Latissimus Dorsi Breast Reconstruction
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Michelle - I am a recent bi-lat flap patient. My bi-lat was delayed. I had complications at BMX and had no choice except lat flap for recon. I am getting my final TE fill tomorrow and then I'll be waiting until late August for exchange to implants. This is a major surgery, but it should be manageable for you. You don't say whether you are right handed or left. If the surgery is going to be done on your dominant side, be sure to follow Linda's instructions to move things down so you aren't tempted to raise that arm before you are allowed to.
Do the exercises that they give you when allowed. Get yourself into physical therapy as soon as you are allowed. I am experiencing a slow recovery on range of motion on my left side. It is the side that needed the most tissue/skin and the lat relocation is very tight on that side. You have to keep stretching and working it through the expansion process.
I have been using Scar Guard on my incisions and can see improvement with just a little over 3 weeks of use. I highly recommend the silicone scar therapy. I would recommend that you discuss the back donor site scar size with your PS. I needed alot of skin flap, so my back scars are really long and can't be hid in a bra. I have seen other women that get the flap in a horizontal flap donor orientation and they are able to hid the scar in a normal bra or conservative bathing top. You may have some choices on that, so discuss, discuss with your PS.
There are many variations of the actual flap placement and the amount of lat muscle that is used. My surgery was Advanced Lat Flap meaning they used the ENTIRE lat muscle on both sides and moved and sutured it to my sternum. Be sure that you are clear about how your PS does the flap. My flaps start in the inframmary fold and come 1/2 way up the breast all the way across. I have seen other variations in shape (elliptical, football, round, etc) in addition to partial muscle or full muscle relocation. You want to know what they are going to do BEFORE the surgery so you can state any preferences if a modification of style is possible.
Your final size is determined greatly by the size of the flap donor skin and how much skin stretch you can handle during TE expansion. Most experienced PS can tell you about what you can expect given the donor site on your back. Bottomline is that they can only work with what you have back there to give.
Ask any questions that come up. There are no dumb questions when it comes to your reconstruction. There is a wealth of knowledge on these boards.
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Linda - so happy to see you still posting with all your wonderful advice. You certainly helped me in the past.
Joiedevivre - if you are still on.... I too had always wondered about the extra skin, so thanks for clearing that up. I understand completely about the wider shaped breast which I don't like either even though I am 50 it makes me feel like I'm odd and matronly. Where my real ones didn't make me feel that way.
I'm going in next week to talk about lipo to see if he can get rid of the "extra pillows under my arms " which are so uncomfortable look icky with sleeveless or bathing suits and in wearing a bra it is just painful as it hits right there. Heard lipo is extremely painful so a bit worried about that.
I hate the nipples I have. He told me using the back skin is so robust that the only risk was having them stick out too far. Well not so as mine are totally flat and just makes me feel odd. He doesn't want to change anything as he said if it went too far the other way for my age it would be worse. He is also about my age so I don't think he meant it ugly.
Well, I had been concerned about having a massage due to lymphadema and such so when I saw my BS office for a one year check up they said it was fine. So today I went. This wasn't a "regular" massage, but this woman is a massage therapist. I went because of the iron bra, the really tight and painful back and numbness in arms ( I also have MS so might be that) and also for siatica problems when I lie down. Well,,,,, she was amazing! first of all I have so much more of range of motion. She didn't rub or do anything but find fasha points and tight scar tissue and she held it and it hurt a bit then quit and then I could move...it was really quite facinating... well see how I do sleeping. If my legs don't hurt then it will be the first time since 1990! I think it really worked! Anyway I'll update on how it goes.
So glad this thread is still going!
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Thank you everyone for the wonderful advice! I saw my doctor today and got my fill on my left side. I'm now at 850 ccs which is where I wanted to be. She said in a few weeks she'd fill me another 100ccs to give room for the implant when it FINALLY comes time for exchange
She looked at my right side and said it had obviously started to heal well. Some of the skin had softened, but the bottom is still hard. She said she wanted to wait until everything in the area felt soft and "squishy" which would give her good tissue to work with. It'll probably be 2-3 months..she said she promised to have the surgery over and all of the drains out by September when I start nursing school again.
I'm fairly active and am in the gym alot. Almost all of the weight exercises I do works the lat muscles- which apparently works in my favor where this surgery is concerned. I have a nice, healthy latississmus to use, but I will have to have a TE placed under it.
She said she will use a horizontal scar on my back which will easily be hidden under a bra. She said the scar is not very wide. She said it will be an elliptical scar pattern on my breast- the only noticeable difference in the two breasts will be the scar pattern, since i have an anchor scar on the left side.
I was concerned about the muscle contraction issue- I had read where some people experienced muscle contraction of the lat on their chest when their back muscles contracted. She said she would make sure to divide the nerve during surgery so I will not have that issue.
I'm glad to hear that sleeping isn't IMPOSSIBLE. I felt like I went through so many pain killers the first month after my mast. but my doctor assured me that it was perfectly fine and she didnt think I had an addiction problem and wasnt about to call AA. (My doctor has alot of patience with me ha ha)
I'm a little worried about..logistical issues during surgery. I know that they have to cut the back first, and tunnel the muscle to the front. How am I placed during all of this? Will they turn me while she's tunneling the muscle? This may be one of the things I'm just better off not knowing...I have a benign brain tumor (from Cowden's syndrome..the same lovely genetic condition that caused me to have a prophlaytic mastectomy. Because a prophlaytic lobotomy is obviously not an option) on the base of my brain, so they always have to turn me on my stomach and lean my head over (I made my doctor swear not to shave any more of my hair then he had to) and I'm always SO SORE afterwards just from that.
Massage and PT is not a bad idea. I wish I had that NOW...I have several muscle twinges and aches. I've been trying to slowly get back to the gym and stretch amd walk. I don't really have any range of motion issues right now though. The PS said that I'm not limited as to what I can do at the gym but I didn't need to push myself and if I started to hurt then STOP what I was doing.
THank you all again for the advice and for being willing to share your stories!
Michelle
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I foudn out today that the pain that I have on my lower ribs and in my back below the scapula and towards the spine is from the serratus muscle. That I "pulled" while doing some minor workout. My PS said it "is a pretty common side effect of the LD flap recon" as the serratus tries to take over the function of the LD in maintaining the torso in upright position and when lifting weights and doing house chores. And also, the lateral part of the implant is under the serratus muscle as well.
So now I am on a "no work-outs for 3 weeks" and PT.....
This never ends... sigh...
On the optimistic note, he will do my fipples with local anesthesia, as I told him I am not going under general anesthesia if my boyfriend is not here (he left in April for Afghanistan) and I will have the final fat grafting after my boyfriend comes back next year.
So at least I will have nipples when he comes home for leave!
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Hi girls! Interesting information you have shared here.
A short update on my latest attempt at increasing foobage: PS nurse took a look at the skin on my left side and said WHOA! She didn't feel it was safe for her to make the call in putting more saline in. Long story short, I had to wait for the PS to get out of surgery....he looked at it and also expressed concern. Said go ahead with 30cc but if you get skin split or small hole going, we will take you to immediate exchange. PS says if I go slowly I may be able to get another 30 to 60cc in but it is in highly risky stage right now.
As a reminder, there is an obvious size difference between my right and left sides with TEs (both had 270cc). They stopped putting anything in on the right side and we are trying to get another 60cc in slowly to help with symmetry before the exchange. PS now says he thinks he can get in 350 implants but doesn't think there is room for a 375 implant. He will have to modify the right side to get them closer in size.
Whippetmom had looked at my stats and we were hoping I could get to a 375 implant.
I am trying not to have boob greed. If we can get another 60 in without a failure, I will get exchange on 07-27-11. This journey has been so hard emotionally. I envy all the gals that went straight from BMX to TEs to Implants and forward.
I am going to take it easy for the next couple of days and see how the skin holds up. I may decide not to do any more fills and just go in for exchange with what I have. Some foob is better than no foob to me.
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Beth,
What's wrong with boob greed! All we want are semi-normal foobs, and lose the constant reminder of BC.
Spliting skin or a hole in your breast tissue is worrisome. Maybe think a bit smaller for less complications and let the PS modify your other side to get a better match.
I don't think the stats take in mind how fragile your skin is and it's history. I've gone from being a 34C to a 34A-, small to avoid fills and complications. Sure, it's an adjustment. All of my form fitting clothes are too big on top and none can be altered. As it's often very warm where I live, I have a ton of sundresses and tops with little straps....but for me it's worth it. My implants are only 195 and 220cc's. Not worth putting a bra on for now but it was my choice and my PS was quite suprised and said 98% of the women she did wanted the same size breasts or larger. Years ago after a DM we wouldn't of had the option of implants and would of ended up with concave upper chests and as a nurse since 1983 I have seen many of these on older women. I felt a little tit was better than none.
Emotionally, I think I know what you are feeling, though my situation is different. I thought 3 months after the DM with permanent implants I would be getting nipples but now I have to wait to mid-September to see how the LD side settles, then I will need a touch-up surgery and then hopefully nipples three months after that.....It just seems to go on and on.
All I want is completion and closure (and foobs I'm comfortable with!)
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Debbie, - I hear you on wanting it all to be done and over. I think with time, I will adjust to having small foobs and get on with my life. I am embarrassed that I have such body image issues and wanted to be "just like I was". My old boobs were sagging and not that great, but definitely real and my own. I look at my body now and immediately go into an obsession that I will have to bootcamp rehab all the rest of it because it looks out of balance to me without my large breasts.
I decided last night that I am done with expansions. I am going to sleep on it over the weekend, but I intend to call the PS office and have them move up my exchange date and get on with it. I may be able to get my exchange by the middle of July.
When I get the OK after exchange to go back to full exercise, I am going back to the gym and working on making this body look as good as it can with little foobs.
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Dear Beth,
I just read your post and I'm crying. You don't know how strong and brave you are. You have NO reason to be embarrassed about your concerns over your body, boobs and foobs.
So much has been taken from most of us. First we get scared to death because we are told we have BC. Then we get part of a breast cut off or a whole breast, then chemo which makes us as bald as an alien (though I have never seen one), then our boob, if there is anything left of it gets fried with radiation and then we get to swallow a pill every day which robs us of our female hormones, makes us ache, dries our skin and tries to turn us crazy. The finale is getting both or boobs amputated from our body and new play-doh ones attached on that have no feeling and have people tell us (or they at least tell me) how lucky I am. Which part?
Your old boobs may of had some sag, but they also had sensitivity and a long history with you. I just don't think it's an easy thing to surrender to, and I'm not saying to give up! You may decide to accept your smaller pert foobs and it sounds like you are.
Women's magazines and all these movie stars have done a number on us as to how we should look. Also, heaven help us if we age - that's a no-no too.Since I have been cursed with BC I am not fearful of aging. The alternative is too grim. I say don't give in to aging and do what you are comfortable with to make yourself feel better. Just getting outside and walking 5 days a week for 30 minutes can have a tremendous effect on your metabolism, weight and emotional well-being. Go to the gym or do whatever but make sure it's something you really want to do. All you need is your winning smile!
PS: did you finally calm down that area under your arm which was giving you so much discomfort with swelling?
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Debbie - I don't mean to make anybody cry! I'm just keeping it real.
Thanks for making me feel special today! I've been a take charge/no prisoners kind of gal most of my life, but I have to admit that this BC thing really tested me emotionally. I just don't think I am as strong as I used to be. It's knocked me down a notch or two and shaken my faith in my own ability to handle the bad stuff and keep smiling.
I have really decreased my activity on the side that swells. Heavy activity that activates that lat muscle on the right side causes me to swell up. PS says it isn't normal this far out from the surgery. He says we will address it after exchange if it doesn't resolve during the exchange phase. I suspect that it is truncal LE, but I just don't know for sure. They only took 4 nodes on that side. Can a person get LE with only 4 nodes gone? He says he will need to do a little liposuction on the area under the arm. I will let him lipo anywhere he pleases because I have definitely put on the weight during this BC journey.
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Beth,
I am actually crying tears of joy that you are not beating on yourself for not being able to attain bigger foobs.
Anyone can get LE with the removal of nodes and the area under the arm is very susceptible. I saw this a lot in my nursing career outside of the hospital as people in our community who knew of my profession sought me out for advice. I have 3 suggestions for you: when sitting and watching tv, use pillows to get your elbow higher than your shoulder - helps decrease the dependent fluid in the tissues. If in the morning and at night before you go to bed you could take any creamy lotion and spend 3 minutes massaging the area and if you could rope your DH into the night one it would give you a better range. Wear nothing that presses into that area but gently encompasses it - like spanx.
You and I sound so alike. All my life when I have seen something that needs to be done I just attack it with a vengance. We have moved from San Francisco to Los Angeles to Kauai to New Zealand and finally here to Australia. I've made it through 32 years with my DH and at 41 went through IVF to have my son - had to fly monthly from New Zealand to Kauai for IVF as NZ said I was too old! While living in Kauai, two hurricanes 10 years apart demolished my home. My parents were nonfunctioning alcoholics and I am the youngest of 4 and the only one to finish high school and have 2 university degrees. No, can't do, isn't in my vocabulary.
Never doubt yourself! You are handling everything so well. This BC stuff is not cut and dried. This was a full-frontal attack on your physical and mental well-being and you have met the challenge.
Now, rest up, prepare for this surgery and look forward to the rest of your life. I do think exercise will help, as even though I am a long distance runner, my 30 minute walks have been a life-saver. They give me health, centering and a time to think or not think. Could you now fit a 30 minute walk into your day at least three or four times a week?
My husband saw me on this website recently and said why was I here becaue I don't have BC anymore. Sadly, and I accept it for me, it's just not something I can put in a drawer and forget about!
Hugs to you - you are a warrior!
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How's everybody doing? I'm still unpatiently waiting for my exchange on July 22nd.
I have a 30yr class reunion coming up over the July 4th weekend. Dress shopping has been less than fun. It's so challenging to find anyting that fits the TEs and doesn't show my scars coming up on the edge of my underarms or the bulges at the dog ears on my back. Are we all hyper sensitive about it when no one may notice at all?
Am I in a funk or is this normal? I usually love to shop, but now it's difficult and no longer fun. I'm thinking about recycling a dress that I have had for 10 years just to avoid having to go out and look again. When it comes to shoes, I could shop all day. Maybe I can wear the old dress with some killer new shoes!
I don't want to put too many false expectations on the exchange surgery, but I hope it makes it easier to find clothes that actually fit.
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Beth,
Good to hear from you. Of course you are unpatiently waiting for your exhange!
Wow, 30 year renunion - you realize most of the people there will of also undergone physical changes over the years, so you won't be the only one. If someone is looking at your scars on the edge of your underarms, they should get a life! If you are concerned about scars and some 'extra you' peeking out on your back, instead of wearing something reavealing, think about soft material in the colour that compliments your skin tone and hair, and have it graze your body, not be form-fitting or sleeveless.
YES, we are all hyper-sensitive when it comes to how our body image has taken a blow, all thanks to bc....or at least I am......... I think you are in a 'normal funk'. These renunion times can be stressful at best, so wear something you are comfortable in. It doesn't have to be new - old it 'new' nowadays. If it will put a smile on your face and a song in your heart, go girl and buy a new pair of dancing shoes!
I don't think a person would be telling the truth if they said they didn't have great expectations from the exchange surgery. I just hope for you it brings closure to this chapter in your life.
Before I had bc, I had difficulty finding clothes to fit and now I have a closet full of clothes that are way too big all over because of the weight I lost due to chemo and stress. I have gone from being a 34C to a 34A- Size and clothing from a size 10 to a size 4. Even my pajamas are too big. I would be rejoicing at the overall weight loss if I had gone on an exercise binge and diet but as it was all due to nasty bc, I haven't welcomed it. I am just now learning to accept my body changes. My son dislikes my very short pixie hair, since my hair before chemo was past my shoulders, but I am happy to just not be bald. Acceptance of the things I can't change is still a challenge for me.
I do think being in a funk is normal. My dh is the only person I know who is in a great mood all the time. He chooses to not think about sad or bad things. It's not that he isn't aware, just doesn't think letting it bother him gets him anywhere. Hmmmm.
Have a good weekend and go girl - get those shoes..........
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Thanks Debbie! I am headed shopping tomorrow. A girlfriend suggested a store that carries dresses that are more modest and I AM going to find something PLUS some shoes! Retail therapy here I come!
I'd like to see a pic of you with that short hair. Attitude is everything and you strike me as a gal that can sport it well. Hope you have a great weekend too!
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Beth,
I haven't let anyone take my photo since I was diagnosed last year. People used to say I looked 20 years younger but no one says that now. I do feel every one of my 58 years but I am not ready for grey hair and orthopedic shoes. Now the comments are that my short hair suits me - well, I don't exactly have a choice! My son had never seen me with short hair, so I guess to him this is a constant reminder of the bc....like any of us need reminders.
I have had so many challenges in my life, and I did take having bc as another but it was the biggest to have my health, well being, the security of my family and my life longevity threatened. Nasty, nasty BC - just go far, far away.
I would love to see a picture of you all dressed up on your big night on the town!
PS: there is spannx which cover the top part of the body and decreases bulges in the tummy and back.......just a thought.
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Ok girls....I went shopping for Tops and a dress. I am pleasantly surprised that I will be able to wear a small shirt off the rack! I had always suffered with shirts that hung off my shoulders in order for them to be big enough around to wear without popping the buttons off or being too tight. I think I may like being smaller breasted just for the ease of shopping.
Debbie ~ I found a fantastic dress that is modest on top and fitted through the body. It's a Calvin Klein black/white animal print and drum roll.......size 4! I always wore a size 8 before to wrap around my chest. I feel so svelte and I haven't lost a pound, just lost alot of BOOB! I got some great new shoes and I'm all set for the Class Reunion.
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Beth,
Za za voom! You will be the belle of the ball! See, there is some advantages to being smaller on top! A size 4 is teeny tiny!
You sound so much happier and that is ever so nice.........
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Debbie
I needed to shop some and see that all is not lost....just changed. I can live with this size. I can't wait to get the exchange. About 1 month to go.....and the countdown will begin at the 30 day mark!
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Beth,
What a good excuse to put some serious $$$ on your credit card!
So thirty days from the 22nd?
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Debbie,
Yes, July 22nd is E-day for me!
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Beth,
I'll countdown with you! Guess at the hospital they don't have too many people looking forward to surgery!
I would assume it will be a short surgery, time wise, and a short hospital stay, which all is in your favour. I think you are ready to get on with your life.
I'm looking at September to go in for a lift and an equal size implant on on LD flap side. The PS wanted to let the muscle have more time to atrophy and lucky me, the fat bulge under that arm has gone way down, so may not need liposuction. I do have a good size dent at the top now, and I can clearly see where the implant ends. Hmmm. I did think about just leaving it this way but am not happy how that foob hangs so much further down than the other and the implant feels loose under the pec muscle, compared to the other implant, which now seems part of me.
Have a good week. It's freezing cold here (not really freezing but I like to run around in shorts and tank tops) so I best get the fire going to warm the living room for tonight.
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It's been hot and stormy here. I have to remind myself that you are in a different hemisphere!
I have no idea about the time required for the surgery. I'd rather he take the maximum time needed to shore everything up. I assume he will alter the right side flap to make that one smaller so it will better match the left side. If he doesn't do it at exchange, I will be looking at a revision surgery in the future after that. I really don't want to have to do the revision, but like you, I want it right and it is worth it in the end to get it right and feeling like a real part of you. Strange how different the two sides can be.
We are officially at day 30......so the countdown begins! I know it will go by quickly because I have alot of activity going on at work and home, plus the reunion weekend. I also want to use my pool as much as possible. I won't be using it for many weeks after the surgery. I look forward to summer pool season every year. It's relaxing to float and sip a cool drink and take in the nature. I am watching my little hummingbirds feed and dart all around. They are amazing creatures!
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Beth,
Yes, I am quite a ways away from the US. When my son and I visited Kauai (where used to live) last November it took 16 hours of flying time to get there! I want to take him to see my home town of San Francisco and Los Angeles (lived there too) but dread the flight. It's so hard to sit in that cramped seat for so long.......
Hmmm, I am imagining you floating around your pool with an icy drink in hand, relaxing, listening to your hummingbirds and soaking up the sun rays (with sun block, of course). Just be sure to not go into your pool until your incisions have healed on the surface tissue - you don't need an infection. I know it is your pool but just to be one the safe side! We have a pool too, and acres of privacy, so I am getting your drift. I like to read in the pool!
Can the surgeon make the flap side smaller without removing any of the muscle? Yes, I agree with you - I just can't accept my breasts until, with the PS, they are the best they can get. For me, with a LD flap on one side only, I think my breasts look very strange. My PS says all will look better with nipples and tattooing and she put the flap skin incision on the innerside right where the tattooing will cover it up so looking at it straight on she said the difference in the superficial skin from my back won't be noticeable.
I remember when I first looked at my breasts after the surgery I was amazed to see something there. I started nursing in a era where a mastectomy left a women with a huge horrible scar and a concave area where the breast tissue was removed. I am ever so thankful for modern medicine and the skill of my ps. The ps said she understands how emotionally difficult it is to wait between surgeries but it is necessary to wait 6 months after using the LD muscle to allow it to atrophy as much as it is and then she could get a better position/fit on the implant. She did suggest last time I was in on putting in bigger implants on both sides as there is space on the LD side, but I would rather her decrease the space than have her do surgery on both sides and get bigger foobs.
I am so bad, I hate bras and don't wear one when I am home except for gardening and running. I don't have anything much to support and they sure don't jiggle. Can't wear a bikini top anymore due to my smallness so buy tankini tops and alter them so the bottom comes just below my breasts. If I wore a bikini top I would have to use double sided tape to keep it in place and don't think that would work with water.
Are you getting your hair specially done for the reunion and a mani and pedicure?
Best go. Work calls.....
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Question:
How long did any of you have to wait after dm using a LD flap on one side to have the LD muscle atrophy and settle so the PS would go in and do adjustments? I had permanent implants put in at the time of the DM with LD flap on one side and the LD side implants sits like an inch lower than the other, and moves around under the pectoral muscle if I bend over or roll in bed and it feels so weird. If I am doing a lot to make it repetitively move again and again it actually gets sore. My ps said I had to wait 6 months from the initial surgery before she can go in and tighten things up?
What happened with you?
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Hi Day, Just wanted to check in with you because you have a similar story as mine. Double mx and lat flaps. Whay did your dr. choose to go back in and cut the pedicule instead of cutting the thoracordorsal nerve? Did he explain why? I'm still trying to figure out what to do. When he cut the pedicule, did you feel less strain/tightness across you chest? Did it also relieve your breast animation?? Do most people have the pedicule cut?
Thanks Day!
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Hello LD sisters...I have not been on in a while...super busy because of upcoming surgery. Hope all is well for all of you. I am having a total hyster with ovaries removed also and rectocele repair tomorrow June 30th.....I will come back and update when I can. Appreciate your prayers.
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Hi Linda,
I want to thank you for your encouraging words to me after my recent LD surgery. You were the only one that responded to me and I am very grateful.
You will be in my prayers. Be sure to rest and take care of yourself during your recuperation.
Looking forward to hearing from you soon!
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Dear Linda,
Sending good thoughts your way for your upcoming surgery and recovery. You have been inspirational guiding me through this maze. Hope to see you back posting soon!
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Linda,
Hope to hear that you are back up and doing well after this surgery. Take it easy...the hysterectomy part is a little rough on recovery. I did NOT enjoy the ride home after that one.
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Has anyone had a LD flap surgery recently who can advise me on some of my aches and pains. I had mine 3 months ago!
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Varshavaja,
I had bi-lateral advanced LD surgery just a little over 3 months ago. What kind of aches and pains are you having?
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