Latissimus Dorsi Breast Reconstruction
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Hello Everyone, I have read some of the posts on this site now and again but have not posted ..not sure if I did at one point.
Need all the help and opinions, advice I can get!!!
I am considering breast reconstruction using the back flap in less than 4 weeks from now. It is a huge decision for me seeing I have had radiation and am told that healing might be an issue. Can anyone tell me of their experience .. I had radiation in early 2013. The skin over my implant has tightened and is now miss shaped. The plastic surgeon says he can remove some of the scar tissue that is causing the shrinking and replace with back flap. Has anyone gone through this surgery this far out from radiation???
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June, - I had radiation 14 years before lat flap. PS first tried small implant without back flap, but I had trouble healing and finally gave in to LD flap, with skin graft from back, too. (I am not sure if that is always done?) It was my only option, - even if I didnt have an implant at that point because my radiated skin was so difficult.
It was not fun, but also not as bad as I feared! After recouping I went for a few weeks of physical therapy which helped with range of motion and discomfort.
Just had fat grafting and nip reconstruction!
Good luck with your decision!
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Thank you anotherNYCG So you had surgery almost a year ago. It's funny how when you are going through it it seams forever.. but later it is hard to remember all the little steps towards healing. I am afraid to do through it all again. Did the scar tissue from radiation continue to cause problems through the years?. You said trouble healing.. was that from radiation? The radiated skin over my implant is thin and always cold. I am wondering if that is poor circulation and if that will be difficult to heal after surgery. I am going to call about physical therapy. I am wondering if that alone will help the discomfort I feel now. Seems the implant is getting shoved up and towards my armpit. When I put my arm out to the side I get all pins and needles. Thinking I should put off the surgery for a while. Really confused.
June
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June, - I never had a problem from the radiation until bmx and implant was put in. It almost healed, but one little spot on the skin was not healing completely, even with alloderm.
The PS caught it before infection set in, but then knew that the only way to fix it was with lat flap and skin graft.
If you are looking into lat flap, be sure to find a dr who does that procedure routinely!
I wonder if your pins and needles sensation is due to the implant's movement on a nerve?
As for the cold implant, - A few months ago I posted a question about that and it seems some people say they have cold implants when in a cold environment, but not everyone. Could it be that those of us with thin skin feel it more?
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Thank you anotherNYCG, Did they need to do another surgery to the area that did not heal?
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June, - when he saw it didnt heal well he had to remove the implant, and put in a TE. Then when that healed, I had the lat flap with skin graft. So far so good now!
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With only 24 days till surgery, I am seriously thinking of backing out. so afraid of the healing process and risk of radiated skin not healing.
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June, - I would think your PS is also doing skin graft to have good skin to work with!
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Yes from my back but the skin is so thin I am afraid it will not heal. Both Onacologest and PS said risk on not healing well
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My radiation was 2 years ago. The area has shrunk around the implant.. pushing it up, it also has become flat and bumpy at the bottom. The implant is now uncomfortable. My PS said he can make me look much better. He would also take change my left breast to match. My Oncologist said not to do anything to left breast that has non malignant tumors until she does ultrasound on it again. I am going for more genetic testing and ultra sound. If I go through with this surgery I might not let PS touch the left side until I get final implant after back flap surgery to replace tissue ex pander on the right side. That may be several months down the road. He said that he would not do fills like the first time after the mastectomy. I go see him in a couple weeks so hopefully get more information then. I am so stressed and don't know what to do.
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Thank you JO-5,
I do have chronic back pain and numbness down my arms into my pinkies... I have had that for many years. Sleeping is an issue with my neck being wired after I broke it due to a car accident two years after my surgery for scoliosis. I was wondering how I was going to be able to rest comfortably after surgery on both my back and front at the same time. I am also worried about when I am on the operating table for such a long time being moved around and placed on my side. Although I have discomfort and deformity from the mastectomy and implant I am seriously thinking of backing out of this surgery. Wondering if I should leave well enough alone. I have to call about some physical therapy ... I never had it after the mastectomy. There is a very tight muscle extending to my arm that I think is the cause of my numbness and tingling when extending my arm. I appreciate the opinion. I will see if I can find any other posts about having back flap with scoliosis.
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I'm not certain if my situation is relevant. I have scoliosis and benign tumors from my genetic disorder - NF1 (Neurofibromatosis). It's also the reason I am unusually small in stature and have some discoloration of my skin. Anyway, the NF1 mutations were identified during my BC genetic testing. I'm one of the women who have done well with the LD surgery. My PS is aware of NF1 and it was a non-issue for me. The scoliosis did not complicate anything. With that said, we're each different and individual evaluation is surely important. I've said over and over on here that I really believe that a PS highly experienced with LD flaps is critical.
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Thank you both,
I have two harrington rods in my back and my neck is wired. I am going for a second opinion. Warrior Woman did you have the surgery after radiation ? Worried about radiated skin healing.
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Like Warrior_Woman, I'm very happy with my LD flap surgery so far. I had skin-sparing double mastectomy with tissue expander last November. On 3/2/2016 I had LD surgery on my left breast. My surgeon insists on doing 1 side at a time so I'll be doing the right side in June.
My first choice was DIEP, but I didn't have enough fat. I could've just do implant only since I didn't have radiation but my surgeon said my skin is extremely thin so the result may not be what I'm looking for. So I decided to do LD flap. I agree with Warrior_Woman to find a surgeon that specializes in LD flaps.
Do any of you know if it's possible to do LD on 1 breast and DIEP on the other breast? I was told I don't have enough tummy fat for both breasts, but perhaps I'll have enough for 1 breast. It's nice to get a tummy tuck!
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junesummer - I never had radiation. I needed the LD because of an infection after my implant exchange. My scoliosis is not bad enough to require a brace or any other intervention. Whatever you decide, just make certain you're 100% confident with your PS. I went out of network for my LD and I'm very glad I did.
Lovejoypeace - I too could not do diep because of not enough fat. At best I was told that maybe I could do it with implants. I have implants now so that was not the issue. It was more that I did not want muscle taken from my stomach and my PS said she would take a little. Ultimately, despite the accounts on BCO, the LD has a much lower complication rate due to the fact that the muscle is never removed from the body...it's tunneled in a different direction. I had so many complications that anything I could do to finally be done with this sounded good to me. It is my uneducated impression that you can have different procedures for different breasts but ultimately your PS will tell you. Also, I had LD on both sides at the same time. Having the same procedure on both sides allowed for decent symmetry. Also, I don't feel lopsided. The PT I needed for one side I needed for both.
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I'm a little late to this discussion - just too much stuff going on - but I want to throw in my 2 cents for junesummer.
I think you might want to reconsider the LD to another type of flap. The doctors don't tell you this, but the LD DOES have a role in holding the torso upright, and the remaining muscles aren't always able to compensate for the lack of that muscle. Especially if you have spine issues, it can and will make things worse for you. I have severe osteoarthritis in my cervical spine and my spine dr. said that all the problems I have from it were made way worse because the LD isn't there anymore.
As the others said, make sure you do your research on the PS and make sure that he/she has a lot of experience with whatever surgery you choose. Not everybody is lucky enough to have no issues. The idea generally is - the less athletic you are, the higher the chances that you won't have issues. The more athletic you are, the more defined and "worked out" your LD is, the higher the chances to have issues. Also, seromas that aren't treated well (i.e. drained) and allowed to "re-absorb" themselves will cause thick scar tissue and that is the main component of the "iron bra/iron corset" problem.
It also depends if your PS will use just the LD and the pulled down pectoralis major muscle to cover the implant or if they will also lift the serratus muscles (the muscles that cover the ribs) and place the implant under there as well. That causes quite a severe pain whenever you sneeze/cough and God forbid you get a cold or the flu.
There are so many ways now to do the breast reconstruction (including with the skin flap) than there were 7 years ago when I had my BR done that you really really need to do your research. Especially as you are not hurried up like some of us who decided on mastectomy+immediate reconstruction.
Jo, I agree with the other ladies. If you feel the slightest bad vibe from your technician, walk out.
Also, question for you: would it be possible that there was a lymphedema aspect to your "loaf" as well? did you get lymph nodes removed from that side?
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I second seachain's sentiment about not having lat flap done if you are athletic.
I have been a competitive figure skater all my life--I still skate on the adult circuit. This surgery was the wrong choice for me. The day after surgery the PS said she had trouble getting the muscle to move b/c it was so tight. Now I am paying for that. I'm almost 11 months out and still feel like I am being crushed in a vice 24/7, despite 8 months of PT.
My surgeon is nationally renowned and specializes in lat flap. She talked me into it against my instincts. I can function, but I function in extreme discomfort 24/7.
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Good news on the mammo going off without a hitch, JoAnne. Thank you for updating us. Kudos to the techs. I'm impressed.
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I'm also am scheduled for a Latissimus flap after failed surgery. My surgery is April 28th and I would love to hear from anyone who has gone thru this procedure
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junesummer and rskellie, like WarriorWoman and LoveJoyPeace, I had good luck with this surgery. It wasn't what I wanted to do. All I wanted was implants and no cutting on parts of my body that were still healthy. But since I had radiation therapy, that wasn't possible. I didn't qualify for a DIEP or TRAM because of previous abdominal surgery and not enough fat. Not that I was particularly interested in those procedures either. The LD flap was my only option. I chose to go ahead with it after trying to live without recon and hating it. I've had no complications and can do everything I did previously. Unfortunately, some people have had big issues with this surgery. That's probably true of any surgery. I can't address the issue from the standpoint of an athlete. I'm active. I swim, canoe, hike, etc. But I'm not an athlete. Definitely get opinions from a couple of surgeons and choose one who has done a lot of these procedures. Junesummer, since you have back issues, be sure that is adequately addressed. Don't go forward with a surgery until you feel comfortable with it. Well, as comfortable as it's possible to feel. Any surgery is bound to provoke some anxiety. Also, I would think physical therapy would be essential for someone who has back issues already. I didn't have PT, and still came out ok, but I had no previously existing musculoskeletal issues. Bottom line is there are no guarantees. You have to weigh the pros and cons and choose what seems best with the information you have. From everything I've learned, this is usually a low complication surgery, and more of us do well with it than not.
Jo, I'm glad you got through the mammogram and had excellent techs to help you through it. I hope your soreness is easing.
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JoAnne, to answer your question about pain. Yes, I have pain/tightness all areas you describe. It's actually like being in a body cast or encased in cement, from all of my foob, around where the loaf sits, and the surgery side of my back and side it its entirety. My pec and shoulder blade also have more traditional pain (vs extreme tightness). There is also a tighter band across my back, corresponding with the back incision.
I am starting with a new rehab dr today who thinks she might be able to help me. The PT group I just fired was clueless what to do.
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Jo, - I am glad that you were able to get thru the mammo, and that the techs were considerate! Some are wonderful and some are downright awful. I have had both!
Interesting that you were told 2 years before feeling much better. I am 10 months since LD. After 6 months, I was still very uncomfortable, with limited rom, then had a few weeks of PT which helped a lot, but I had to stop that when I had the next procedure, so it's another back step of sorts. I am still much better than I was before the PT though.
Drs say that how a patient heals depends on 3 things, - the skill of the dr, the patient's own response, and luck.
Wishing you continued improvement!
BE WELL wishes to all here!
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My observation from following posts on this and a few other threads is that women who are athletic often do well with the LD flap but the super athletes notice a significant difference in ability. I'm a runner and I weight train. I've done this for decades. I run half marathons. I would describe myself as reasonably athletic but certainly not competitive. I personally think that being in good shape helped me to get through this surgery.
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Warrior Woman, I think that it's not so much the degree of "being athletic" (well it is to certain degree), but the different discipline of athletics that you've done. Any discipline involving the over-development of the LD muscle (swimming, rowing, gymnastics, tennis playing, etc) will get you on the spotlight of severe changes when it comes to normal activities you used to do before surgery.
Jo, the shoulder blade issue is usually not from the surgery. It's from degenerative changes in your cervical spine. There's a nerve there that causes the pain if it's pinched. Also, it may also be muscle, tendons and ligaments that are too tight. I personally have that issue, and considering the deplorable state of my cervical spine, my dr. tried first shots in the spine, that didn't work, then he did trigger-point shots in the shoulder blade area and that worked.
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Warrior, I think you're right that being in good physical condition makes recovering from surgery easier in general. If you eat a healthy diet and keep yourself fit, it just seems logical that you might have an easier time. I think that's why I didn't have as much fatigue as a lot of women seem to have after my hysterectomy and the bc surgeries too for the most part. I also didn't have any trouble regaining ROM. Maybe I have yoga to thank for that.
What Seachain said about women with a highly developed lat because of particular sports makes a bit of sense too.
I wonder what the docs anotherNYC mentioned mean by the "response of the patient." How the individual's body reacts? That's sort of tautological like saying your response to surgery depends on your particular response to surgery. I guess maybe they just mean individual characteristics of each patient like how fast they tend to heal. I agree that skill of the surgeon and luck must be involved. My PS has done a gazillion LD flaps.
Jo, I think you really came up short in the luck department! You just plain got dealt a lousy hand particularly with getting a secondary cancer. That's just the pits.
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Yes I should have been specific about athletes with highly developed lats vs athletes in general. Runners probably wouldn't have issues. My lats and entire back are very strong from skating.
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Hi Nash,
After reading posts I was very concerned about the possible limitations after LD surgery. It would only make sense. One woman reported that she lost her ability to swim completely. My first job as a kid was life-guarding. I cannot imagine. I went down my activity list with my PS prior to surgery and he reassured me that I would not have any problems. He also sent me for many months of PT prior to the LD flap surgery. I remember the first time I got into the pool and I expected to sink to the bottom. I was ecstatic to find that I can swim without any difficulty. I cannot help but ask - Was your PS aware of your sport? Was there any discussion of anticipated outcomes? I've seen posts from women I'd describe as super athletes who lost their abilities with this surgery. I was terrified that I'd become inactive and when that happens people go downhill quickly.
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Yes of course th ps and I discussed my skating. It's my life. I was concerned I wouldn't be able to pull my arms in for spins and jumps. She said it would be fine. I think she only thought in terms of loss of strength. I can skate fine although it is hard to twist to the surgery side. I don't have much loss of function. I just feel like I am being crushed to death 24/7.
I feel even more extreme tightness when I exercise. Even just on the treadmill or doing any sort of deep breathing. It's like there is not enough room in my body anymore.
After the surgery when I was complaining of the tightness, the nurse said, "Our younger, fitter patients tend to have more problems. You didn't have a lot of flesh to work with and it was hard to close you up." Wish they'd mentioned that prior to surgery.
Now, I can't imagine the only people who do well with lat flap are older, out-of-shape and fluffy. So I am starting to wonder if there is something specific to my surgeon's technique that causes problems when the muscles are stronger. The surgeon did tell me she had problems getting my lat to stretch around.
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Mine said "unless you want to pursue professional tennis and swimming, you shouldn't have any issues". Yea, right. And apparently they had issues with my LD bleeding profusely during the surgery because "it was so hugely developed". I did need some blood transfusion.
I looked through old photos and scanned the only one that shows my back so you can get an idea. It was taken 8 years prior to BC, I was 40 at the time - it's during a Halloween party and I was supposed to be Marilyn Monroe. You can still see that my back was quite muscular and definitely V shaped.
I noticed also that besides the herniated muscles I had on the left, talking about the twisting nash mentions, it's definitely there. It's like the oblique abdominals were affected on both sides. They definitely do not have the same tightness and it's like they don't "respond to controls".
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Thank you everyone, I am still on the fence. I went for a second opinion where the surgeon said the same as the first .. that the LD flap would work for me. He seemed to think my skin was okay to do the surgery too. I was most concerned about healing. I started PT also this week, working on the scar tissue. I go to my PS on Tuesday and will hopefully make my mind up after that visit. I am going to really give him the third degree.... discus all the things I read about on here.
I am chicken, I do not really want to go through another big surgery. But my chest is so lopsided. The right side where I had the mastectomy is very tight..high and feels pushed up. The other side hangs .. the PS seems to think I can get good results by adjusting both sides. I don't want a lift. Still confused. Surgery is scheduled for the 25th, I have a girlfriend coming from Florida to stay with me a week. I guess if I chicken out I will just have a nice visit with her. If I go through with it I will have a live in helper for a week. Going through this alone is hard. Making the decisions alone is also hard. I live in chronic pain anyhow. Never know what will hurt till I wake up. I went a week with a terrible sinus infection that created unbearable tooth pain. Didn't think I was going to get through that. Could this be worse than that? Even typing at my computer I have pain radiating under my arm from the pressure of the implant .. pins and needles going down my arm. I guess I should try to get this fixed.
How long will be down for? How long is it really bad? I can't remember how long after the mastectomy that I was feeling okay. This might be just as bad or worse. I remember the pain of the drains ... worst part. I am really nervous ... unsure what to do. I must be repeating myself by now. Sorry.
How many are really glad they did the LD flap? Had good results?
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