Latissimus Dorsi Breast Reconstruction
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rltoomey, we're sorry things aren't going as you'd like! But rest assured, it sounds like your doctors are helping you make the best decisions for your situation, and there's always time to get the reconstruction later -- which will give you time to research the best options for you!
Also, we're sending warm, healing thoughts for your surgery today.
Please keep us posted with how you're doing and what you ultimately decide. We look forward to hearing more from you soon!
--The Mods
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rltoomey, I've read your posts, but unfortunately I don't have any good input for you. Although I did have a lat flap, it was only one and I had delayed reconstruction, so completely different situations. I'm sorry you have had so many struggles and disappointments. My heart goes out to you! Let us know how you are doing. Sending you healing hugs!!
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rltoomey, the more athletic you are the more issues you will have. In athletic people, the LD muscle is very developed and takes on an important role in holding the torso upright and also the spine. I'm a former gymnast and ballerina, and I'm disabled now because of this surgery. I've know at least 4 other former athletes who had the same issues.
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Stopping in to say hello to everyone and hope you're all well. I've stayed off the boards in an effort to have a more normal life almost 3 years out from a BMX.
Linda - It's great to see you're well. I credit you with giving me the confidence for this surgery. Because I you I had enough hope to have the bilateral lats and I am doing well.
I agree with anotherNYC, we stay here more when we have reason for concern. And yes, my surgeon is known for lat flap surgery.
Honeybadger & rltoomey - I'm certainly not a super athlete but I run and lift weights almost every day. I was very concerned that this surgery would limit me but it has not. I honestly cannot think of anything I cannot do. I would just say that I feel older after cancer treatment. I would do the bilateral lat flaps again.
Tabbies, Seachain & Jo - Glad to see you and I hope 2017 holds nothing but good stuff for you.
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rltoomey,
I agree with seachain with that the more athletic you are, the worse this surgery is. I'm a national level adult figure skater. Multiple drs have agreed my level of athleticism is an issue. They have also agreed that if you are an average middle aged woman who considers herself athletic b/c she jogs around the block and goes to the gym, it's not the same. This surgery has ruined my athletic and regular life. Make a decision about this surgery based on what you know you can (and want) to do athletically. If it's anything that involves twisting you torso, forget about it unless you want to devote your life to rehab. Which is where I am at now over a year and a halt out. I had a nationally renowned surgeon at a NCI hopsital who specializes in lat flap.
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Hi Nash,
I found out last month I have another local recurrence in my skin and Lat Flap. I will have surgery again in two weeks to remove Lat Flap, skin and implants. Then they will give me radiation for four to six weeks. I guess we all need to stay focused on treatments. My cancer did not show up on PET scans nor MRI. It was felt by my breast surgeon and then biopsied . Same kind of cancer PILC.
Take care,
Nancy
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Nancy, that's so nuts. Thank goodness your BS felt it.
All these years of being PleoPals over on the ILC board, and I had no idea you'd had lat flap! Good luck with the surgery. Are they putting the lat muscle back into place after they remove the flap? I'm not even sure that can be done! Just wondering about the logistics of the whole surgery.
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hi, I haven't been on the site for awhile; at one point I had to separate but I had by Lat surgery a few years ago and I think it was one of the hardest things I've done BUT I came out on the other side and have finally done reasonably well. The lat gets relocated and the other muscles have to compensate; it takes awhile and physical therapy helps. I have gone to physical therapy for almost two years, now I go to deep tissue massage to break up scar tissue and knots (my lat on my chest still jumps, back muscles ache ) what feels painful helps rebuild your strength but it needs to be supervised. I am 58 and always been active so I think I am pretty average. Just know it's not a quick rebound. I am 7 years out from Dx and feel so fortunate but I still deal everyday with remnants of this disease. For those dealing with active situations or recurrence, I totally hate that - but stay the course, stay positive and we will be there for you. I wanted to check in and will again. There are not many common folk that know about this surgery so I think we all find strength in those that do -- take care
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Hello all,
Thanks for continuing to talk about this. It helps to read about other peoples experiences.
I have gotten a date for my lat flap/expanders. Dec. 26th.
Right now, I have nothing in and am healing from the implant removal. I'm getting loads of push back from my family and friends about doing the lat flap, mostly in the vein of "why would you put your body through this to have boobs?" I understand why people feel like it is a lot and their perspective that I should just go without and use prosthetics because it is extensive but I find it frustrating to constantly have to justify my desire to have breasts again. Their concern is me hurting myself to have something that is decorative, but I thought at least women would be more understanding.
I am nervous about possible side effects for my back, but the only other choice I have is to go flat and that's a hard choice to voluntarily make when I have an option to restore.
Rlt
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Rlt
I totally understand your desire to have boobs. I often feel that some family and friends mean well, but until they are in the same position they really don't understand fully how much having boobs, even fake ones, can make us feel whole again. I don't consider breasts "decorative". That is ridiculous.
I had my lat flap on one side in 2011. I didn't have to have radiation. I can still do anything I used to do. I wasn't an athlete but I did and still do work out with weights, swim, kayak, etc. I'm prone to seromas and the only issue I've had is that when I took a class that had a lot of side planks and stretching on my lat side, I got a seroma. This was over a year later. So that would be my limitation due to lat flap.
Talk to your surgeon and ask questions. Make sure YOU are comfortable with our choice.
jen
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Rltoomey, I agree with Jwilco as I'm sure most of us here do, "breasts are not decorative"!!! Also as Nycgirl & Warrior said, your PS needs to perform your chosen surgery regularly. There are some cautionary stories that have absolutely given me pause because I am athletic. However, if you are more moderate in your activities your likelihood of success is greater. Most women seem to be fine. As Jwilco said, you need to feel comfortable with your decision. Please do not rush into it. I am in analysis paralysis, so I don't wish that on you! But if there is a PS who offers DIEP, PAP or GAP flaps you may want to consider those if you haven't already.
Prayers for you, Jo, Illinoisnan, Nash, Seachain & everyone dealing with this awful disease, its treatment, reconstruction hardships and all the other fallout that comes with it.
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Thank you for the prayers, Honeybadger! Best of luck in your decision making process, and I wish a fantastic outcome for you, whatever you decide!
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Update:
Talked to my PS and he explained (complete with drawing on my body with a marker) what he will do. I feel better after talking to him and he has done many, many of these. He will not be placing drains in my back, rather he will use "barbed" sutures to pull the area tight. More pain initially but he feels that but not leaving space for seromas to develop, I won't need drains. He says he has done the barbed suture technique many times and that it prevents problems.
Has anyone had a lat flap without back drains utilizing these barbed sutures? (You may not even know that he/she used barbed sutures; I had to draw it out of my PS exactly what he was going to do.) How successful is it in preventing seromas?
He also said that he feels the use of valium post surgically will help with spasming. Does this work? I always thought valium was for anxiety and such. I am happy not have to take muscle relaxers as I do not react well to those at all, but I am hoping he is right about valium's properties.
Can anyone tell me how quickly the spasms show up afterward if they are going to happen? Does my sleeping position affect whether or not I will get them? I thought about buying an orthopedic pillow so I could sleep sitting up, but my ps seems to think that will make the likely hood of spasms showing up worse.
My PS so far has done the most beautiful work on me and is tireless in his efforts to make this work, but so often they tell you that you will not have this problem or that problem and then when it shows up, they seem mystified by the fact that this documented side effect has appeared. I'd like to be prepared for as many side effects as possible so that if something goes wrong, i'll know what I'm looking at.
When I had the sub glandular implants placed on oct 13th, I literally took a picture every single day of my chest so that I could spot changes or problems developing. It helped to identify problem areas early enough for him to try a repair but ultimately I lost them.
Emotionally, this has been so exhausting and I inexplicably cry at random stuff i think because it has been so hard to go up and down with each hope and defeat. When i was trying to decide if i wanted to do this, my husband told me point blank that it might fail and I might end up with prosthetics. It was the hardest thing to hear, but I think I needed to hear that and think that possibility through before I made the decision. Life without breasts is not a terrible life and I can see benefits, but its the effort of trying so many surgeries, doctors appts, and medications only to be without that makes it such harrowing possibility.
Thank you again for this site. Family and friends are very supportive, but talking about this is like talking about going to the moon. it's very hard for someone who hasn't been there to even have a point of reference.
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rltoomey, - i had drains, but never needed more than tylenol and perhaps a 1/2 valium to sleep. (I still rely on the valium to sleep on some nights, but my ps originally prescribed it as a muscle relaxer after bmx with tissue expanders.) I slept propped up with pillows for the first days, - never had spams.
I did only have one side with lat flap done, - are you doing both?
Good that you have a ps with lots of experience!
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rltoomey,
The "barbed" sutures might give you an extra set of scarring from the tiny dots. In the multiple surgeries I had, I noticed that the seri-strips left the most minimal scarring. Unfortunately, myself I have a tendency to develop keratic scars from surgical glue, but I've heard that for others it does wonders.
I did not have back drains, and I had huge seromas (felt like I was sleeping on water pillows). My PS refused to drain them saying that they will resorb by themselves, even with me trying to convince him because I was afraid I'll develop scar tissue more than normal. Guess what? I have horrible scar tissue on my back and I need therapeutical massage from time to time as the scar tissue will start tightening and tightening to the point that I feel like I'm in a corset and can't breathe. So careful with those seromas.
The muscle spasming depends on how well the remaining muscles will be able to compensate. If you are in any way athletic and your LD muscles are well developed, expect a lot of spasming, as the remaining muscles won't be able to compensate, will get tired fast and start spasming. If you are not athletic in any way, no worries. But if you do get muscle spasms, the only thing you can do is to do exercises to strengthen the remaining muscles, otherwise it will be a life-time thing.
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Hi Jo, - I hope that you are seeing improvement even if slowly!
I never had spams, but I have to be verrrrrry careful with my lat flap side, - anything strenuous, even vacuuming, leaves me with pain on that side, - from under arm and around implant. My other side has implant without lat flap, and although I am always conscious that it is not my natural breast, it is not nearly as uncomfortable or as easy to hurt.
Hoping all here are doing well, and have a happy and HEALTHY holiday season and new year!
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You know, a lot of this wouldn't happen if the surgeons would actually tell us the truth about potential life-time issues, instead to just want to increase their portfolio of cosmetic surgery procedures. TBH, of everything that I've seen and read, it seems that overall, the easiest and with minimal side effects is the one-step implant with Alloderm sling. One thing I don't understand - because of course, some of us need skin flaps after radiation - I have seen over and over procedures where they need skin flaps for various areas of the body, and they use that under-the-skin balloon in order to obtain extra skin and use it. Why can't they do that for us, and they subject us to potential life-time morbidity procedures?
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rltoomey, I've been away from the boards and just saw your questions about the lat flap. I think you had your surgery a week ago. I hope it went well. I was very lucky with this procedure. I didn't want it. I only wanted implants. But since I had radiation, I needed a flap. The lat flap was literally my only option without traveling across country for one of the less common procedures. That really wasn't an option. I wouldn't consider myself an athlete, but I am pretty active. I can do everything I used to do including things requiring upper body strength. The scar on my back is a bit tight and annoying but not painful. I'm going to work on getting it loosened up. I totally understand why you felt strongly about reconstruction. Breasts aren't just decorative. I thought I'd be fine flat, but I definitely wasn't. I was totally blind sided by how much I hated it. Nobody can know how they'll feel until they're in this position, and other people need to butt out. I hope you'll stop back and let us know how you're doing.
Honeybadger, good luck to you too whatever you decide.
Seachain, I've wondered about those skin expanding procedures too. I wouldn't have minded them taking the flap of skin from my back. It was the muscle I didn't want to lose, but I was told that was necessary to hold the implant. So, I don't know if expanded skin from elsewhere would have done the job.
Happy New Year, everyone.
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Thinking about having lat dorsi recon on both sides in June, can anyone tell me what their arm mobility has been like? Will it be possible to swim or ski afterwards? As I am keen on both. Would be really good to hear from others on this.
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2Tabbies, see that's what I called out to the surgeon as BS. When there's no need for skin flap, what is "covering the implant"? I think that in most cases (like was mine, as with no radiation and skin-sparing I did NOT need a LD flap) the surgeons just want to expand their portfolio.
Lottemarine,
You will have issues. Anything that involves pushing and pulling you will have issues with. Because it's the LD muscle that is used for those movements. Most of us had to reconstruct the movements we need to make for things as simple as getting up from a chair or even rolling on the side in bed. And these are small movements for every day life. If you are going to do movements that involve force and strength for pushing and pulling, you will have a lot of issues. It will take a long time (as in more than a year) before you will strengthen up the remaining muscles to be able to do movements like that without injuring yourself. And even so you might still injure yourself (see the surgery I had to have a year ago to repair a herniated muscle due to torn fascia).
So practically this is what you will have to say good-bye to: swimming, rowing, skiing, tennis playing.
Ask around and see how many ladies who had this procedure, if they sit on the floor, now, after the procedure, instead of pushing themselves upright, they have first to turn on all four and then get up straight. Yes. That is the truth of it.
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Lottemarine - I wanted to let you know my experience. While the surgery itself was more painful in recovery then any other of my procedures, I have returned to all of my previous activities, in fact, I'm more active now then I have ever been. I don't ski, so I can't speak to that at all. But I work out with a trainer twice a week, and at a gym on my own at least two other days. This is a health choice I made for myself after slowly gaining weight that wasn't coming off anymore (thank you, chemopause!). My trainer helped me tremendously and I'm very proud of how good I feel and how much better I look. Rowing is a part of my workout, as well as weights. There is a small amount of tightness in my back along the scar, but nothing that I notice on a regular basis. Swimming recreationally has been fine for me, but I've never been a distance swimmer. I had the surgery on my right side, not both, as you are considering. I'm curious as to why you would need it on both sides? I had a BMX but had regular implant surgery on my left side. I actually had routine implant surgery on both sides, but the radiation on my right side eventually broke down the skin, so I had to go the lat dorsi way.
Anyway, you can find people that had great success with this (in fact the tightness that the radiated skin had caused is gone now, so that's a bonus for me), and others that have had nothing but problems. Do your homework and make sure you're very educated on the surgery.
Hugs,
Kathy
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Thanks seachain and Jo-5 for your advice. That sounds pretty awful about the mobility restriction, I didn't realise it could have such an effect on the little things. This has definitely made me reconsider this as a option. I guess it's hard because I don't know which way it's going to go, but i will definitely do more research.
Thanks kSteve, that's great to hear you doing so well.I had uni mas, but surgeon found calfications in good breast so plastic surgeon has said to do mastectomy and lat dorsi on both sides. Initially I was keen for one side only (the radiated one, but I think he was thinking aesthetically it would look different, but to be honest I care more about mobility than look. It's tricky because I'm 35 and not considered suitable for the tummy or butt ones
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lottemarine - I hear you about your options. I wasn't eligible for the tummy or butt ones either. I can tell you that I have great symmetry, even though one is lat dorsi and one was standard reconstruction. I would not choose lat dorsi for both just because of concerns of aesthetics. Mine really do look good in a mirror. However, like I said before, that doesn't mean your result would be the same as mine. I would just hesitate to go through it on both sides if you didn't need to. One other option to consider, could you do standard reconstruction for both and just see if your radiated skin holds up. My PS was very straightforward when we went that route originally. He said that some radiated skin will last fine, and others don't. Mine held up fine for about 3 years, and then it began to break down. That's when I had the lat dorsi on the right side. He and I both figured it would be worth a try because it is much less invasive. Just a thought. Good luck with your decision.
Kathy
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Hey Ksteve, thanks for your advice, really appreciate hearing from others on this. I agree, I think lat dorsi on both sides is overkill and will be saying that to my plastic surgeon. Fair enough on the bc radiated side, but not the other. Restricted mobility on both sides scares the hell out of me. I think I need to do more research on lat dorsi in general and there's a reconstruction support group, which I'm going to attend to find out more. Thanks again.
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Hi! Sorry I could not reply in PM anymore it restricts the amount per day I gues
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Hi MADISON , not sure if you are seeing this post or not , I could not reply to your last message , I will message you tomorrow
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Hi Lottemarine,
I agree I would not do a flap on both sides unless there was a darn good reason. I had radiation and was told that was my only option. I danced competitively until I was 18 and was very muscular. I was diagnosed at 22. I am very happy with my decision to have a lat flap. I have not noticed any difference in pushing, pulling or lifting. I can do everything I did before surgery. I guess everyone has a different experience. I would make sure you're surgeon has done many lat flap procedures. I got three opinions before picking my doctor. I am very pleased with my decision, it has been 8 months since I had my lat flap. I just had a revision for my "good" side because the pocket was too low and the implant was a little too big. Now I look perfectly even, I just have to let the scars heal!
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Chery, Although I got your PM, I thought I would answer your question here, in case the info could benefit Lottemarine or anyone else. You'll see that I had my LD flap just 7 months ago and I feel my mobility is good. Although I am not a serious athlete, I do lead an active life (when I'm not recovering from surgery) and I have a physical job. I am not currently as strong and flexible as I was, but I expect that to improve with time. I had my exchange a month ago, and right now I am not symmetrical, BUT I am told it takes time for the implants to settle. Honestly, I like the shape of my LD flap side better, but I would not go through the surgery on both sides only for the reason of symmetry. (Lottemarine) As far as recovery...I was in the hospital two nights, then home on pain pills for the first week. I would say it took a total of 6-8 weeks after surgery for me to really feel good. During that time I was also caring for two children, but not working. I dis day to day things during that time, but not always comfortable, and tired easily. Regarding lymphedema, my PS specifically told me that anything he was doing would not have an impact on it. My case was very mild, and has not been impacted by the reconstruction surgeries.
If you have more questions, ladies, let us know!
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Hello Wildtulip and thank you so much for your valuable information, it makes me feel less anxious about recovery and I am hopeful my recovery goes well too. I also have children that I will be caring for after and that is a concern however it is promising to hear you were able to manage it during recovery. Thankhful your lymphedema is not affected too. I appreciate your reply.
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Chery, how old are your children? It definitely makes recovery more challenging. Mine were old enough that they could dress themselves and I could go off & nap when needed. I would suggest that you take time in next couple of weeks to freeze some meals, or at the very least cook meat and freeze. If you have people to bring you meals, all the better. As my PS said, it's a time to call in favors.
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