Latissimus Dorsi Breast Reconstruction
Comments
-
Honeybadger, I'm not giving up my healthy habits if for no other reason than they are long time habits. I also don't want to put on more weight. I'm not convinced they did anything useful regarding my ovarian or breast cancer. The exception might be my lymphoma. I suppose it's possible that could be more aggressive than it has been if I hadn't had a healthy lifestyle. As far as getting stronger, I'm fighting just to maintain what strength I have at this point. You and AnotherNYCG are probably younger than I am and more likely to get stronger. I'm just trying to hold off any more of the old person problems that are showing up. I hadn't expected to get those until I was at least in my 60s.
0 -
Lat flap surgery coming up in a couple of weeks. Drain in the front I assume will be at the same site or near where my last one was in the spring. But drain in the back too? Hmmm... how did you ladies sleep while the back drain was in? On one side? On your back but just a little raised so the drain didn't pull? Was the drain more on the side than your actual back?
0 -
Hi all. I'm so glad for this thread. I've learned a lot. I've had "conversations" with a few of you and I appreciate the support of this board.
As some of you know, I've had numerous infections (starting all the way back in 2002 & jumping forward to now when we decided to try this reconstruction thing again). My body just keeps rejecting any expander they put in on the left radiated side. So my ps & I have decided to try an LD flap.
Due to all the infections (seriously a lot of them) I've had in the past, I'm extremely nervous to do this. To go through such a surgery, only to have my body reject it, would be horribly depressing.
Oh and the first thing to get infected for me every time is the drains! And they stay infected until removed. I soooo don't want drains but will obviously have to have them. I really don't want FOUR😕. I forgot to ask the ps how many I'll have. Is 4 the usual number?
Anyway, it looks like I have a tentative date of December 22nd for the surgery.
0 -
Thank you Jo for your opinion, I do appreciate it and the experience / knowledge that you have.
The thing is that I have gone without breasts for 14 years (my bilateral mastectomy was on December 26th, 2001. I was 25 y/o at the time. Since I couldn't keep the left expander, I opted to have both removed) and it has greatly affected my self confidence. I totally stopped caring about the way I dressed or even how I looked. The left side of my chest is sunken in greatly due to all the scar tissue that was scraped out after the expanders kept failing. I have to wear socks underneath of a prosthetic on that side (to push it forward out of the sunken area) just to look 'somewhat' normal....for years I didn't wear anything, telling myself that I didn't care when in fact I cared very much.
Back in April when we decided to try having expanders placed again, I felt myself getting excited about my appearance for the first time in so long. I looked forward so much to having "that shape" again. When the infection started to come back, I could feel myself start to slide into that old pit again. I cried for days (while staying in the hospital). I didn't want to feel that sense of loss anymore. I was able to keep the right side expander (no radiation on that side) and I find myself looking at it constantly. Even though it doesn't really look anything like an actual breast, just the shape of it.....just the shape makes me tear up after all these years.
Though I am incredibly nervous about this surgery, I'm also excited. I really, really want it to work. I know you did as well and so again I truly appreciate your telling me your story and how you would not do it again if you could go back to that decision.
0 -
Ruth, I felt the same as you about being flat. I don't know how you have tolerated it for so long. I only lasted about 10 months trying all the different prosthetic options and hating all of them as well as hating the way I looked flat. At that point I knew I had to try reconstruction. I didn't want a flap, but radiation ruled out just expanders and implants. The lat flap was my only option because prior surgeries ruled out the other flap procedures available locally. Not that I wanted those even more complicated surgeries anyway. As Jo has said, it's possible for complications with the lat flap. I was lucky and am in the majority who have not had complications. I have no pain and have good range of motion. Do you know why you had so much trouble with infections in the past? How is your PS addressing that issue? It sounds like he's doing a lat flap without an expander? I don't get that because you usually need an expander as well as the flap, but maybe he has a different way of doing things. I had 3 drains total for this surgery. Two were on the left (the lat flap side) - one in the chest incision and one in the back incision. The third was in the incision on my right side where they just put in an expander. Good luck, Ruth! I hope it works out with no more blasted infections!
Jo, have you tried the microbead prosthetics? There's a woman who custom makes them. I bet she could make you a saggy one. She only charges something like $15 too. Here's her web site.
0 -
Thank you Jo, I appreciate all prayers coming my way! I will pray for your healing as well.
2Tabbies, I will be getting an expander. The theory is that the damaged skin & muscle wall is the reason behind all the infections. The hope is that adding new muscle and replacing the radiated skin will help that side accept the expander.
If I do get another infection and it has to be removed, then at least I know I tried everything I reasonably could. I think if it comes to that I will have the right expander removed as well, as I did 14 years ago.
The ps office called and my surgery is scheduled for December 17th (not the 22nd). I will stay in the hospital anywhere from 2-4 days. I'm sure he will have me on a variety of antibiotics for awhile. I see him on Dec 7th for pre-op and will ask him. I'm allergic to a lot of meds, so we will have to develop a plan ahead of time. He's already told me that I'm not to exercise except for light walking for 2 weeks. And no driving for the same time period.
0 -
Hi Ruth,
I think you will be pleased with the lat flap in the long run. I must admit, it was not comfortable, but also not as bad as I feared.
My PS tried tissue exp and then put in small implant on the side that had been radiated, but it didnt heal 100%. He caught it before any infection started, but he said it was imminent. He thought he could fix it, but ended up having to remove the implant on that side. He put a TE back in at that time. The skin was so thin that he convinced me that Lat flap was the only way to go. My breasts were small to begin with, so that TE was never expanded and I went right to small implant a few months later. Healing has been slow, but all in all it has been ok.
(I, too, had an infection soon after bmx so I am always concerned about another!)
My range of motion has improved, but it is still a bit painful to reach behind to slip a coat on, or to take some clothes over my head, so I am meeting with a PT dr on Tuesday. Perhaps it will help, - but if not, that's ok, too.
There are times I've said that I wouldnt have opted for reconstruction if I knew it would be such a long drawn out procedure, - but I now think that I feel much better about my appearance than I would have. I still need to have fat grafting to fill in a couple of areas, and I may see about those 3D tattoos so that I dont look like Barbie boobs, but I have time to decide that.
You are much younger than I am, and I think that if you have a GOOD PS, - one that has done MANY MANY lat flaps, you will be fine!
Hugs from NYC!
0 -
Ruth,
Of course, the decision is up to you. However, I would suggest you personally do your research. I had a bi-lateral mastectomy lat flap a little more than two years ago by a well-known (and well-respected) plastic surgeon in Atlanta. It has been a complete disaster for me. I know many women do not have problems, but I am in chronic pain and I, too, feel crooked. I was very active and cannot swim or bike or play piano (for an extended amount of time). I go to Turning Point (they are amazing!!) for physical therapy and my physical therapist said she sees the most problems w/ those who get lat flaps. I haven't read all of the posts, so I don't know your body type. I am thin and was told I was not a candidate for a diep, but have since seen another plastic surgeon who thinks differently. Anyway, like I said, the decision is up to you and I don't want to be a bummer, but getting a lat flap was one of the worst decisions I ever made.
However, I can completely understand you wanting to have breasts. They're such a part of our femininity. And 15 years is long, long time. Whatever you decide, I wish you the best outcome.
0 -
Also, I'm wondering if anyone has had their implants removed. I am definitely taking them out and am either having a diep during the same time or doing the diep further down the road. Does anyone have advice about doing both or waiting? Thank you!!
0 -
oh wow, ok I'm a bit more nervous. Thanks for sharing your experience Shannon. Unfortunately I am obese, even in the morbid category which disqualifies me from DIEP. I have lost some weight recently but do not have the luxury of waiting a year or more which is what it would likely take for me to lose the close to 100 lbs that I need to.
NYC thank you for sharing your experience as well. It is much appreciated. I know this is going to be a long road. My numerous infections (which included weeks in the hospital and then home IV antibiotics) were definitely no picnic and I understand this has the potential to be much worse. My husband is a Physical Therapist Assistant which does give me a little advantage in that regard.
0 -
Ladies
My respect and honor to all of you!
My ps tore my rotator cuff and ligament in my shoulder during my last flap. Going through that sugary and extensive recovery has been far worse than my cancer trestments! I am in PT 2-3 times a week for 8 months!
the Lat Flap has left me quite tight under my arm but I am very pleased otherwise. I plan to never wear a bra again! I have no nipples and I am very happy with that decision. Who knows...maybe one day I will get a wild hair and get them tattooed on.
I wrestle with a mild lymph edema on that arm. I wear a sleeve every day. Thank goodness I found all the fun ones at Lymphedivas! I've looked into lymph node transplant surgery but it's much more involved than I thought. Think I will table that idea for a while.
0 -
Hi Ruth,
I didn't want to give you information that would make you nervous, just aware. Sorry about that!! I know it's a HUGE decision. I just don't want anyone to go through what I've been through. However, every surgery is different for everyone so you may not have any problems at all. Actually, your plastic surgeon may be able to take less muscle than mine did. I am surprised that he is using implants, though, as you should have enough tissue. Perhaps you should ask him about that if it's a concern of yours. Good luck!!
0 -
I didn't realize that lympedema had redness (as this presents) as a symptom. I have mild lympedema myself and am very thankful that it has never really caused any discomfort other than swelling & looking pretty unattractive. I hope that this gets cleared up for you soon Jo.
0 -
Hello everyone!! I have not been on this site it seems like in forever. I was going through some anxiety so had to take a "cancer" break, it seemed like reading posts and coming on the 2 different sites I visit was making it worse. I am better now and wanted to check in to see how everyone is! I had my total hysterectomy and oopherectomy, breast revision and hopefully my last surgery forever!! I am happy with my boobs now. I wasn't going to do the surgical nipples, was set on doing the 3D tattoos but now I am wondering if I should get the nipples. I Have been longing for normal breasts lately and especially nipples. Its really weird because I have not had these feelings before and was determined I was just doing the tattoo. Anyone have the nipples done and have any feedback for me??
Kathy
0 -
Jo, I hope your doc is right about the lymphedema. I have it in my leg from my ovarian cancer surgery, but it's never been red. It's a pain in the patoot though. Like the new avatar!
Kthielen, good to hear from you! I'm sorry about the anxiety. I sometimes wonder if I should take a break from cancer sites because of my depression. I do for a few days sometimes. Regarding nipples, I'm getting them in January. I thought about the tattoos, but decided it would be too much of a disconnect to look in the mirror and see realistic nipples, but look down and see flat skin. I'm glad you're happy with your new breasts. I'm not totally satisfied. In addition to the nipples, I'm getting a little bit of a revision in January to try to make the upper poles more symmetrical. What I really think I need is for them to sit higher, but the PS says there's not enough loose skin to do a lift on my non-lat flap side. This is nothing I can't live with, but I'm a bit disappointed in the droopy look. WarriorWoman got nipples a couple months ago. Maybe she'll stop by and weigh in that subject.
0 -
kthielen - I too have taken a break for a while. But saw there were new posts on this one so I'm checking. It's been a while since all of my surgeries.
Regarding your nipple question. I totally felt incomplete and couldn't look in the mirror....then I got the "nipple". After that a tattoo to give it some color. Huge difference in how I feel about my fake ass boob. I had the one where they use the existing skin and sort of origami it into a nipple. It did go flat a lot, so it doesn't exactly match the real deal on the right. But it's sort of there, and the tattoo made it even better. I would recommend both.
0 -
Jo, it sounds like that red area doesn't like pressure on it if it got worse with the massage and compression foam. Despite what your surgeon thinks, LE massage does work. It reduced the swelling in my leg immensely. But it might not be the right approach in the area where you have that redness. I don't know what to suggest for that area. Maybe just time. I didn't have a huge "loaf" under my arm. It took months to go down. I didn't do anything special. Just left it alone. It sounds like yours is going away just more slowly than you'd like. I don't blame you for being impatient with it considering all you've been through and all the setbacks.
jwilco, good to hear from you! Thanks for the input on nipples. Maybe when I get mine I'll feel better about my pseudo-boobs. My surgeon makes nipples the same as yours. The origami method.
0 -
Hi Ruth,
I too had to have tissue expanders removed after two infections, and the second one landed me in the hospital with sepsis. After that, the PS did not want to try implants again and suggested the lat flap.
At first I was confused because a lat flap requires tissue expanders and implants, but the PS assured me that since they are introducing a blood supply by bringing in the muscle from the back that they don't usually get infected. The muscle brings in your own tissue into that space which usually means the implant behaves.
I was set to do the lat flap, but I really didn't want to move muscle, so I worked with my original breast surgeon to explore options. He connected me with a surgeon who does the DIEP flap that is not too far away for me: Dr. Chu at IU in Indianapolis. So, that is what I am planning to do now.
Dr. Chu did his fellowship at U of Penn where he did 250 DIEPs in a year. He mentioned that at the U of P, they don't limit who can get a DIEP, so it is possible to have it when you are overweight, but too much weight does increase the risk of a failed flap. The lat flap is more reliable.
In any case, before I decided on the DIEP, I did some research on the lat flap and found that it is a pretty stable surgery with good outcomes in general. I met with a friend of a friend who had it, and she was happy with her results. As with any breast reconstruction, the important thing is to use a surgeon who does it a lot and has plenty of experience.
HTH!
0 -
You might want to check more into the LD flap reconstruction. Not everybody has happy outcomes. There are quite a number of ladies on this forum who had big issues from it. Not from infections, not from failure - but from how much the body can be affected by not having that muscle working anymore. I am on disability because of that. Make sure you do your research because the plastic surgeon will NOT tell you the truth about the real possible side effects that will, unfortunately, last for the rest of your life.
My foobs look gorgeous but I can't even open a jar by myself.
0 -
Thank you so much for the advice & encouragement BigSister-2015. It was very helpful! I have been reading up a lot on the procedure (I do wish I could have DIEP instead) and am feeling more confident in having it done.
Seachain, thank you for the warning. I'm so sorry that you've had such complications. I truly hope that you can overcome & heal. I'm definitely going to continue to do much more research. I have a bit more than 4 weeks to go and I plan to know everything I can about this surgery. I can always back out if I feel the least worried.
0 -
If I didn't trust my surgeon to tell me the whole truth, I'd find another surgeon. From everything I've read about this procedure and what 3 different plastic surgeons told me, the complication rate is very low. But of course, low doesn't mean zero. I'd definitely find a PS who has done a lot of any procedure I was considering and ask him/her about his/her rate of complications.
0 -
Thank you for the input on nipples! I will try to PM Warriorwoman:). I made an appt with my PS on Monday to see pictures and explore the option a little more....I know he does the origami as well.
2tabbies, I started Effexor about 3-4 weeks ago to help with the hot flashes I have been having since my hysterectomy but think it has helped with my mood as well! I feel like I wake up in the morning feeling rested and am not having the extreme fatigue I was having prior. Not sure if it's the Effexor or just going through a good stage. I guess I will find out in a couple weeks to see if I get back in a slump.
You ladies are amazing and I appreciate all of you!!
Best wishes,
Kathy
0 -
Kathy, I'm glad the Effexor is helping you. I think it has helped me as well. I could use a bit more help and still have down days, but I'm better than I was.
0 -
Jo, - I have those sharp needle feelings when I least expect them. At this point, I have so many pains and aches coming and going, all over my body, that nothing surprises me any more. =/
I assume there must be nerve damage from all the surgeries. Residual chemo nerve issues remain, too.
I still rely on tylenol now and then, - but those needle like feelings are gone before any pill would take effect.
Hope they pass quickly for you, too!
0 -
I heard my name. I've missed everyone but I'm doing well by focusing my life in areas that are unrelated to cancer.
Jo - It's so hard to know what is going on. I have often had weird things happen that sent me racing to a doctor. Ultimately I've learned to call for an appt. the minute I notice something to get it off my mind. I am so happy when I go a week without thinking I have a recurrence, LE, an infection or any of the others things that cause me to panic. When I was going through the big mess, someone told me it will all work out if I can be patient. It was good advice for me and gave me hope.
Kathy - Thanks for the PM and I did write back. I say get the nips!
Ladies - I love my nipples. They make me look normal and no, I don't need a bra. For clingy shirts Ulta sells silicone pasties that cover them. I'm scheduled to see Vinnie in 2 months!
Big Sister - I was at Penn before switching to Steven Copit. Penn doesn't have anyone with expertise in lat flaps and that is extremely important for this surgery. As you've likely read, some women do very well and some do horribly. I was very lucky. I have no pain, no complications, full ROM and I am very happy with how I look. My 2 best suggestions for lat flaps - go to someone who does them all the time and get PT starting before the surgery. BTW, Penn wouldn't consider me for DIEP because of being too thin. Trust me. I'm not too thin.
Tabbies - I've missed you. I'm glad you're finally getting close to done. From the sound of things you;re feeling better about your outcome. My PS said something I liked. He referred to my scars as my body art. Well, it's not the design I'd have chosen but it does make me feel differently about them.
0 -
Warrior, good to hear from you. I'm glad to hear you've been able to focus on things other than cancer. I don't know if I'm feeling better about my outcome. I try to concentrate on other things and not think about it. If I do that, I feel ok. If I look in the mirror, I still get angry. Then I feel bad about that because I know people with way worse problems than weird looking fake boobs. I just wish some part of this would turn out as I want it to. I found out recently that I can't get my nipples positioned where I think they belong because one foob has a scar there (right across the center). My PS says they belong higher than center anyway. But when he drew circles there, it looked weird to me. Way too high. Lower, and we run into the scar. I don't know what to do. I'm still wondering if different implants would be better. I should probably just get over it and move on. Yes, I'm getting therapy. It hasn't helped yet.
Jo, I can't remember if I answered you, but I didn't try massage or compression on my underarm swelling.
I hope all the US folks here are having a good Thanksgiving.
0 -
Jo5, My surgeon gave me neurontin for those pains you're describing. It seemed to help.
0 -
Hello, Everyone. Thought I'd check in here, and give you a quick update as well.
Had my lat flap surgery 10 days ago. It is totally weird for me to think that my back muscle is now in the front (along with a tissue expander) but so far so good. Got off the pain meds and valium before the first week was up and now just need a Tylonol from time to time. Had 2 drains, neither gave me trouble, I did have a little sensitivity to the tape on the dressings which gave me a couple of blisters and itchy spots. Drains came out after 1 week although the back one should've probably stayed in but PS wanted me to not have it over Thanksgiving and so I could shower. I'm collecting a bit of fluid back there as she thought I might but will take care of that in a few days when I see her again. I've become extremely adept at napping, but the hardest part is staying quiet (partially for the fluid build up, partially for the healing). I'm home from work, feeling OK, there are things to do around the house, I want to exercise- but I have to remind myself often I need to take it easy. I am definitely thankful for my husband who has taken good care of me and my mom who was able to come visit for the first week and help out while he was at work.
I hope you all have a great weekend.
0 -
Tapanga, glad to hear things are going ok. Definitely rest and don't use your arm too much to keep the fluid accumulation to a minimum. Look at it as your chance to be pampered for a while.
0 -
The "loaf" can't be helped, as it's not swelling, it's simply the LD muscle itself, as it comes from right behind the axilla towards the front. It will very slowly go smaller as the LD muscle atrophies after the thoracodorsal nerve is cut. Also, very helpful in getting that "loaf" smaller is to... lose weight. I had put on a lot of weight due to the treatment, and was able to lose it only after I got off of Femara after 5 years of treatment. I lost 60 lbs and the "loaf" is almost non-existent now. You can see how it looks in the enlarged photo that is my avatar, I have posted it in the pinned "breast reconstruction photos" thread.
The "fluid accumulation" (seroma) is not responsible for the "loaf", see above. The most common areas where you may get seromas build up are the reconstructed breast itself as well as the area on your back where your LD used to be (bottom 2/3rds of your back, essentially). If you feel that there's liquid build up there - it's actually easy to feel, press gently with the tip of your finger like you'd check a water balloon half-deflated - be very assertive in asking your PS to drain the liquid. A lot of PSs prefer to let the seromas slowly and naturally drain in time, but that actually creates a lot of scar tissue that will take even longer to go away, and will require a lot of therapeutical massage for breaking scar tissue. It will give you a horrible feeling of "iron corset" where you will be unable most of the time to take deep breaths. Believe me, I've been through this for about 5 years - now the scar tissue is much softer but it seems to tighten in bad weather - and I'm 6 full years after the surgery!
Also, please check my thread on "what PS don't tell you" that links to a study about what damage to the thoracodorsal nerve and to the LD can do to you in terms of disability. It's VERY important.
0
