Latissimus Dorsi Breast Reconstruction
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i had LD delayed reconstruction two weks ago, I had left side only as only had modified radical mascetomy on the left side in may 2009. i am delighted so far, mine was a one step procedure using my ld muscle and skin graft from my back with a small implant to recreate a 36b bust. i will be getting the dressings off on tuesday and looking forward to it. i had three drains in and got two out on day two and the last one out on day four. i am great, still a bit stiff with some of my exercises and have to wear sports bra 24/7 for six weeks. its looking good so far, i could not go bigger as i was initally going for a c on both sides by getting a small implant on natural side but i had not enough skin on my back but i am very happy with what i got.
the recovery was way easier than expected, i have slight lymphedema and has not flared so far thank god. i can go walking etc no problem and off all pain meds with over a week. after the first few days i used to take one painkiller going to bed and that was it, for the turning but now is o.k. i could go back to work tommorow but decided to take an extra few days. hth someone deciding what to do. its like that chapter in my life is closed and now i can wear anything again, yes i have scars but i am not a bit worried about them. this was the only reconstruction i was eligible for as had rads for 7 weeks and deemed as unsuitable for other types.
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Hope ~ Glad to hear your spirits are good and that you are happy with the outcome. It's really a life changing procedure for us gals when we have been through so much and have limited options in reconstruction. Hoping your road to complete healing is uneventful and that you are back to regular life once again.
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Hope, how wonderful that you're doing so well, and pleased with your result. It is great to hear from someone who is having a positive experience with the LD procedure. Just curious, did your PS use the entire muscle, or only a portion with the skin island?
Aza
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sorry to be delayed getting back with an update on my hysterectomy but I was without internet for 5 long days.
My surgery went well but had a rough night at the hospital. The gas settling in my shoulders and just that nauseated feeling made for a bad night. Each day is better. The worst part is sitting around doing nothing. Thanks for your thoughts and prayers.
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Linda~I was beginning to worry about you! Glad to hear that you are back on-line and with us once again. The gas bubbles moving up is a bad part of that surgery. Luckily, it goes away, but still tough to deal with at the time.
I am on the E-day countdown. Just 17 more days! I am tired of fighting the rocks every night. I'm hopeful that my sleep will improve with the implants and that I can finally get comfortable after I heal up some.
Hello to everyone! Did anyone have any great things happen over the Holiday?
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Beth....the exchange was one surgery I looked forward to.....and the implants are soooo much better. Just 17 days....those days will go by fast for you.
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Linda,
Well, your surgery is past and it's wonderful to hear you are on the mend! Just rest up, read books and relax for a while! I'm sure you will be back working soon.
Beth,
Countdown time! How was your reunion? Bet you were the Belle of the Ball!!!!
My LD implant is hanging much lower than the other implant. I saw the PS and she said I had to wait 6 months from the original surgery so the LD muscle would atrophy and she could then go in and tighten things up and put in an implant equal in size to the other. Yikes.....and I still need nipples after that? I wonder if I can get her to do the nipples at the same time? Or if it's possible...probably not with my luck. So, 4 surgeries down and two to go. This just keeps on going........
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Hi Linda--I haven't been checking in lately so I missed that you were having this latest surgery. glad it's behind you and you are doing better. Hang in there, girl.
Take care,Bobbi
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Linda ~ thanks for the encouragement. I am SOOO ready to get the exchange. It's hot here and the days are dragging with discomfort. I know it will be over soon.
Debbie ~ We had a great time at the reunion. I wouldn't say I was the Belle, but I didn't look to shabby and it was so much fun to visit with classmates after all these years. A class officer put up a Facebook site for us and he posted photos on his Facebook site. We were a fine looking class.
I just looked at my avatar and I need to change it. Winter coat/scarf doesn't seem to suit the summer I'm going through here. Its 91 and feels like 100. Man it's hot.
Hang in there on the surgeries. I am blissfully denying that I will probably need a revision. If he doesn't cut out alot of the area above the flap on my right side, I'm gonna end up majorly lopsided after exchange. The right side is a full cup bigger! That left side skin just did not cooperate and still won't. PS said let's do the exchange and take a look at things after that. Hoping he is a pure genius and can do it all in the exchange, but I'll be having another surgery for fipples. This BC crap can't end soon enough for me.
I have a question about follow-up screening. My BS says that she wanted me on Tamoxifen. My oncologist said I didn't have to take it if I didn't want to. My BS said no need for mammograms anymore and that the PS will order breast MRI in a few years. BS released me and never said anything about going back to see her at all. Who monitors for recurrence? PS or BS? I feel like I got the hand off and somebody forgot to tell me where the ball went. I'd like to bury my head and believe that nothing will come back.
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Beth,
Lets hope for both of us that there is not too many more surgeries in our future....
As far as your question on followup screening I'll answer as a fellow BC survivor as well as a nurse:
My oncologist said I should take 5 years of Femara as in the chance of having any breast cancer cells floating through my body, by denying those cells the estrogren and progesterone they need it betters my chances for not having a reoccurance of Cancer.....and that's good enough for me. But, being me, I checked with my bs who agreed I should take the Femara and my GP said yes, it's like insurance. I think oncologists want us to choose treatment for ourselves rather than them mandating it and hopefully we will be more compliant. I say take the Tamoxifen. Between my oncologist, GP and BS, I feel well covered. I wish it were only one Dr but it's just not that simple. Now for reoccurrence: my bs said the chance of reoccurance of bc was less than 1/2% and every year she will have me get an ultrasound of the area surrounding my implants. If anything is detected, then an MRI....more insurance. I like the comfort of this and it's practical and easy. I detest taking the Femara, but after 10 months the side effects are lessening and I can and will continue on it.
I too, would like to believe I will never be touched by cancer again.....oh to be so naive...those days are past.
As far as you having more surgeries, I can understand why the ps can only do so much at one time, as the tissue where they are working swells up quite fast as they make their incisions and the 'fine' work can only be done after the major is accomplished and by then it's so swollen that is distorts where they need to remodel.
I don't mind the surgeries so much, I just resent the down time afterward. And, I would like to say I don't need any more surgeries - I am complete. I just want to get on with my life!
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Hi
I have not posted for quite some time and not at all on this topic. I had a LMX on 1/31/11 with reconstruction. Two weeks later the skin around the incision died and I had to have surgery to remove it. I woke up with a high fever and ended up with an infection. I lost my TE. To make a long story short. This week my PS has decide I am now healed enough to consider trying again but says my skin is to thin and wants to do the Lat Dorsi. I have a few questions that maybe someone can answer.
Do you have drains again with this surgery? I am scared of getting the infection again and no one can tell me if it was from the drains. My PS has said there would be no drains but what I have been reading it sounds like I will have.
I am a teacher assistance for children with disabilities. I lift children all day(any where from 50 to 80 pounds). Will I be able to do this after the surgery? I know it will take time but I need to know I will be able to go back to my job.
Right now I am just gathering info. So I can make an inform decision. Any advice would be greatly appreciated.
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dmho~
You are asking all the right questions. Alot of the answers depend on how much muscle and skin your PS needs to complete the reconstruction. Did he tell you anything about the size of the skin/muscle pedicle he wants to harvest?
The amount of impairment you will initially have is dependent on how much muscle is used, the size of the flap and the style of Lat flap he does. Not all PS do the same type of Lat Flap surgery.
1. Ask to see pictures of his patients. Ask to see both the front photos and the back scar photos.
2. Ask the PS to mark your body with a pen to show you how large the flap will be and the positioning on your breast mound. Getting this visual will help you cope with it and tell you more about the amount of skin/muscle that will be relocated.
3. The physical size, shape and positioning of lat flaps varies greatly from PS to PS.
4. Get a second opinion with a different PS and search for the best people in your area that are trained on the NEW lat flap surgery techniques. Send a PM to Whippetmom and ask her for PS recommendations in the area where you live. She keeps a list of PS that specialize in certain procedures and have good track records.
5. Ask specifically how MANY lat flap procedures the PS does in a year. If they only do a few....move to another PS. You have to do this procedure more often to be good at it and trained on surgical technique and improvements. PS practices that help alot of radiated BC patients will have someone in their practice that specializes here.
6. As to your question about going back to a job with a heavy lifting situation, I am not sure. I am now 4 months out from my bilateral lat flap and I don't think I could do a job that required that much daily lifting. Keep in mind that every person is different. If you are that strong now, and the lat flap is on your non-dominant side, you may have no problems lifting. I would consult with a physical therapist before doing the surgery to have them assess your lifting technique. They can help you modify your actions and may suggest ways to keep doing your job, but with a change.
Feel free to PM me with any questions you have. I have photos on the pic forum. I am getting ready for exchange to implants in 2 weeks. It's not an easy surgery, but I am pleased with the results thus far.
There are other more experienced ladies here on this forum that will come along to chime in on what I have started and also offer you other suggestions/advice. Do your homework before consenting and be sure you are with a qualified and trusted PS.
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Thanks westieluv!
My PS has not said anything about the size yet. I am suppose to make an appt. to met with him again to go over everything. I will write down all the info so I can ask him. Thanks again.
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Can you get Lat Dorsi if you've had full axillary node dissection?
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Fearless_One ~ Unfortunately, I can't answer that question. I don't recall any PS asking me how many nodes I had dissected in my consultation appointments. I am not sure that the presence or absence of the nodes affects anything with Lat Flap since it involves relocation of that muscle and they are not disturbing the chestwall other than suturing the flap pedicle over the existing pectoral muscle.
Anyone else have experience with this question?
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Dmho - I don't know how long its been since you had the necrosis removed but I would make sure your skin is not only healed but healthy. It will make a difference.I had a BLLatFlap on May 4 last year with my exchange nov 17 . So far so good. Sorry if my typing is bad as I am on my phone. I'll finish when I get on a pc. PM with any questions.
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dmho,
Do not fear having your ps, if he has done many LD flaps, do this to give your implant a good strong base upon which to rest. With my DM in March I had this done and small (225cc) permanent implants put in. The ps said she wouldn't be able to put an implant into the side that had BC as the tissue was 'fried' due to the radiation treatments and wouldn't hold up.
I do a lot of heavy lifting in our gardens and use equipment frequently - like a chainsaw. I saw a physio 6 weeks after my surgery to gain my flexibility back and at 12 weeks started strengthening exercises. So, surgery in March and now I'm back to doing everything I did before they took my LD muscle.
Surgery: You should have at least one drain at the base of the incision for the LD on your back and one or two under your breast where they have put the muscle and implant. The smaller the implant the less stress on surrounding tissue and muscle.
I looked at your postings and you said you got a staph infection. Hospitals are notorious for transmitting staph infections to patients. DO NOT let any nurse or dr touch your dressings, incisions or empty your drains or touch the sites of your drains without gloves on. Your PS should start you on preventative antibiotics during surgery and continue until you leave the hospital, at which time you should take oral antibiotics until your drains are out for 7 days.
Drains are a necessary evil to allow extra fluid to escape injured tissue and such tissue weeps and the build-up of this fluid impairs healing. Every day the amount of fluid in your drains should be viewed by the ps and such fluid should be red, then pink, then light pink and then a light pinky yellow before being removed from the drain. Upon removal, the fluid should not have any smell. If it is green or dark yellow or smells pungent then it needs to be cultured for infection.
You also can help yourself by being in the best state of health you can be. Walking is a gentle exercise. Eating right, with 40% of your diet being protein for bone and muscle growth and red blood cell count. Colourful veggies, carrots, red bell peppers, tomatoes (I know it's a fruit), spinach, broccoli, pumpkin are a start, along with oranges, apples and grapes. A good daily multivitamin and calcium.
I wonder if your PS has admitted that the hospital gave you the staph infection? If you didn't have it before you came into the hospital, then someone passed it on to you. I am sure none of your visitors were coughing all over you or drooling onto your incisions.
Also, keep an eye on the little incision sites where the drains stick out. Wash the area daily when you shower and pat dry. They will be red and sore but not weeping any fluid.
I have to tell you that when I worked in the ICU on Kauai, if ever there was a patient that came down with a 'hospital acquired case of staph infection' the first thing they did was a reverse isolation on the patient and then culture all staff who came into contact with the patient. Often people have staph but aren't aware of it. 98% of the time the staph was transferred to the patient from an unknowing staff member. Handwashing, gloves and no coughing please!
I'm sure you will be able to lift the children you work with again. It will just take time.
Sorry to be so long-winded.....
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Fearless_One: Yes, you can have lat dorsi if you have had axillary node dissection. I had a BMX w/AND in March & I am scheduled for lat dorsi next week.
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DLL66 ~ Good luck on your surgery. Let us know how you are doing when you are able.0
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Hope, Glad to hear you are doing so well, and am looking forward to updates on your healing processes . . . and overall assessment of the LD operation. It sounds like it is working very well for you!
God Bless,
Aza
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Thanks, westieluv!
Glad to be at this point in the process!!
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Beth,
Is your date still the 22nd? See, I remember! Exchange away to complete this journey.
How's the summer treating you? It's winter here, and a cool wet one but just another month and it will start to warm up. Some of my spring blooms are already budding, so guess it hasn't been too cold.
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This is my first winter with my implants and I'm still adjusting to the fact that they are cool feeling when I touch them. Maybe I feel the cold more because of my short hair - yet it's better than this time last year when I was just finishing chemo and bald as an egg. Wow, what a difference a year makes.
I see the ps the first week in September so she can schedule me for the revision surgery as the LD muscle has atrophied and the implant sits about an inch below the non LD muscle side and I have a sizeable dent at the top of my implant where the implant stops and it's just my chest wall.
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Beth: Question, did the soreness self-correct itself under your arm? Is your PS also going to address that (if still there) and the extra skin/fat? you spoke of in the past that bulges up on your back?
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I actually look fine with a bra and clothes on. It's just when I see myself naked in the mirror I get upset. I know - quit looking in the mirror! I even measured how long my LD scar on my back is - 10 1/2 inches. The PS did a great job as the scar is now just a pale pink flat skinny line. Even the horizontal scar on my non LD boob has faded away. I think when I get the fipples and tattooing it will look great.
The LD breast still looks weird with the football shaped scar, which is sunken in and very pink - but narrow. Also, as I guess we all have, the superficial tissue from my back is very different from my breast skin. Do you think the scar and skin difference won't be as obvious once I get a fipple and tattooing?
Everyone, have a good week!
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Debbie ~ My date is still this Friday, the 22nd. My youngest son is suffering with some kind of flu or respiratory infection. Doctor took blood tests today. I am staying a good distance away from him. I don't need anything that derails my surgery!
I still have soreness from the muscle tunneling. If I swim in my pool, it really bothers me. I have decided to not swim and let the muscle atrophy. I tend to be too aggressive and end up in pain. PS says he will take a look at the left side when we do the exchange surgery....but I am not expecting him to change anything. I think it will be something that I just get used to. Supposedly, the atrophy of that muscle will actually help me from having pain. I guess it takes a few years in some cases to get the full effect. It's slowly becoming a part of me that I don't notice that much anymore.
September will be here before you know it and you'll be ready for your next surgery. I am sure that getting the sisters at the same level will help with how you feel about them.
I plan to post photos on the pic forum when I get feeling well enough to unveil the new foobs. I have tempered my expectations. I just want to be comfortable and getting the rocks off my chest will go a long way in achieving that part. I know they won't be like my old ones so I am trying to release the expectation of realness. I see from the pic forum that you are really, really lucky if they come out looking natural. My PS is good, but I told him that due to the size difference, I didn't want small and droopy. Give me small and perky!
Hope everyone else that is going thru surgeries here in the Lat Flap thread are calm, reassured and moving forward in their plan. Getting through this process is long, but I am so grateful that it is possible.
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Yes, if the PS were not able to do a LD flap, then I know I wouldn't be able to have the reconstruction with an implant. I am so thankful for modern science and the hands of my PS. Her incisions are fading away to nothing and I am hopeful once I get nipples and tattooing I will feel and look more 'natural' again instead of like a Barbie Doll, which is what my GP says I look like and that sure is a lot nicer than what I think of my bumps.
That's it - I think of them as bumps, not breasts....
Do you think the ps will make me nipples at the same time as this revision or will that have to be later on? Would be nice to get all done at once!
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Thank you, Westie and DLL ..... DLL good luck to you next week, keep us posted!
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Thanks, ladies! I got home from the hospital yesterday. Everything went really well. The actual flap is smaller than what I was expecting & my PS was able to get about 300 ccs in each TE. I feel like all I do is sleep--the pain meds & muscle relaxers knock me right out. My husband ran into my breast surgeon in the waiting room & couple of times, so they had a chance to chit-chat & he gave my husband updates during surgery.
Glad I kept my wedge pillow that I bought pre-BMX. I did not need it then, but it sure helps now!
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DLL66 ~ So glad that the surgery went well. Having smaller flaps is a good thing, I think. Getting 300cc in at time of surgery is freaking awesome! You are well on your way already. What CC size are you shooting for in your fills?
Take it easy and rest during your recovery. Is your back incision giving you any issues or pain? Mine just felt really tight back there. That wedge pillow really helps you to get in and out of bed. A very handy device! Hoping for smooth sailing on the recovery. Hugs to you ((((!))))
Beth ~ aka Westieluv
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I made it through to the other side of the implant exchange surgery. He was able to get in 450 size Mentor smooth round moderate plus profile gel on both sides. Can't wait to unveil tomorrow. I plan to post on picture forum as soon as I get home. Not secure to upload here in my hotel. I am so excited!
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WooooHoooo Beth
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Beth,
450 sounds beautiful! Amazing you are already out of the hospital and in the hotel! Low cut tops and dresses - here you come (with lots of amazing shoes).
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