Latissimus Dorsi Breast Reconstruction
Comments
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Warrior, thanks for the compliment, but I look like I've got Frankenboobs next to you! I'm pretty happy with the shape now that I've had some fat grafting. Not so happy with the scars and patched up look, but there's nothing I can do about it except maybe get tattoos. I'm considering it. Something that I never in a million years thought I'd do prior to this experience. Maybe they'll make me look badass as another woman on the picture forum put it. If I screw up my courage and actually do it. I'll decide after I find out how much the nipple tats hurt. I agree with you that the picture forum is a big help for women just starting on this process. Even though I look far from perfect it's several orders of magnitude better than I was after my mastectomy which is obvious in my series of photos.
Frill, yes, that damn radiation, pardon my expressive language, is the problem for lots of us. It's why I had to have a flap of some sort, and prior procedures ruled out everything I could get locally except the LD flap. That said, at least I look good in clothes and have the added benefit of not having to wear a bra. I've always hated bras.
Madison, I don't think radiation rules out round flaps completely. I had a consultation with a PS who was going to try to use them so they must sometimes be an option. But he did say he was going "try." I ended up choosing a different PS because he had a longer track record with this procedure. He always uses elliptical flaps. I think he wants as big a flap of healthy tissue with good blood flow as possible to increase the chances of a successful outcome. That may be why I've had no complications, but it does give me the lovely
patch of skin that doesn't match the surrounding skin. Some people are luckier with matching skin tone so it doesn't show that much once the scars fade. Maybe I should have gone with the other guy, but my gut said to go with the very experienced surgeon. As far as anatomical versus round implants, I think either can be fine. I've seen great and not so great photos with both types. I don't know if you never get the grapefruit look with an LD flap, but certainly the bottom will be fuller because of the flap. Also, are you having the LD flap done on both sides? I did not. There was no reason to do it on the side that didn't have radiation other than for symmetry. My PS considers that medically unnecessary so does not do it. I had to agree with him. I didn't really want one muscle moved around much less two. I didn't have any choice on the one if I wanted to reconstruct, but I did have a choice on the side that didn't get radiation. If you're only having the flap on one side, you won't have the fullness from the flap at the bottom on the side without it. That said, that doesn't necessarily mean your PS can't achieve that in other ways. I got anatomicals. The reason my PS prefers them to rounds is that he hates the "step off" that you can get at the top edge of rounds. In his experience, his patients are happier with anatomicals, but that's just his experience not everyone's. The step off can sometimes be fixed with fat grafting, but grafts sometimes fail especially in irradiated areas. (That damn radiation again!) Some people don't mind the step off. I had a little bit of it at the inner top edge of my left implant which didn't particularly bother me but bothered my PS. Since I was getting some fat grafting for shaping elsewhere he went ahead and fixed that too. So far the fat grafts have survived even in the irradiated areas. Fingers crossed that continues. Good luck to you! You might want to look at the picture forum. I have the same screen name over there as here.0 -
2Tabbies- You look great too!! It is encouraging to see such great results with LD Flap. I am only having the flap done on the radiation side, and just a TE put in on the non cancer side. LD was my only option I didn't qualify for any other flap. I will see what my PS has to say about the shape of the skin flap and the style of implants he originally said her prefers round. Its funny how each doctor really has their preference. I saw another guy here in Michigan who prefers to do only anatomicals. I am a long way off from the exchange surgery so I have time. I won't be able to do the exchange until I graduate from college, 6 months after the flap surgery.
Not sure if this is the same for everyone but how much can your TE be filled at the time of surgery on the flap side?
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Tabbies - I barely felt the right areola tattoo and could not feel the left at all. No numbing, no medication...nothing. BTW, let's not forget where we were last year facing the distinct possibility of not having boobs again.
Nash - You PT description goes far beyond what I'm understanding of. My first PS who did my BMX told me she would only refer me for PT if I really needed it. My current PS required it for months before scheduling me for the LD surgery. So not to be misleading, I can feel that I've had major surgery. I have to stretch a couple times a day because I feel tight. I have my husband massage my scars because I worry they'll stick to my ribs again. However, you'll read some very disturbing accounts here of LD results. I don't have pain, there isn't anything I cannot do that I did before and I'm actually more flexible than I used to be from all the stretching. I think that is good. It sounds like your PS team knows what they're doing. I did do the lying over the cylinder tube. I'm not sure what that was for. I assume I'll have to keep doing what I'm doing for the rest of my life. I am concerned that if I were to stop things would stiffen up quickly. I certainly hope continued treatment produced great results for you. I really think being in good shape before my dx was to my advantage although I understand your concern about having a lot of muscle.
Madison - I was so drugged I cannot remember the TEs after the LD surgery. Normally they fill them as much as safely possible. I did have to go for fills like when I had the TEs the first time but not nearly as much. The muscle give a lot of fill.
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WW, do you have any problems with a feeling of having an "iron bra" on? I think that tends to be neurological and (bad) luck of the draw, person to person, but I was curious if that was ever an issue for you.
That's impressive that your PS had you in PT for months pre-op; I bet that would have really helped me, especially considering my tight muscles via genetics and skating. I think my PS gave me an unrealistic expectation of how to feel post-op, b/c she told me I should feel perfectly fine at the six week mark. I'm 9 months out and am struggling to function as well as I did before the surgery. It is helpful to know you still stretch a couple of times a day and massage the scars. That gives me a more realistic picture, and I am highly encouraged by your results. Thanks again for sharing your PT experience.
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Hi Nash -
From my own experience and the accounts on here, 6 weeks seems to be the magical feeling better point. However, feeling better means no more pain meds, able to return to normal life, etc. It does NOT mean back to normal and feeling normal. I don't know anyone who is "perfectly fine" at 6 weeks. I don't know my time frames but everything has been a gradual process. I still feel tightness when I'm sitting too long and not stretching. I had the iron bra before the LD. I'm not sure that it got worse after the LD and over time it has gotten much better. I only feel it now and then and it doesn't bother me anymore. My PT says it takes about a year for the iron bra to go away. Everyone is different.
One of the best things that happened for me before my LD surgery was receiving a private message from a woman on here who had the surgery several years earlier. She described feeling fine, doing well and no limitations. She said the only thing different about her life is that she doesn't do Lat Pulls at the gym. That saves me about 15 minutes a week. LOL! And her message gave me hope. It's gradual, Nash. Nothing magical happens at 6 weeks. We just have to keep up the PT and all that we need to do to be well. I figure I'll be doing this for the rest of my life. I don't have much of a choice. This will hopefully keep me more limber when I'm an old lady. I really hope to be there one day.
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Thank you so much for your reply, WW. You've given me a lot of hope and inspiration.
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Madison, you're very sweet. Thank you for the the compliment. I was in the same position as you - no options but the LD flap. And like you, I had it only on the radiation side with just a TE then implant on the other side. Regarding your question on fills, I think it varies depending on your situation. I don't remember exactly how much they added each time. I think it was between 60 and 120 cc's. I do distinctly remember the huge feeling of relief I had immediately after the surgery and even before my first fill. They had done a small fill during the surgery, and even that little bit which gave me a slight roundness, went a long way toward making me feel comfortable in my skin again.
Warrior and Nash, I don't do lat pulls anymore either. No big loss.
Warrior, yes, we're both better off than we were a year or so ago. My big question now is do I get decorative tats to camouflage the scars and flap or not. Not an earth shattering problem in the great scheme of things.
Nash, I do have some tightness around my chest, but I wouldn't describe it as an iron bra feeling anymore. My back scar feels a little tight when I move in ways that stretch that area, and my foobs feel sort of like they're in a bra all the time. None of it is uncomfortable. Just different. Btw, I'm wholeheartedly behind PT even though I didn't have any. I wish surgeons would recommend it more routinely. I've been lucky that I had no range of motion or other issues. If I had, I'd have asked for PT.
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Tabbies - I'm having a hard time picturing decorative tattoos. I also don't know your style. Some are more creative with their personal style than others. I keep thinking of a woman I know who had giant augmented breasts that were too big for her and a giant flower on one of them. You can probably tell that I thought it look hideous. My concern about using tattoos to hide scars is that it could be like using perfume to hide body odor. What concept ideas do you have or have you been given? My personal opinion is that if it's done tastefully and it matches your own personal style it can be very cool. Otherwise, I'd give the scars more time to fade. What is your PS saying?
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Warrior, my PS suggested it because he knows I hate the scars and especially the flap. I don't want dragons (like my niece has) or skulls or something out of science fiction/fantasy books like so many tattoos seem to be. I was hoping for something that looked like a botanical illustration and also a realistic bird. Nothing cartoonish. I was thinking of a fern. Maybe a maidenhair fern because they're delicate and lacy. I'd want it to be somewhat minimalist not solid ink over my entire chest. For the bird, I'd like a chickadee to remind me of my mother. She loved them, and I've always liked them too. I was thinking of getting that on the scar from my port. The problem with waiting is that I'm not sure if I'd have to get it done at the same time as the nipple tattoos for insurance to pay. The artist I consulted said insurance would pay, but I need to clarify with her whether she was just referring to the nipple part. I thought she meant work done to cover scars as well. She showed me some photos of work she'd done to hide scars and even camouflage the uneven shape of breasts after lumpectomies. She did a great job. I'm still up in the air. As I said, I've never wanted a tattoo, but this whole experience has changed my outlook. Maybe it's time to get a little wild and crazy. It would also mean that when I looked in the mirror, I'd see something I chose not something that cancer and the medical community did to me. I have months before I can even get the nips done. I've still got necrotic tissue trying to heal up on the nipple on the flap side so nothing will be happening tattoo-wise anytime soon. If I had your outcome, I wouldn't even think about doing it, but I don't.
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Tabbies - After I posted my comment I thought about it a lot. I remember many years ago seeing a woman with a BMX who did not have reconstruction and instead had a vine like tattoo wrapped around her. Two things impressed me. First of all, it looked really good. Secondly, she was very proud of her body. It made a lasting impression that has stayed with me for decades. If insurance doesn't pay and it is something you're going to feel good about, it's worth saving for. It sounds like your tattoo artist can help you with ideas. I love your outlook. Now I'm hoping you go for it and it is spectacular.
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Thanks, Warrior. We'll see. It's a bit unnerving since it's permanent, but I might take the plunge.
Right now, I'm pissed off at my insurance company. I just got a new EOB from my exchange procedure from last June. They are saying a lot of it isn't covered including, get this, the implants. I know that by law they're required to cover reconstruction although not 100%. But how on earth can they not cover the implants? That's just absurd. I will be following up on this. As if I have the time and the energy for this aggravation.
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It's aggravation but that's the insurance game. Usually I get the statements at 4 PM on a Friday afternoon and I spend the weekend worried. I've had 10 surgeries. I think my tally is higher than yours. A few times it had to get worked out with insurance but they always paid. This is a game they play with hopes of saving money. The game is called "Make the crazy woman with BC treatment even crazier".
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Warrior, that does indeed seem to be the name of the game.
Jo, bring on the cookies!
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Yes, please pass the cookies!
I am wrapped up like a mummy today and sore all over after fat grafting and skin grafting yesterday. I SURE HOPE IT TAKES!!
My ps is wonderful, and I trust him, but until I see whats under this surgical bra I have trouble believing.
Like many of us, I've had infections and failures, and I am one of those few chemo patients whose hair didnt return as well as it should, so I am so skeptical about everything. ugh
Spring is only a few weeks away, and cookies to tide us over til then!
Hugs to all!
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I have been entertaining the thought of getting 3D tattoos over the LD scars for a while now. My thought is some kind of botanical/floral thing, like for example cherry-tree flowers with the scar itself being the branch (considering that usually scar tissue doesn't take the ink too well).
Anyway. 6 weeks after the surgery I had to fix the hernia and I am getting ready this time to sue my PS. He got away too many times in the past but this time I am going after him, especially with how rude he was at the appointment I had with him yesterday.
To explain: when he went in for the herniated muscle repair, he said he had to also fix a tear in the right pectoral muscle, and as I would be "under" anyway he was going to fix a SMALL dent I had in the right breast - that honestly didn't bother me much as it was in the inner bottom area of the breast.
Fast forward AFTER the surgery - I discovered that it seemed like there was too much fat missing from my abdomen, and also right breast seemed huge and I could see he had also done some fat grafting on the left one (remember, wasn't supposed to and I didn't have any "drawings" on it before going in). He said at the first follow up a week after surgery "don't worry it's all swelling from surgery it will go down". Not that I had put much faith it that as I had heard it before.
Fast forward a few weeks, things start looking worse and worse. I had contacted a lawyer I knew and told him to be on his guard as I might need his services after my next appointment.
To sum it up: right breast is a cup size bigger than left - everything I wear skews to the right very unpleasantly, I need to put padding in a bra (and freaking wear a bra) if I want to look normal; there is a dent on the LEFT breast (the one that didn't have any issues) that is right at the inner top of the breast that makes it so that now I can't wear cleavage anymore; I have HUGE dents in my abdomen. I had lost weight very carefully and very patiently so I wouldn't get hanging skin on my abdomen - he went in and took a huge horizontal chunk of fat that now makes me have loose skin and look deformed - all my hard work on losing weight slowly, using creams and specific exercises so I'd have a good looking abdomen out the window. Moreso, above that area, he only took fat from the right side (and a sizeable chunk of it too) so I am deformed. I am not going to post here the whole discussion, just the fact that in the end he declared "he can't help me" and "I needed a second opinion" and "my results are beautiful". Are you freaking kidding me?!?
Now these photos aren't very good quality as I took them with the phone in the bathroom mirror - waiting for a friend to come and take "pro" photos for my lawyere. But you can still figure out how mutilated my abdomen looks.
Would you sue over this? I personally will. I think i went through enough pain and suffering not to deserve to deal with yet another self-image issue, not to talk about the fact that it is painful, under each chunk of fat missing is very hard scar tissue and I can't even put a belt on my pants and have to pull them up constantly because it hurts.
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Seachain - A few thoughts are running through my mind. What are we told are reasonable outcomes to expect and what do we end up with? I would not be happy with a lumpy abdomen and it is something I worried about with fat grafting. You've had a lot of complications and I don't know what would be considered a good or poor outcome for you. What concerns me is that you're not offered any further assistance but he did recommend getting a second opinion. I know that in the process of reconstruction I had less than desirable results but my concerns were addressed. I always figured NOLA is where I would go if all else failed. They fix what other surgeons have screwed up. A malpractice lawyer could advise you on the legal end. I think separating the liability from the anger becomes important. I get angry when people are rude or just not listening to me. The fact that he thinks you should be a happy camper and go about your merry way and he is dismissing your concerns is a problem. A lawyer will help you sort out what you may actually be compensated for. Personally, I'd want to know my cost of fixing what can be fixed.
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Seachain, how frustrating and disappointing for you. I agree with Warrior that a big irritant for me would be that he's dismissive of your concerns and not offering any help. I wasn't thrilled with my results initially even though my PS was, but he never dismissed my concerns and was more than willing to work with me to address them. I'd be unhappy with the lumpy abdomen too. I probably wouldn't sue just because I'm loath to go through a lawsuit myself. But that doesn't mean you shouldn't if you have a legitimate case of malpractice.An attorney could certainly help you figure out if you do. I'd also get that second opinion. If another surgeon says he/she can fix it, and it's not going to cost you a lot, that might be an easier course all around. Warrior's idea of going to NOLA is also a good thought given all the complications you've had. Good luck with it. Just what you didn't need. Another problem.
JO, I didn't have a really awful day, but I'm so frustrated at work that I could scream. Yes, I have definitely been depressed. I still am, but it's improved. I think switching form tamoxifen to letrozole helped. I get down days, but not quite as far down as I was getting. Feel better and pass those cookies!
AnotherNYCG, I hope your fat and skin grafts take also! I'm sorry your hair didn't grow back as expected. On another forum, somebody else had that problem and said that they got a prescription from a dermatologist for that medication that helps men with baldness. Can't remember the name. Minoxidil? They said it helped. They also said there's a women's version but to go with the men's version because it's stronger.
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Guys, it's not anger. Or not just anger. The majority of my disability stems from this LD flap surgery. It's documented in my disability file. Then the herniated muscle that has been documented in a few cases that all involved improper prelevation of the LD muscle. The way he dismissed me and said that I should be happy with the results - I found absolutely insulting. Just because I'm 54 I should have to walk around with a lumpy abdomen because he decided during the surgery to go beyond the scope the surgery was supposed to be for, and actually mess up both breasts that were ok before that. I got better pictures today for the lawyer (who happens to be the same lawyer who did my disability case), you can get a better idea how he mutilated my abdomen.
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Seachain, I get it. If his screwup caused your disability, then yes, it probably is worth suing pending advice from your attorney. I don't blame you for being upset about what he did to your abdomen as well. I get the age thing too. I'm 58, and there have been times in this process when I've wondered if I would have been treated differently if I was younger. Not with my current PS, but with other docs.
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Thanks, 2T. I did look into minoxidil, but I am reluctant to try it because of possible side effects. I do go without my wig, but hair is nothing like it was before chemo. =/
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It's been a while and I thought I'd check in. It took me a while to catch up on all the posts - thank you everyone for sharing your questions, advice and support to each other.
I had my last TE fill a few days ago, now I wait 2 months before the exchange surgery. I have my date - April 29. I have been very blessed as I haven't had one issue with the Lat Flap surgery and subsequent "fill ups". No pain, I have most of shoulder range of motion back, I'm back at the gym running, lifting weights and even doing little tiny pushups on my knees. I'm limited in some things but just keep working at it as I can't have my left side always compensating. (Mastectomy was 369 days ago, Lat Flap surgery Nov 18, 2015.)
Until a couple of weeks ago I was having to "pad" my right side to get it even with the left, now I have the opposite problem since my right side is so full - lol!
Now i just have to figure out how to handle a couple of side effects of Tamoxifen, so I'm going to hop over to that thread now and catch up. Have a good day, everyone!
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It feels like such a long road, Tapanga. I'm glad your light is at the end of your tunnel.
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Just checking in after a LONG absence, it's the two year anniversary of my BMX with lat flap reconstruction. I know many women here have had difficulties and pain post lat flap (and I don't mean to minimize these in any way) but for people who are reading because they are trying to decide whether or not to have surgery I can say that I have had a mostly positive experience. No pain two years out, full range of motion, back to all my usual activities (dancing, swimming, biking, running). I've just recently started to do strength training and really cannot do pushups. I'm not sure if this will improve with time and my plastic surgeon (who I haven't seen in a year) isn't able to offer much advice (do I push it even if my chest feels tight or just give up on increasing upper body strength? He can't really say and I think doesn't really care. A minor problem considering most women's issues).
Every so often my back really hurts and/or feels tight (maybe once every few months). The pain is in my upper back and must be related to the surgery or missing muscles. It lasts a couple of days and seems to improve with motrin and heat. I can never figure out what triggers it -- doesn't seem to be related to activity. Other than that and the pushups I'm fine, happy with how my breasts look (have not had nipple tattoos, still debating), never need to wear a bra which is nice. For my surgery I took two months off of work, and it took a few months for sure to feel back to normal. I never had chemo or radiation (DCIS and BRCA+ were my reasons for surgery).
Hope that helps anyone who is considering the procedure. It's a hard choice. Best wishes to anyone who is still struggling with issues from this surgery.
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gabriella, thanks for stopping in. I had good luck with this surgery too. I'm also back to doing everything I used to do. No pain at all. Just some tightness around the scars.
Jo, how are you doing? Any better at all?
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Sounds more like muscle spasms. The remaining muscles can't compensate for the LD missing. I am plagued by muscle spasms, any time I have to keep my torso erect for over half an hour it becomes quite unbearable. You might want to ask for some muscle relaxers - I have Tizanidine for during the day and Flexeril for night time (Flexeril works better but makes me sleepy)
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Gabriella, careful with that upper body strength. The mild exercise I did managed to split my right pectoral muscle and it needed repair.
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What you are describing as "up and down your spine" are muscle spasms from the spinal muscles (erector spinae) that run along the spine. The other ones may be several things, now it depends where exactly you are feeling the pain. To me it does not sound like nerve re-growing, those usually feel almost like there's a wire with live current discharging. What people don't realize is that there are a lot of muscles affected and touched when the LD is prelevated. Where exactly is the pain located in relation to your lower ribs? There are three possible causes - in my opinion and using the medical knowledge I have - I am attaching a drawing showing the pain area for the situations described below:
1. Could be costochondritis. That is a condition that many women who have mastectomy + implant, with or without LD flap (but it is to be noted that with the LD flap reconstruction the risk goes much higher) who develop this condition. Even if the actual cause of the pain is the inflammation of the joint where the ribs meet the sternum, sometimes it can become a referred pain to the flank and even to the back. The pain would be felt at the level of the lower 3 ribs. Green color on the drawing
2. Could be spasming of your serratus posterior inferior or your internal or external oblique abdominal muscles (the last ones were the ones affected in my case, those were the "frayed" ones that had the fascia ripped and herniated). The pain would be below the lower ribs; if you'd trace a vertical line marking your side, it would be in the fleshy area between 1"-2" in the front of your side line to about a hand-width behind it. Blue color on the drawing
3. Did you check your kidneys lately? A kidney stone or even a mild kidney infection can cause stabbing pains in the flank. Purple color on the drawing.
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Thank you! Scar tissue. That is the main area for the scar tissue that is specific to LD flap breast reconstruction. The scar tissue is made worse if you had any seroma in that area post-surgery. Most of the time it feels like there's a fishing hook somewhere in there that pulls on certain areas when you move (and even when you don't move). The scar tissue pulls and also can envelop some nerve endings that were cut during the surgery. It's part of the "iron corset" syndrome - the regular mastectomy gives you the "iron bra" syndrome, us with LD flap breast reconstruction are fancier and get the "iron corset" on top of that.
It does get better with time. You need specific scar tissue breaking massage. Check if your insurance covers therapeutical massage and ask your dr. to refer you to a physical therapist who specializes in that. It does get better with time, especially if you have that massage. I used to need it done monthly, now I barely need it done once a year. The scar tissue will tighten back after the scar tissue breaking massage, but it takes longer and longer to do that as time goes by.
My physical therapist taught me a very nifty little trick that really helped - my insurance only covers 15 physical therapy sessions a year so when I needed it done very often I had to do something for when I was running out of paid sessions - and it's very simple to do. Get a tennis ball and an empty pillow case. Put the tennis ball in the pillow case. Sit on a chair with a high back. Hold the pillow case like if it were a bag and throw it over your shoulder so it would be between your torso and the back of the chair. Lean on the back of the chair and start moving around so the tennis ball will actually massage your back. You can adjust the position where the tennis ball needs to be by pulling or releasing the pillow case.
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Thank you so much for this info, seachain. Exactly what I needed. I have iron bra and iron corset. I tried to get my PT to understand at least the iron bra thing today (after 8 months of spinning our wheels) by using stronger descriptive words like "boa constrictor" and "bp cuff". Her response? A lecture about mindful diaphragmatic breathing, and the inquiry--"have you seen a psychologist"?
I'm so livid I could spit.
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Jo--If I wasn't comfortable with a mammogram, I would not have it done. No matter what the doctor said. JMO
I hope you continue to heal, it's been such a hard journey for you.
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