my form fitting t-shirts when working out. I wonder if some fat-grafting would help.
I just made my surgery appt to have my rectocele repair and also my bladder prolapse fixed. June 30th....uuuuggggg....so I go down again for a few weeks.
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Ok PS assistant looked at my area of swelling and says it is not LE. In her opinion, it is swelling of the lat in the tunneling of the arm pit. It just doesn't enjoy the relocation yet, so it swells with too much activity with that arm. Time will solve it. I got another 100cc fill today in both sides. Man am I sore. This one hurts the most so far. They want me to slather on the lotion/oil on the tissue and work the left side to keep it stretching. On me, the flaps aren't where the stretching is taking place. I'm stretching on the skin above the flap. I will be taking it easy for a few days to get things loosened up.
LINDA - Sorry to hear that you have to get more surgery...but those to things are really necessary to quality of life. I hope that you heal from that quickly.
JUSTAGIRL - I think my PS is a really skilled guy. The surgery was easier on me because I wasn't under anesthesia so long. Honestly, it was better for me than the BMX.....by far!
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Linda, i know when I first saw the photos on the pictures forum, I thought that those incisions weren't that terrific, and they needed re-worked. They looked too tight compared to the skin around them.
Do not be shy asking your PS to do it, I asked mine, as I didn't like how one of my incisions' scar looked like, and he removed the scar tissue and did a new suture and it looks wonderful now.
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Linda,
I'm not as far along as you, Beth and Day as far as post LD flap surgeries but I do have a thought for you in regard to the outline of your transferred skin. Our breast tissue is thinner and therefore softer than our back tissue. You do the LD flap and end up with a piece of your back on the front of your breast in a prominent place, so you will have more of a demarkation at your incision. The fat transfer might help soften the ridge or the insertion of a filler, like restalyne, used for lips and facial creases/wrinkles. I know with restalyne, once injected in the general area, you can massage it more 'into place'. It would need to probably be topped up once in a while but if you are consious of the outline then I agree with Day to first approach your PS if the incisions aren't smooth/flat. I can't get into the picture forum but I know as a nurse a scar revision can bring results that are worth going through the process and it's minor compared to when you originally had the LD flaps done.
My thoughts are with you on your upcoming surgery. Better stock up on some good books and DVD's.
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Hi Ladies,
I am now 3 weeks out from my LD recon with implant and doing well- I have been given a special sports bra with an implant 'belt' to hold the implant in place and help to 'mould' the implant, however noone has told me how long to wear it for? I have read varying things on this website, with some wearing them 24/7 and some not wearing them after the first few weeks....can anyone shed light on this? I have a permanent implant in (one step implant).
Cheers L4L
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L4L,
I couldn't help you with that. My PS is the "no bra" kind, actually I was forbidden to wear a bra (execpt for the surgical bra to reduce swelling for 48 hours after the surgery). He told me I will never need to wear a bra for the rest of my life, and IF I need to wear a bra (i.e. cleavage or see-through blouse) to not wear it for more than 2 hours at a time.
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I am about at the end of my expansion process. The left side skin is not going to take the full expansion to where I wanted to be. PS says we can try to put another 60cc in on that side in a couple of weeks. If we are successful, then they will look more evenly matched, but I can't go any larger with the skin issues. It is only because of the lat flap that I can get some foob.
I won't lie. It's a disappointment to me. I wanted to end up a little larger than the present TEs. I'm going to spend some time accepting all of this and readjusting my vision of success.
We are delaying my exchange to give the tissues time to recover and stabilize more. Right now my exchange is scheduled for Aug 19.
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Beth
I am so sorry for your disappointment. I wonder if maybe a month before your exchange if your PS could try one more expansion on that side?
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Dear Beth,
I read your post and cried. BC is not in any way 'nice' and not being able to have your foobs as you desire is truly unfair. Your vision of your body 'completed' may not be 100% of what you have been hoping and desiring but you are a SUCCESS!
Look at how far you have come over the months. You should be very proud of yourself.
My thoughts are with you and I'm sending positive wishes your way........
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Linda - PS says maybe 60cc if they can get it in that side, but no more. I go back on June 8th to see what he can get in. He says the tissues are so stretched that I need the longer time period of waiting with no further attempt at expansion so they can stabilize....then he can attempt to put in a larger implant if the skin can handle it. We did not discuss the need to trim down the right side flap so that he can attempt to make me a matched set, but he implied it and was waiting to see my reaction. I am at least one cup size lopsided right now. After the shock and disappointment, I have decided that symmetry is more important than size.
Whippetmom told me to look at your photos again. She says that I will be good with 375 high profile implants IF he can get them in. I will probably end up with different sized implants. I think you got different sizes, or was it in your revision?
Justagirl - It is a fact that BC is not 'nice'. I am surviving this, but as I have said before, I am FOREVER changed. I haven't even begun to come to terms with that.
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Is anybody on this thread going to Vegas with the group?
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Beth,
I hear you when you say you are 'forever changed'. The other day my dh saw me on this website and said 'why are you there - you don't have bc anymore'. I think bc will always be with me, hopefully not in my body, but in my mind, and it sure has left a physical imprint!
Take care.....
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justagirl.....you said it sister
Beth, I went to Vegas 2010. It was great meeting all the women I had grown close to in the time we shared after our diagnosis. I am not going this year because of "things" but hopefully 2012. I would like to meet you and spend time with you. Are you planning on going?
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Linda, I didn't sign up for this year but want to plan to go in 2012. It sounds like a great time and it would be wonderful to meet you! It would be wonderful to meet some of the other ladies too! Hopefully, they will go again next year. I had already planned to be in Vegas this year for a business convention that is being held the week after the TaTa Sisterhood. I just couldn't do both this year.
My hope is that I will be all done with my recon by next year, back in shape and ready to have some fun!
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I have a question:
It's been 3 months since my LD reconstruction on one side and just the implant on the other side - both with permanent implants. The LD implant side the last week feels like it is shifting around in there when I walk or roll over in bed. I can put my hand on my foob and feel it 'roll'. The other implant seems to be snugly in place and doesn't move like this. Since about 6 weeks post op, the LD breast seems to be lower than the other but the PS said that was because the other implant has gone up due to the pectoral muscle and that the LD foob is in the right place.
Is this movement due to the wasting away of the LD muscle? When I saw the ps three weeks ago this wasn't going on but I felt the LD side was mis-shaped compared to the other and she said I had to wait until Sept, 6 months, to allow for the LD muscle to do what it was going to do and then she could take me back to surgery and tighten things up and maybe put in a larger implant which would then equal the other one.
It is just to weird to have this foob rolling around! Before I make the 4 hour round trip to see the PS about this, I thought I would check in with experts like Beth and Linda.
Any thoughts?
Wish I could come to Vegas but I'm way over in Australia and have lots of medical bills still to deal with...........
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Hey Justagirl, that is interesting what you have noticed as I am starting to notice something similar I think with the LD reconstruction-not the implant shifting but there seems to be some weird mishapen-ness to the side of the breast, made worse if I 'flex' the muscle-and the line where the edge of the implant is stands out a lot. I am 5 weeks post surgery (all in one) so I guess it could settle, and it doesn't feel as though the implant is 'shifting' as you describe, but the shape seems to be becoming more distorted on one side....interested to hear other thoughts on this...
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I have to defer to Linda on this one since I don't have my implants placed yet. Not sure what could be going on....but would guess that the muscle atrophy would be a major factor. Linda, can you jump in here to tell us what you know???
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justagirl and lust4life
I have never read of anyone with the LD having the problems you are describing. I never experienced any of these things. I did have a revision on my prophylactic side because it ended up slightly lower than the cancer side. justagirl...what do you mean by rolling? like a ball would roll? My implants move but like a normal breast would move...
lust4life, you should not be able to feel the edges of the implant. Something is not right. Most of the time PS will tell you to wait and see if the implant will settle.
I really cannot give you much advice with these problems except to trust your PS and do what they say and if your problems do not improve over a certain amount of time then you might need to have a revision.
sorry I cannot give you more
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Linda54,
Hmm, now you have me thinking, maybe the LD implant does roll like a 'normal breast would? Wow, a normal breast - that's amazing. The LD implant does sit like way lower than the prophylactic side, but when I saw the PS a month ago she said the LD implant hadn't dropped from where she put it but the prophylactic implant had ridden up a bit due to the pectoral muscle (and that's the implant that I think looks so good. I realize the LD side looks kind of squashed and maybe with my muscle in there it makes the implant act more natural.
Gee, you must think me crazy but I've had a wicked sore throat, migraine and flu this past week and with that all I could think of was maybe my implant was making a break for freedom! My implants are quite small, 225cc and 195 on the LD side, so they have never seemed to move at all until the LD one started up this last week.
I do trust my PS, just wish she wasn't so far away so I could just pop into her office and show her what I am concerned about. She did say when I saw her a month ago that in September the LD muscle will of done whatever it was going to do and she could do some adjusting - like putting a bigger implant in but I said I just would like them to rest equally on my chest. And I know, all of this has to be done before I get nipples, and maybe then I will feel 'finished' and only have to deal with 4 1/4 more years of Femara - yucky stuff.
Linda, don't know what I would do out here in Australia with the kangaroos and snakes if I didn't have kind women like you and Beth to guide me through this.
Guess I will just have to wait a while. I know I can see the PS sooner than my September appointment and you have sure helped to reassure me. After going through this last year, I have to admit, at times I just can't stand the thought of a complication or this nasty BC ruling my life!
Have a good weekend!
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justagirl
you are welcome
I stay on the boards in hopes of helping my sisters even if it is just a kind word. There's not to many of the LD girls that stay active on the boards.
My PS recommended doing a bi-lat LD so they would match. I agreed to let him do both sides. I cannot relate to having one side LD and one side with just an implant. I never had any complications except the tightness. I could have not had the revision but I thought what the heck I have come this far might as well get them looking good. LOL
have a great weekend
I have always wanted to visit Australia..I have a client who is from Australia but has been in the US for a number of years. I love to hear him talk. When he first called me I thought someone was playing a joke on me. hehehe
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Linda,
I orginally asked the PS about doing bi-lat LD and she said she never took a muscle she didn't actually need. I could see her point, but if I had had bi-lat LD's then the foob's would have a chance of looking similar. I did realize before the surgery that they wouldn't look alike, and I think once either the LD side gets raised or the simple implant one is lowered and then finally nipples and tat's,I am just going to have to stop looking in the mirror when I'm naked!
I've been in Noosa, Queensland, Australia for the past 14 years and before that spent 4 1/2 years in New Zealand. I am actually from Kauai and an american like you, so no accent.My son is aussie-speak through and through. Oprah came here, so can you! You are welcome to stay with us if you ever get this way! Truly.
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Hi Ladies! I started another thread about LD Recon, but saw this one with so much great info I decided to hop on here and ask my questions! I had a prophlaytic mastectomy in April, with tissue expanders. My left side did fine, and is expanded to 750 CCs (I'll probably get another fill tomorrow at my PS appointment). However, my right side had numerous problems and had to have the expander removed. I'm currently in the healing stage- and am going to have LD recon on that side in a month or so. (Maybe sooner, will see what the PS says tomorrow). I'll have an expander behind the LD flap and eventually an implant.
What can I expect as far as pain and recovery? I've been pretty much sleeping on my back since the surgery- I would much rather be on my side but am more comfortable on my back. Now, I'm scared after this surgery that'll be taken away! Is there alot of pain associated with this- or should it not be too bad since I've already had the mast. and it's only on one side. What things do you suggest I take to the hospital and have on hand for recovery? I know I'll have drains, but not sure how many (yippee...ugh)
Anyway, any advice or tips would be very much appreciated! Thank you so much!
Michelle
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Hello Michelle
First let me say that everyone's experience is different. Don't let any one person's experience scare you and also don't let someone's good experience give you false hope that this surgery is a piece of cake. I did not have any problems with my surgeries. I had a bi-lat MX with immediate bi-lat LD flaps with TE's placed. I prepared myself for this long surgery.... my recovery went well considering I was cut on both sides of my body front and back. I do think the healthier you are going into a surgery such as this the better and faster your recovery will be.
The only thing I wished I had taken to the hospital was a pair of silky bottoms. I had a hard time getting out of bed and then back in and I think the silkies would have let me slide. I am short so a step stool would have been nice. The first time out of the hospital bed was horrible. Each day was better. I was in a lot of discomfort...not what I call pain. When I got home I only took 1/2 pain pill at night thinking it would help me sleep.
I would sit up all day but ready to go to bed at night and ready to get out of the bed in the morning. I was very uncomfortable. I was able to sleep in my bed with lots of pillows. I had to sleep on my back and it helped to put a pillow under my knees. DH had to help me in and out of bed. I hated so bad to wake him up when I had to go to the bathroom.
I am a side sleeper. You will be able to sleep on your sides again.
I'm a hairstylist, I was back at work in 4 weeks. It depends on what kind of work you do. If your job requires lifting then recovery would be longer...a desk job may be shorter time.
As far as preparing for when you return home, I think since you are having only the one side done it will be easier for you when it comes to getting things out of cabinets and etc. I had to put all my "things" at a level to where I could reach them. I could not reach because of having both sides done.
I hope this helps you. Please let me know if there's anything else I can help you with. You can do a search (click the search button at the upper right of screen) and type in LD flap or Lat dorsi flap and then scroll down that page and you can read all the post related to this subject.
please keep in touch.....
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justagirl
Thanks for the offer....doubt I will ever get to visit unless I win the Lottery....
Yes, Oprah's visit...if I only had 10% of her money...LOL
I am so sorry you are not happy with your results. There's a downside to all of these surgeries. None of us are 100% happy. I just wish I had my itty bitty titties back...I never liked them and had a hard time finding bras to fit but at least they were me and not something foreign. :'-(
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Linda,
Don't get me wrong. I am happy I had the DM wit the LD flap on one side, but now wish the ps had taken both LD muscles so I would look more even. And, I am super glad for the reconstruction versus a DM with no implants! I guess I should start not looking at myself naked in the bathroom mirror with my reading glasses on! In reading your posts, I see that having the DM isn't the final step I thought it was. I know in September when I see the PS again she will suggest another surgery to neaten the LD breast up and I'll agree to it even though part of me just wants to get my nipples on board! I can see where it will take until this time next year to finally have the tattooing done and then I can say my reconstruction journey is over.
I've regained 100% of my flexibility and now there seems to be no residual weakness due to taking the LD muscle. I look at you and marvel at how you were able to go back to work as a hair stylist just 4 weeeks after double LD's - superwoman!
Like you, I wish I had my little 34 B's back. I'm not upset about the lack of feeling in my breasts as far as my own sexuality goes, but with all the heavy gardening work I do, I am concerned I'll poke a hole into one of my implants when a branch or something comes up to my breast area.
I know these silicone lumps are me, but it sure is a gradual process to get used to wearing what feels like two lumps of play dough on my chest!
The 'shifting' feeling of the LD implant that I asked about last week seems less. I think being sick just made me more sensitive to everything.
I realize it's only been 12 weeks since my DM but I am trying to adjust and be accepting.
My kind GP tells me my breasts look just like a Barbie doll's! That always makes me laugh and cheers me up as it sure is easier on my old brain than to think I am weird looking and so not nornal....but then I guess this is my new normal. Ok!
If all of us could even share 10% of Oprah's money it would be like winning the lottery? Think she would like to adopt all of us?
Thanks for your guidance Linda!
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Michelle,
Linda gave you some good advice for your upcoming procedure. You may have two or three drains in and they are good as you don't want that fluid to sit in your body. Take some good books and magazines with you and silky like pajamas. Also robe and slippers as you should be out of bed within two days. At first your chest arm and back are going to hurt and ache quite a bit so stay up on your pain meds and muscle relaxers. Be sure and ask for help to get in and out of bed! Sit on a shower chair while you shower and ask the nurse to help dry you. I had the most pain from my back and it did take about three weeks to settle down. You will be significantly impaired with your arm movement on that side also, at first but slowly but surely it stretches and you will be able to reach more and more.
Be sure to ask your ps to refer you to a physio by week 6 for massage and stretching. My ps doesn't believe in any weight bearing exercises until week 12 so I didn't but I did stretching under the physio's guidance and now at week 13 I am doing weight bearing strengthening exercises. My ps also wanted clear paper tape on my incisions at all times for the first 12 weeks but after 3 weeks I couldn't do it as the skin got irritated. When I started at week 6 with the physio she recommended Swedish Bitters (a naturopathic ointment of extract from leaves and flowers) to the incision and it worked a charm. It made the incisions more flexible, flat and so much less visible.
After your surgery, be viligant and check yourself every day for any signs of complications, like infection. After I had my drains out the ps had to drain fluid from one breast about a week later and also from my back at the base of the incision. In fact, the back had to be done a total of three times. This is all perfectly normal.
Good luck and get yourself as healthy as you can before you have your surgery. Do whatever you have to do at home and work so afterward you can relax!
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