Latissimus Dorsi Breast Reconstruction
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Hi seachain, wow I never heard of subcutaneous inflatable balloons, I guess I need to reasearch this. I have an appointment with my PS next week May 9, I will ask about this. But I will go ahead and start with the research on this so that I am somewhat familiar with the subject and jot down questions to ask him.
Thank you for your advice.
Marivic
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seachain - is subcutaneous inflatable balloons is also known as tissue expanders? TE, yes I am familiar with the concept of it., but I am guessing I will need a big piece of healthy skin if my PS will need to cut out all the irradiated skin. Well I guess I will know more after I see him bext week.
MVP
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MVP, I really don't know what you surgeon intends to do, bot I'm sure he wouldn't take so much skin from your back that the wound wouldn't heal. Usually, they don't replace all of the irradiated skin. They just need a patch of healthy skin with good circulation to help support an implant. Then a TE is placed under the patch on your chest to stretch the tissue to the right volume to take the permanent implant. I think the balloon that seachain mentioned is something placed at the donor skin site to stretch the skin to the right size before surgery. I've seen that done on someone who was having reconstructive surgery on his nose. They were stretching the skin of his forehead so that there would be enough to reconstruct his nose. I've never heard of that being done with back skin prior to a lat flap procedure, but I guess they could do it. Your surgeon is the one to answer these questions.
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2Tabbies - thank you for the clarification between TE & subcutaneous inflatable balloons, yes I never heard of it being done as well, but of course it doesn't mean that it was not done before.
I will definitely ask my PS on Monday.
By the way, I am feeling a little bit of twitching pain in the corner of my open wound, do I need to be concern about it? Does it means it's healing that's why I feel a little bit of twitching pain every now and then?
Marivic
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Nash and Bunny1966 - I'm sorry it has taken me a while to check in. Very busy trying to get everything taken care of before my exchange surgery that took place a few days ago. But I wanted to share with you that I was very afraid of what limitations I might have after the lat flap. For me it wasn't whether I was ever going to be able to do a pull up or push up again, but as a professional classical musician, I need that muscle on my right side to play my instrument. After talking to some colleagues in the industry, I decided to go for the surgery. I tried playing 1 month after my lat flap and had a little fatigue but no pain. I worked up to the point where I could get through a three hour rehearsal and played my first gig about 6 weeks after the surgery. As for exercising, I was making some good progress from New Years until a few days ago when I had the implant exchange. I was starting to do pushups again (I'm about 3/4 down to the ground), and am able to push weight on the sled at the gym. I started with no weight on lat pull downs to get back range of motion (my left side still wants to compensate sometimes because it is stronger) but have worked my way back up to 55 pounds. Sure, it's 1/2 of what I used to do, but I'm still a work in progress and I'm OK with that. I'm lifting more than I used to on shoulders. A couple of exercises I just couldn't do since the tissue expander just didn't want to give and it felt too weird, but I hope that might change in the months to come once I'm allowed to start to do upper body exercises again (have to take a break as per doctor's orders while this new implant settles). I have gone kayaking and canoing with no problems except a few of the smaller muscles getting a little more tired than they used to because they weren't used to working that much (this is where range of motion and light weight training at the gym really helped).
sml - I always said that I would try reconstruction once and I did and so far so good! I decided to do lap flap over diep because for me I didn't want to lose any abdominal strength and was willing to put the extra time in to regain strength in my shoulder and back after the lat flap despite the concerns I describe in the above paragraph. My plastic surgeon really only gave me the option of the lat flap and in a way I'm glad about that otherwise I probably would have driven myself crazy trying to weigh all the pros and cons of each. I have been lucky to have the best surgical team and finally just had to trust that her recommendation based on my health was going to work out for me.
That probably doesn't help much, but it's my experience. I am active and was concerned that I would be pretty much crippled on my right side and it is far from it. I'm still a work in progress and have learned to celebrate the little victories at the gym.
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MVP - Because of the radiated skin that has not, and may never, go back to "normal" coloring, my patch of skin is very pale compared to the skin on my chest. I have a lot of peach fuzz on my body too and you have to look hard, but it's there on the little flap patch - LOL! The color difference doesn't bother me nor my husband at all. It amazes me what the surgeons can do and how my body has healed and adapted both in the short term and long term. Best of luck to you!
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You are doing amazingly well, Topanga. That is awesome!
I am starting to think my lat flap experience is in a tiny minority and that I ended up with almost worst case scenario.
May 15 will be a year, and although I returned to skating 7 weeks post op, did 8 months of PT, and now am getting myofascia release and scar release treatment, I still can't twist to either side without major restriction, and the restriction is especially bad on the surgery side. I can't do my housework without extreme discomfort. I can't skate without discomfort. Lifting my surgery side arm can be done but it is still tight. I am constantly aware of the iron corset/iron bra/boa constrictor 24/7. The intensity has decreased--at least I don't feel like I'm being crushed to death anymore--but I sure can't move properly and don't feel anywhere near normal. I tried lifting some light weights one time and had so many muscle spasms afterwards that I haven't tried again.
I spend several hours a day sitting with a heating pad, doing ROM exercises and soft tissue management (foam roller, massager, self-MFR stuff). I'm getting frustrated that my effort over that past year hasn't resulted in more improvement. I have made good progress in the last month since I started the MFR stuff, but it just doesn't seem like I should still feel this awful one year out with this much effort going into feeling better.
Alas. I guess I shouldn't be surprised, b/c I have fallen into the "if it isn't supposed to happen, it will happen to me" category with all of my bc stuff. I was diagnosed with pleomorphic ILC at age 38. PILC accounts for something like .5% of all bc cases. 38 is fairly young. I recurred while on Tamoxifen, going into year 8 of the stuff. Not sure what the stats on that are, but surely they can't be high. So if someone was going to have an abnormal reaction to lat flap surgery, it was bound to be me!
Anyhow! Enough whining on my part. I will continue to chug along in pursuit of some level of comfortableness, and I probably am not a good example of how this surgery ends up.
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Tapanga - thank you for your advice. I am a new member of Picture Forum special thanks to nowheregirl AKA Timtam for accepting my request. I hope I can see some of your photos if you don't mind, maybe I can search you on the picture forum. It will give me an idea on what to expect and understand LD Flap more.
I am happy for you that you are done with your reconstruction and hopefully it will continue your great healing.
MVP
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Hello everyone, I just read the whole posting threads of 2Tabbies last night in picture forum. It's very informative and it can help you understand the Lat Dorsi more better. Thank you for sharing your journey. I appreciate it!!!
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Hi, I'm considering a lat flap. Can you send me a link to your pictures? JoAnn
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MVP - I'm jumping in after missing a few weeks of posts. I am not caught up reading so excuse me if I'm misinformed. My double LDs were due to infection and I never had radiation or wound healing problems. I'm posting now because of your concern about skin discoloration. My PS made my flaps where my areolas were to be. This way, I have round circles for the flaps and then Vinnie Myers tattooed over them. This eliminated concern about skin discoloration. It's the method some PSs use but not all. My first PS does the ellipse shaped flaps. I'm happy with my outcome both aesthetically and in terms of my ROM, comfort and continued athletic abilities. My pics are on the forum.
Inflammator - You'll be able to gain access to the picture forum after you've been active here.
I hope everyone is well.
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Warrior Woman - thank you for your input. You mentioned your first PS did ellipse, did you had ellipse before or did you change PS that's why you had the round shape?
I saw the picture that you recently posted here and the one in the picture forum, you really look great.
You also mentioned that you deleted your old photos did you just transfer it somewhere or is it all gone.
I will probably end up getting the ellipse island on my left radiated breast, my PS will need to cut out most of the irradiated skin and replace it with the lat flap.
Hopefully I will have a successful outcome on everything.
MVP
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Hello Ladies, I was just wondering if you will be able to sleep on your side with the breast implants? I am a side sleeper but since I still have the TE it's so uncomfortable to sleep on my side.
I sleep on my back since they put TE on my chest (right side) and Iit hurts to go on my left side because of the open wound 😞😡😁
MVP
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Mvp, yes, you can. Even on your tummy after a while, but it's not the most comfortable position. On the side though , yes, definitely. I'm a side sleeper too. My favorite position is a little weird, I put my arm under the pillow, stretched all the way up under my head, with the hand touching the headboard. It has two perks, one is that it keeps my head fairly level spine-wise, and two - the most important - it actually stretches all that scar tissue on the sides, the one from the LD prelevation site. Try it, if you regained your ROM enough to do it.
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Seachain - thanks for the info. I am just worried that if I sleep on my side that the implant will be push out of the pocket or it might burst.
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That won't happen. You can sleep on your side all you want.
Sleeping on your side is not even as "brutal" on your implant as the required massaging of it is.
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Happy Mother's Day to All of us mommies!!!
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Seachain - thank you for the info
MVP
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I have my BMX schedule for May 20 with LC recon at the same time. What is the average recovery time
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Jo - I have no medical background whatsoever, but I just wanted to say sorry to hear that you have another pain to endure or added to your list of concerns with the Lat Flap surgery.
Hope you feel better and the pain is just temporary. Hugs to you!!!
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Addlantan - I have had my BMX separately from my TE surgery and not at the same time. But I took six weeks EML (extended medical leave) from work but I was feeling better by five weeks, but I took my time and still kept the six weeks EML. Some ladies here in this forum had BMX and at the same time recon, someone will come along and give you more details.
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Joanne,
Did the PS cut the thoracodorsal nerve?
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Hello!
I am 3 days post-op from a left breast mastectomy and latissimus dorsi reconstruction with expander. It feels so tight. Does this go away? I'm almost afraid to ask.
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sml - congratulations to you and we wish you to heal well and have a fast recovery. Like you I am new to this forum, I've read a lot of postings from different members of this site and they have posted about feeling tight after mastectomy and lat dorsi flap and they said it should loosen the tight feeling with time.
I'm sure one of the ladies will jump in to give you more information or you can go back and read older postings from other members of this forum.
MVP
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Joanne, yes, that is what the "twitching" is. I still remember how horrified I was after the first surgery when I first pulled the blinds up and my new breast jumped towards my shoulder - that was before I had the nerve cut. If the nerve is not cut, the latissimus dorsi muscle will flex whenever you do a push or pull movement. In the case of reconstructed breasts, it's called "breast animation". It can happen not only with the LD flap reconstruction but also simply from the pectoral muscle as the implants are usually set with the upper part under the pectoralis major. This plastic surgeon explains it really good in this video and there are examples of breast deformation animation caused by muscle flexing.
sml, the answer is not clear cut. In some it does, in the most unfortunate ones you stay in an "iron corset" for the rest of your life. Also, just the mastectomy alone can bring the "iron bra" feeling. You will just have to be patient, do all the stretches that are recommended (not now, after you've healed) and pray and hope that you will be among the lucky ones.
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Hello!
First off thank you all for your input. This thread has really helped me to know what to expect. I had a Lat Flap surgery 12 days ago and I am really surprised at how well I feel. I do have back pain from having to lay on my back until I get the 3 drains out. I have to be below 30cc's for 2 days to get the breast drains out and back drain has to stay for three weeks no matter what (it's already below 30 cc's. The 2 breast drains are still at 45cc's each. When did most of you get your drains out? I'm getting frustrated!
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MVP - Hi. I deleted the photos from when I did expanders to implants. I developed an infection and that is why I needed to do LD flap. I'm a side sleeper too - no problem. As you read through the thread you'll see that most of us turned the corner at 6 weeks. I think that was about the timing for me too. Improvement continued for quite a long time.
SML - I had the iron corset from my BMX even before the LD. My PT said it would go away after a year and I rarely notice it any more. I think for me it was a combination of PT and simply habituating it. It's a nonissue for me now.
Seachain - After reading of your concerns about the twitching I asked my PS about cutting the thoracodorsal nerve. He said he never does it. I do not have any twitching or uncontrolled movements but I could make a career performing bar tricks.
Jo - I was thinking the other day that at my time of Dx I had no idea how much I'd have to endure. I'm so sorry you're still going through this.
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Thank you for the info. It ishelpful to know what to expect.
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Jo - yes, it would help, of course. To put it in layman's terms, pain is an electric signal that is transmitted to the brain through nerves. Cut the nerve, no pain. Think of trigeminal neuralgia - also called the "suicide pain" because the pain is so fierce and unpredictable that many patients commit suicide because they can't stand anymore a life spent in fear of the next pain attack. The trigeminal nerve is cut, leaving the affected part of the face almost paralized, and patients prefer that to the pain. The LD muscle doesn't really atrophy without having that nerve cut, because the "you must flex" signal from the brain is transmitted to the muscle also through the nerve. As long as a muscle is functional, it will not atrophy. If it doesn't atrophy, it will keep its size. So yes - but this is just my opinion - I think that cutting the thoracodorsal nerve would help with both pain due to muscle flexing and with size of the "loaf".
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Warrior Woman - I wish I could see your transformation photos,I am sure that it's inspirational.
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