Latissimus Dorsi Breast Reconstruction
Comments
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Hey all. I have been reading all of your posts with much interest. I haven't gotten the call yet to schedule surgery yet mind you but In light of having no radiation and the fact I only had an MX, getting an implant anyway and a lift to the right. I'm kind of going back and forth in my mind to not doing the lat flap now and just going the TE/implant route. I'm still not going to have the best symmetry ever which is totally fine with me. They never were all that symmetrical to begin with you know. I'm so on the fence.
Is the result that much better with the flap?
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Wow...That Good To Know Kthielen, I am really leaning towards the LD, because the thought of going straight for the exchange with implants and the possibility of it not succeeding and I'll have to do t all over again, is something that I can't effort. I do appreciate all the response and positive attitude.
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Typically the lat flat is done if radiation is involved? Unless you are really thin I think they recommend it. The flap is the only surgery I have had so I don't have anything to compare it with plus I had radiation. I have been very happy with the results!
Kathy
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Wow...That Good To Know Kthielen, I am really leaning towards the LD, because the thought of going straight for the exchange with implants and the possibility of it not succeeding and I'll have to do t all over again, is something that I can't effort. I do appreciate all the response and positive attitude.
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Kthielen
Nope, no radiation here. I've seen 3 PS and I have the perfect tummy for the DIEP surgery but I can't stand the thought of such a long recovery. The last PS I saw said she could give me a really nice result with the LD. My way of thinking is if I can get a decent result with the TE/Implant alone, why go through the additional surgery. I'm not looking for perfection, just to look half decent which is what I told the last one. I don't know, I really don't
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Thanks Kthielen, if I may ask how long did you stay in hospital and how long was your recovery period? I m glad that you pull through and is doing well.
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light1,
I had my lat flap surgery done outpatient, didn't stay in the hospital. I took 3 weeks off work, but think I should have taken 4. I was driving in 2 weeks, my PS cleared me to start exercising at 6 weeks.
Best wishes,
Kathy
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my leftboob,
Good luck with your decision! I don't think I would have the lat flap if the PS thinks they would be able to just do the implants/TE....I'm with ya on that one!
Kathy
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hbb, that stick-on nipple looks very realistic. Quite impressive. Thanks for the recommendation. However, I don't want to ever wear a bra again so I don't want permanently erect nipples. Adhesives also give me a rash. I was debating doing nipples at all, but my PS insists they really help you "take ownership" of the foobs. He says he can build me some that will be flat enough to not appear erect all the time. I'll have them tattooed for color and possibly to give them more of a 3d appearance. After all the surgeries I've had, an office procedure to make nipples doesn't bother me.
Regarding the surgery, I was in the hospital 2 nights. Another PS I'd consulted said his patients usually stay in 1 night. The guy I chose was a bit more conservative and wanted 2. When I woke up from surgery, I had only small mounds. I had my first fill a couple weeks later. That's when I really felt like I had boobs again.As far as recovery limitations, my PS is a bit different. He doesn't have a lot of rules. He said I could do whatever I wanted but to do it slowly and stop if it hurt. I didn't drive for a couple weeks and was just very careful what I lifted.
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Light1, I have no problems lifting or with range of motion. That said, I don't think there's a best way for everyone. I consulted 3 PS's, and they all recommended a lat flap because of the high failure rate of implants without a flap after radiation. Had I found a PS who was willing to try making it work with my radiation damaged skin and muscle, I might have tried that figuring I could have the lat flap later if needed. But I was tired of checking out surgeons after 3 who all told me the same thing so I bit the bullet and went with the flap.
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Myleftboob, if I hadn't had radiation, I'd have left my muscle where it was and just done implants. That's all I wanted. I'd been planning on that for months because the PS I consulted before all my treatment didn't tell me that radiation would be a problem. I was furious when I consulted a different PS and found out that it definitely was a problem. (Even the first guy had recommended an LD flap, but hadn't told me why.) I agonized quite a while over doing the LD flap. I'm just happy it seems to be turning out ok as far as there being no loss of strength, etc.
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Thanks Ladies for the feedback. You know how they say go with your gut. My gut was always telling me to go the implant route but I had to investigate the other reconstruction types. I just booked an appointment for June 30 with the 2nd PS I met, whose work I've seen and liked and is locale for fills. Best of luck to all of your in your recovery.
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Myleftboob, good luck! I hope it turns out great. Be sure to let us know how you make out.
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Hi guys, I'm a little two week out from my LD and wanted to provide my experience to some of the questions I have seen recently. For those on the fence of LD, I understand it is generally used for people who cannot go the TE/implant route. It is recommended in those cases where radiation is know prior to the MX and is done at that time; or for many of us, who did not know they will be going thru radiation prior to the MX and the radiation damaged the skin beyond repair, it is used to reconstruct the breast after damage. I don't think it's generally an option if one is not going thru radiation or other complications; honestly I couldn't imagine choosing it if the TE/Implant is a good option.
My PS did the surgery in his office, so it was outpatient. I thought I would need a couple of nights in the hospital as well, but he said he only requires it when it's in conjunction with a MX. He prefers his office so he can control the envirnement. For me, it was such a nicer experience because of all the personal attention since I was the only patient.
Regarding sleeping upright, rather than laying down, I believe it has to do with drainage-which is so very important. I think if we were to lie down to sleep, fluid would accumulate in the sites and would be difficult to remove. I believe by remaining upright, gravity pulls the fluid into the drain.
For me, the surgery was not as bad as I thought it was going to be-as in my prior post, I was scared sh*tless. As I've recommended to others, I took the painkillers on schedule, whether I felt I needed them or not. The nurse said you want to stay ahead of the pain. My biggest discomfort and pain are the drains, which I don't think is the case for all, I think I'm more sensitive in that area. One drain was removed two weeks out and I'm still stuck with the one from the back-Aaarrghh!
I am quite surprised by the mobility I have with my left arm (the LD side). I lift it without realizing it and then get a heart attack when I see it lifted. My PS said that activity shouldn't be too hindered by the surgery. He explained that there are three levels of lat muscles and he uses the middle one for the flap; whatever strength is lost will be compensated for by strengthening the other muscles.
Please remember, these comments are only as they relate to my situation, everybody is different.
Hope this helps
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Keep feeling better and better Cali!
T2 and Cali, -thanks for the info! I hope I do as well tomorrow!!
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my leftboob - I had just implants last year that failed and the LD this year. The LD looks much better but is a lot more surgery. If I could have just had implants I would have but it wasn't in the cards. It did work out well for me in the long run.
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hi ladies, thanks for all the respond and information. Indeed there is no right or wrong way to go, when it comes to breast cancer and its treament 2Tabbie, we all just have to do what we have to do. It's a good thing though to hear from others experience and knowledge to help us all in our individual journey. Hats up to all those who has finished and to those who are in process, hang in there and be strong.
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anotherNYCGirl, good luck tomorrow! I'll be thinking about you!
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hi there LadIes! I met with my PS yesterday and got all of the details for my impending surgery. I will have to stay in the hospital 2 to 3 days and he said I will have a small b at first as I expand to the D cup that I will end at. He mentioned that he will put in a pain pump but that by the time I leave the hospital he will remove it because people are typically ok by then. did you guys find that to be the case? I am having difficulty picking my surgery date because it is now summer and all of my kids will be at home with me. How long before you all felt okay to leave the house even for just a short outing? My plastic surgeon really stressed that the surgery is not as intense as people often think it is. Do you agree? He told me I can lay down flat and I will only have one drain in. It is amazing how much difference there is in this field!
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And with regard to my stick on nipples, they do have ones with little or no projection. They can custom match your existing nipples if you still have them as well! They will even send you a mold. I'm sure it sounds like I am the sales rep for this company, I am NOT! But having gone three years without nipples and then getting such realistic ones I can't say enough good things about them! The adhesive is medical grade and stays on anywhere from 1 to 3 weeks but if you are someone that has problems that I imagine you should probably stay away unfortunately.
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hbb...I had the pain pump removed before leaving the hospital, but for ME...I was on pain meds for a very long time. I was filled to the size I am at the time of the surgery so never had to go in for fills. I had four drains and the last one lasted over an entire month until it split on me, and then the PS pulled it out. I was filled to 500 in my right breast and 550 in the left one...that was the breast that had radiation 10 years ago. However, because I want to enjoy my summer like you, I am having revision surgery in August and will swap out the left implant to match my right side. He said it should be no problem at all. I also had 3D tats done this past November and they look great!!!
But everyone is different and hopefully you won't have the problems I had. Wish you the best.
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hbb, there is a lot of difference in protocols between different surgeons. We also don't all get the exact same procedure so that probably accounts for some of it. Some people have both sides done. Some only one. Some have the lat flap on one side and just a TE placed on the other side. Some have a big back incision, but others don't. I had 3 drains - 1 in my back and 1 on each side of my chest. My pain pump was removed before I left the hospital, and I went home with just oral pain meds. That was good enough for pain control. I only really needed them at night so I could sleep easier. I will say that I needed them for a lot longer than I needed any pain meds for my mastectomy, hysterectomy or any other surgery. I wasn't instructed not to lay flat. It was just a lot easier and more comfortable to sleep propped up. I can't remember exactly when I felt up to going out on errands, etc. but I think it was within just a few days. Less than a week for sure. I didn't drive for 2-3 weeks though because it hurt to pull on the steering wheel especially in my car which steers hard. DH's car was easier.
The stick on nipples sound like a great option, but I haven't found an adhesive that doesn't give me a rash. It's highly annoying! If I decide I don't want another surgery, even a minor one, I'll just get the 3d tats. I don't have anything left to match so either the surgeon or the tattoo artist can just try to duplicate their own work on both sides.
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2 Tabbies I'm glad to hear you were willing to run errands within a few days. Father's day is a week after my surgery and I want to be able to go out or do something for my husband.
in my past several surgeries i usually decline 90 percent of the pain medicine after I wake up. Typically I survive on tylenol and xanax. I get a terrible reaction to pain medicine which is less pleasant than the relief it gives me so it does me no good to take it.that fact scares me though because I know this is a much more extensive surgery so I am a little worried about it. Hopefully I will persevere just like all the other times. 2 tabbies I'm glad to hear you ony took pain meds at night. That gives me hope that sounds a lot like my typical protocol.
Thanks again everybody for your help. I have a6,7 and almost 1 year old at home so it definitely won't be easy but it's time. I can't take the failed skin experience anymore. Three times is enough!!!
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Hello all! So great to hear mostly encouraging news about LD surgery. For once I'm not posting a question, but to offer my experience to HBB and everyone else. I've had awful nausea from the anesthesia after surgery and with several of the pain narcotics. My 1st advice is probably obvious: Make sure you tell the anesthesiologist if you are even slightly sensitive.
My 2nd piece of advice: Tramadol. It made a world of difference to me compared to the other narcotics. It still helped with the pain, but without the nausea. I'm sure it has it's down sides like all drugs. So please ask your doctor and do your own homework, but I hope this info helps someone.
Oh one more thing, by "terrible reaction" to pain meds, HBB, it occurs to me you may also be referring to constipation. If so, unfortunately I've been there too. Sorry for over sharing. Many Drs give or recommend stool softeners before during & after surgeries. Mine did, but it wasn't enough. It may sound frightening, but at the time it was the stuff of miracles: Suppositories.
Again, sorry for TMI. xo
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Hi, ladies. I am two weeks out from unilateral lat flap. The pain isn't bad and I have full ROM in my shoulder. However, I have unbearable tightness in my back ribs on the surgery side that continues around my side (waist area) and up into my ribs right under my new foob. There is some tightness in the new foob, but nothing like the back/side tightness. My torso on that side feels slightly swollen. I had three drains, two have been pulled, and I just have the one that goes into my back. Is this tightness in this area normal??? I read about the iron bra syndrome and all that, but this tightness seems to be different.
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Honey badger, thanks so much for your tips! I actually discovered tramadol with my last surgery and used it a bit. It does help! I do get all of the nausea and everything and the anesthesiologist has been doing a great job as far as I'm in the hospital. In addition to those other symptoms including the constipation, lol, I also get terrible anxiety, hot and cold, and occasional other symptoms with the narcotics and it just isn't worth it to me to take them and feel worse. Not to mention the fact that regular Tylenol has more actual pain relief than those drugs do milligram wise.
did you also have a pain pump? Did they remove it before you left the hospital? How many days would you say before you felt up to leaving the house after you got home?
And a question for everybody, as all of these questions are, did you have absolutely horrific pain from the tunneling when you first woke up? That is what my doctor keeps telling me to expect but that it goes away rather quickly.
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hbb, that's interesting what your doc said about bad pain from the tunneling. I did not have that. It felt like I had a rolled up towel or something under my arm, but it wasn't particularly painful. No worse than anywhere else.
Nash, I had a lot of tightness from my back around and across my chest. I can't say if what you're feeling is normal, but it sure could be. You don't have heat, redness and swelling like from an infection or seroma, do you? If you're concerned, call your surgeon. Answering questions is part of their job. I hope you feel better soon.
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2T, Now that I think of it, it was his scheduler that told me to expect that. Perhaps she's just trying to manage expectations by presenting the worst case scenario. So are you saying you weren't in horrific pain when you first woke up?Or just not from that particular area?
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Thanks for the reply, 2T. I actually had to go in to the surgeon yesterday to have a seroma drained (it was in the front), and she said the tightness/locations I was describing were normal. Do you remember how many months you were tight?
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Nash, I remember having that tightness(extreme numbness feeling)for prob about a month, at the time it felt like it would never go away!!
Hbb, I never had a pain pump, just took oral pain meds. I wasn't in a lot of pain when I woke up, the anesthesia is still working for a while even after you wake up
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