Latissimus Dorsi Breast Reconstruction
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Kroge6-
You get to make the decision and the answer is different for each person. I tried immediate reconstruction but got an infection which turned out to be better for me in the long run as I did radiation without any tissue expander and the skin got a chance to heal after that. I bascially had 2 choices because of the radiated skin 1) no reconstruction (and if in the end that is what I ended up having to do, I was totally fine with that and having to wear a prothestic on one side) and 2) lat flap.
I was concerned - I make part of my living using that part of my body to play my instrument, I like to work out and be outdoors. So I decided to give the lat flap a try and put my trust in my doctor and know that it would take some time but eventually I would be able to do what I needed to again. It has been just over 10 months since the surgery. I can play my instrument (I was back playing concerts 6 weeks after the surgery), lift weights at the gym, back at doing a few pushups (ugh, I hate pushups), run, yoga, go bowling (I'm still a horrible bowler), kayak, canoe, and hike and backpack/camp without any issue. I am just starting to be able to hang again, I do a few seconds at a time. I never was able to do a pull up so I don't miss them and there is one back exercise with weight I can't do, it just feels too weird on my chest. The other thing I just realized recently that I can't do is push off my right side to get up especially off the floor. I unconciously turn and use my left side, I'm going to work on that. So for me, it took a bit of time and patience, but the lat flap worked and was the right choice for me.
You are doing the right thing by doing your research and asking questions. I know it is hard, but try not to let it consume you and rob you of your joy and your sleep. So many times I couldn't think about anything else. I am glad you on this board so we can support and encourage you!
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Kroge6, I suggest doing some research and not having any surgery your aren't more or less comfortable with. I say more or less, because who's ever completely comfortable with any surgery. I didn't want this surgery either. I really didn't. But according to all the docs I consulted, it was my only option due to prior surgeries and radiation therapy. I thought I might be ok going flat and tried it for a year. I was not ok. I wish I had been. It would have been simpler and spared me some annoying consequences. That said, the lat flap has worked out ok for me. I can do everything I used to do (yoga, canoeing, weight training, etc.). I'm active, but not an athlete. I hope you have options and can choose something you're comfortable with. Good luck with whatever you choose.
Jo, good to hear from you! I also still have fatigue. Oddly, this has only come on since my last surgery in January which was the most superficial of all my surgeries. Just nipple construction and fat grafting. I'd had fatigue during chemo, of course, but nothing major with the other surgeries or even during radiation. But the little surgery in January knocked the stuffing out of me. I've gotten better, but still don't have my normal level of energy. The only thing I can figure is that everything finally caught up with me. All I do for it is try to get enough sleep, eat a healthy diet and stay as active as I can. Best wishes.
Scotland, Njohnson, and any others with recent surgery, best wishes for an easy, uneventful recovery.
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Kroge6
I agree with seachain and 2Tabbies. I would hold off until you can do more research and evaluate other options. I am 7 years out from a bilateral lat flap. I have lost a decent amount of strength and my underarm is always sore when I do anything out of the norm with my arms (lifting, raking, etc). My boobs move when the chest muscle is engaged. I cannot wear anything close to form fitting when I work out. I don't regret it necessarily but at the time didn't feel there were better choices for a decent set of boobs at the age of 43. I didn't carry enough belly weight to do the other flap procedure, but I do now! 😡 Best of luck to you in your decision
Take care, Laura
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Two and a half weeks out, and I'm doing OK. Both the BS and PS think I have achieved best case scenario so far. The iron bra has eased into feeling like a regular bra. I woke up with about 200cc's on each side. The side that had a prophylactic MX is about the same size and shape as it was before surgery. On the radiated side, the corner of the flap at my sternum looks annoyed, and I'm on oral antibiotics for that. The iron bra feeling was bad for a few days, but has eased up a lot. Yesterday, I went to work for a few hours and stayed too long. Between the two back drains and the healing incisions, leaning on the back of my chair is uncomfortable. My back muscles were really sore by the time I got home. I still get tired late in the afternoon.
But it's better every day, and I should get one (or maybe both) of the remaining drains out on Monday. And my first fill!
My surgery is too recent for me to have any words of wisdom, but I think my surgeon used part of my lat muscle instead of the whole thing. So far, I have no obvious loss of strength (I'm still under lifting restrictions, though). My range of motion on the non-radiated side is really good, and honestly not bad on the radiated side.
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Hi all
This is my first ever post on a BC forum and the information I've gleaned from the other posts has been very helpful. Everyone has such a different experience!
I was diagnosed two months ago with early stage BC and widespread DCIS and thus had a full mastectomy and lat dorsi reconstruction, at the same time, 3.5 weeks ago. The surgery was far bigger than I had expected. I was out for 8 hours and following had to have four blood transfusions as I'd lost quite a bit of blood during the surgery and my BP dropped (it's normally pretty low). Apparently this is not hugely unusual as the breast area does bleed a lot.
I found the first 36 hours after surgery pretty scary and traumatic because of the transfusions and pain: I couldn't move and was very out of it on the pain meds, but then I came good pretty quickly and was up and walking about (and showering!) by the 48 hour mark. I went home with four drain tubes, three of which came out after two weeks and the last was taken out five days ago (hooray). I really worried about pain associated with removing the tubes, but it didn't hurt at all! It was great to have them out.
The first two weeks after the surgery I was extremely tired, but now I'm starting to feel a lot better. I'm planning for my first big beach walk today and really looking forward to it.
I've had quite a lot of 'burning' pain - my boob and under my arm feels like it has been badly sunburned. My back surgery site doesn't hurt much, but I most certainly have the 'iron bra' feeling. So it feels like I have a severe sunburn and then a very very tight bra put on top of that. It's really very uncomfortable/painful, but I can tell that it's getting slightly better every day.
I guess I really didn't understand how big the procedure was going to be, or anticipate how long I'd still be feeling pain and swelling for. Every day by about 4pm I am swollen through the breast and in my side under my arm. The whole area is lumpy and distended. I still need to take opiate-based medications at night or I am awake with quite bad burning pain throughout the night. Still, every day it feels just a little bit better. I'm hoping that by the 6 week mark I might be in less pain and able to manage without the pain meds at night. I still take paracetamol during the day at regular intervals and I need that. I'm going to the doc's today to get a referral for physiotherapy.
Has anyone else found that the pain, burning and swelling goes on for a few weeks? Any idea when I might start to see the swelling lessen and the pain subside?
Thanks everyone and good luck to you all. I wouldn't wish cancer on my worst enemy, but I feel very fortunate to have had access to such good medical care and support.
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LittleNell, Eight hours is a really long time to be out!
As you said, everyone's experience is different. I had an LD flap, but not the same time as BMX. I don't remember how long I had swelling or pain, but in general, I think it took me about 6 weeks to recover from the LD flap.
I'm sorry you've had such a hard time so far. You've been through a lot, so be patient with yourself. Sending healing hugs!!
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Thank you so much. It's lovely to connect with women who've had this experience, even if on the other side of the planet! Hugs to you too
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LittleNell, I'm a few days behind you. In August 2015, I had a UMX and ALND, followed by cording, PT, lymphadema, and lymphedema therapy. During chemo. Three weeks ago, I had a prophylactic MX on the remaining breast and last flap reconstruction with TE placement on both. My surgery was about 4.5 hours, and the end of day fatigue seems to be easing up. I read somewhere that for every hour you're under anesthesia, it stays in your system for a week. You were under a long time. Hopefully, you're feeling a bit better every day.
Yesterday, I got my last two drains removed and my first fill. I was so happy to be able to sleep on my side again! Except that the TEs make finding a comfortable position on my side difficult. After three weeks of positioning myself in bed with only my abs and legs, I can now carefully roll over without my back complaining. Continuing to inch towards recovery
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I feel like I turned the corner yesterday - all of a sudden the pain eased and I was able to sleep lying down rather than propped up on pillows. I even managed to sleep on my side for a while! Best of all, I was able to go for my favourite 10km river walk - the first big bit of exercise I've been able to do since the surgery (one month ago today). I'm feeling far less tired and even plan on going back into work tomorrow. I'm still feeling very swollen and uncomfortable, with the 'iron bra' feeling quite relentless, but I can cope with that as long as it is gradually improving.
Good luck Scotland! I hope that you continue to do well!
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Great news, LittleNell
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Hello Lat flap sisters,
I haven't posted on BCO in a very long time. I just wanted to give an update since I am 8.5 yrs out. I am still doing great. In fact, the iron bra syndrone has subsided. Someone recently sent me a private message asking me about the iron bra. I hadn't really thought about it in a long time so I removed my sports bra and really concentrated on how my body felt. There's no tightness across my chest. I still feel the lat muscles where they were moved but it's not bothersome. So all in all I am very pleased with the Lat flap reconstruction.
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Scotland and LittleNell, it sounds like you both are doing ok. I'm happy to hear it. Recovery can be slow. I remember feeling like it was going on forever. But it does get better. Treat yourselves kindly!
Linda54, nice to hear from you. I was wondering about whether the chest tightness ever went away completely. I'm glad to hear that at least in your case, it has. Mine has definitely improved but is still there at 2 1/2 since my exchange procedure.
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Good news, Linda!
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Hi, Jo. I did get a flu shot and didn't have any side effects at all. I never have. How long has your sore throat lasted?
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Hi Jo,
I had flu shot a week ago, - arm still sore, and also slight sore throat. I wonder though, if the sore throat is because we have heat on indoors here in NY now and perhaps the air is dry. Or, - maybe you had a slight cold brewing and the flu shot brought it on?
Feel better!
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Jo, - I know how you feel and I hope you are getting back to yourself more each day!
Glad you have no fever, - use lozenges and keep liquids nearby to sip throughout the day. My throat has always been my 'achilles tendon', - even too much talking leaves me with a sore throat. My last surgical procedure left me with blisters in my throat. An ent dr prescribed a gargle called 'magic mouthwash'. (Benedryl, lidocaine, and I think Mylanta.) Good for those really sore throats!
Hang in there and take it easy!!
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Hi Joanne,
I got the flu shot and I now have a sore throat and stuffy nose, but I know mine are unrelated because my flu shot was early Oct.
I've been drinking a lot of tea, and tonight I'm going to use a Netti Pot for my stuffy nose.
You'll probably drive yourself crazy looking for a source/reason. I hope you feel better soon!!
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Jo, I'm sorry you struggle with SE's. I know that stinks! Best wishes to you.
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Ladies, I am sure the flu shot and sore throat are unrelated. At about the time we get the flu shot, fall allergies are starting, and also we turn on the heat that dries up the air in the house.
There's something else I wanted to say though that I think is fairly important. For us, the LD recon ladies, the mere thought of getting the flu or a cold is horrifying, because repeated coughing is horribly painful.
Back in 2010 I had the flu shot in October. Then in January I ended up in the ER with the flu. Which was the simplest strain A, covered by the shot. The doctor in the ER told me that he has seen it over and over again, that for people who had chemo, the flu shot doesn't cover them for the full 6 months it's supposed to, but for only about 3 months, and advised me to get TWO flu shots for the 5 years following chemo. I did so and didn't get the flu anymore. It is true that insurance only covers it once a year, but it's only $30 so not hard to pay. I'd normally get one in October and another one end of December - beginning of January. This year is the first year I will only get one flu shot and we'll see how that works. Hopefully I won't get the flu in January lol
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Seachain, I ended up with pneumonia this fall, just months after my LD flap, and yes, THAT was painful when I coughed. Interesting info about the flu shot after chemo. I'll have to ask my MO about it because I'm only one year out.
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I was fortunate in that - my surgical team made sure that I had the flu shot and the pneumonia shot well before the surgery.
Back in the day I had asked my MO about that piece of information. He said that it made sense, and that it wouldn't hurt. So I went ahead and did it. After that first time I never got the flu again. I guess this time we'll just have to wait and see, for my first year without "double flu shot"
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Seachain, interesting about needing 2 flu shots, but it makes sense. Chemo really messes with the immune system. I'm surprised I don't constantly have a cold or flu because in addition to chemo, I have a rare form of non-Hodgkins lymphoma. My former MO told me that my immune system probably isn't even good enough to mount a response to the flu vaccine. However, I don't seem to get sick any more often then normal people. Go figure. I agree with you that we also tend to blame things on the flu vaccine that just happen to occur at that time of year. My throat has had a tendency to get dry and scratchy for the last few months. I was wondering if it was a side effect of some medication, but I didn't start any new ones. So, who knows. Maybe allergies.
Btw, I don't find coughing painful. Even major coughing spells are no worse for me than they've ever been. After the surgery while still recovering, sure, but not now. For that matter, coughing was painful after other surgeries like my hysterectomy until I was fully recovered. So unless there are long term issues like you have, I don't think coughing is necessarily painful for us LD women.
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I think it depends a lot on how the implants are "inserted" and held up. I know that for me, about 1/3 of the upper part is the pectoralis major, the bottom 1/3 is covered by the serratus and then the LD comes on top of everything. It's mainly the serratus that causes this pain, as it's the muscle that normally covers the ribs area and the one that contracts during coughs. It feels very weird to even say "if I cough my boobs hurt" lol
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LOL! Indeed it does sound weird. Mine just jump.
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Hello all,
Thank you for this site. I pour over it whenever I have need a boost of "you are not alone" therapy.
I need advice. Original Mastectomy Feb 2014, straight to implants. Fat grafts in august to smooth. By the next March I was having one removed because of infection and capsular contraction.
Left it out for three months, and then attempted to go an expander to implant but never got there because the tissue was too damaged. Spent three months developing a tunneling wound that was closed by a new surgeon. Left the implant out for 10 months and when I went back to talk about removing the nipple and smoothing the skin to be flat on that side, the surgeon started talking about a small implant sub glandular (over the muscle). I was hesitant because of all the trouble, but the thought of having both breasts again was too tempting. He worked on both sides because the remaining implant was larger and he thought a smaller size would hold better.
Had the surgery oct 13. Everything was fine for two weeks, then the thinness of the skin began to show and I started to develop one fluid drain after another. The surgeon repaired 3 of them and then finally realized that the thin skin could not hold alone.
I have until tomorrow morning to decide whether to scrap and remove both implants or to have a bilateral lat flap. I am on the fence and can see benefit to both and misery to both.
if anyone has words of wisdom, i would happily take them.
Thank you
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Rltoomey-
We want to welcome you to our community here at BCO. We are so sorry for the issues you're having with your reconstruction, it sounds very frustrating! Hopefully a member who can relate to what you've described can offer some insight. If you need some info on the bilateral lat flap procedure and what you can expect as far as recovery, we have some on our main site: http://www.breastcancer.org/treatment/surgery/reco.... Obviously another surgery isn't what you wanted, but hopefully you can come to decision that brings you peace either way.
Please keep us posted!
The Mods
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rltoomey,- it is a tough decision, we know. I was SOOO afraid and reluctant, - but I, too, couldnt keep even the small implant that I'd had on one side (where I'd had radiation many years before)
You dont provide any background info, re your age or medical history, and that would need to be taken into consideration before opting for lat flap.
The procedure itself was not fun, but do-able, and after a couple nights in hospital, you are still in need of help around the house for a while. PT would also be beneficial to regain arm movement. All in all, I am glad that I agreed and had the lat flap.
You MUST use a surgeon who performs lat flap procedures on a regular basis! This is no place for someone who is not well practiced and highly regarded!
I am sure that others here will share their experiences, - but you have to keep in mind that many people dont come back to post, - they move on with their lives and dont think much about BC. Due to that, it;s those of us who may have had recurring issues that post, - so take that into consideration when reading
These boards are wonderful, as are the friends you will make here! Good luck with your decision!
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If you are in any way athletic, don't go for it, chose a DIEP instead. If you're not, then go for it.
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I know this isn't really the forum for it, but just thought I'd ask. I'm still scared to move forward with lat flap reconstruction, I'm also quite athletic. I am most likely too thin for the diep, so anyone with thoughts on the PAP flap? It's a muscle sparing version of GAP/Inner thigh flap. There's not much info on this site. I haven't heard back much on the pap forums besides hearing one awfully unsuccessful experience. So I have been warned. Don't know if there are pics. I never made my way in there. Thanks to you all and wishing you all good health. Honeybadger
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Thank you all for your responses. I am somewhat athletic and on the thin side, which is one of the reasons that recon was not very successful without some support. Thin skin after the mastectomy and not enough fat to support.
Can I ask seachain why you say not to do it if you are athletic?
The decision, at least temporarily, has been taken out of my hands. When i called the drs office the next morning, I was told I was scheduled for removal only. Something about being added to the schedule late and not enough time in the OR to do it. I asked to move the surgery forward to another day to allow time, but the implants either have to be taken out surgically or will fall out on their own and then I'd risk infection with an open wound. Now it turns out that the surgery schedule is booked through end of january when i am not able to be down so it will have to wait at least 6 months.
This is a hard week since I've spent the last few weeks having multiple surgeries, two general anasthetic and two local , trying to hold onto the dream of having two instead of one and now I will go through all of this to end up with less than i had.
Trying to focus on the things I will get back when this surgery is over tomorrow instead of wallowing in what I've lost. I feel very sad, but hopefully that will pass.
Thanks again and please continue to add any advice you might have. i may still be able to have the lat flap done sometime in the future.
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