Latissimus Dorsi Breast Reconstruction
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Hello NycGirl! Yes, I've been in limbo land for some time now! I'm SO glad that your surgery went well. It's also so nice that you're paying it forward by sharing your experience with others. I wish you continued good health and happiness.
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Thanks so much Honeybadger! The lat was ok, - but it is still not as comfortable as the other non-lat side, and I am not even athletic!
Keep us updated on your procedure!
To all here: BE WELL!
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Hi there,
Has anyone had a re-occurence of BC following a Lat Dorsi procedure? Would like opinions on chemo with Lat Dorsi and if, like me, muscle has been affected after chemo?
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Thank you JO-5. I would love to hear success stories on lati dorsi. My situation - left breast did not hold the implant which was removed 1 week ago. Two times DCIS with radiation after first DX. I'm a golfer. Avid golfer. Very leery on best procedure to reconstruct. Reading through things, maybe DEIP is better option. Thankfully I have time to decide while I heal and enjoy golf season.
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Nash, that is what I've been saying all along. That athletic types have problems with this surgery, especially when they were in any type of sport that develops the LD muscle. As a former gymnast and swimmer, I actually had a lot of bleeding in the OR, had immediate reconstruction, the surgery lasted over 12 hours instead of 6 hours.
The most idiotic thing is that I trusted my PS to do it. I didn't even need LD flap. I wasn't having radiation and I had skin-sparing BMX so a simple implant would have been fine. But noooo, the guy probably needed that for his portfolio.
Chemo didn't affect in any way the surgery site. Gave me peripheral neuropathy and fibro though
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Seachain, yes, like you've said, it's the sports that develop the lat that are the problem. I've had women on this board say, "well I didn't have any problems and I'm athletic", and it turns out their athleticism consists of jogging around the block. Totally not the same.
I've heard stories of triathletes who do well with this surgery, but I think another factor, in addition to a developed lat, is doing a sport that involves twisting motion. Like you and me with the gymnastics and figure skating. While swimming develops the back muscles, one doesn't twist in the water like one does on the land for gymnastics and skating. So I think the muscles develop differently. Just my hypothesis.
And I would think that fibro would make this all worse. I don't have fibro, but pain clinic did diagnose my post lat flap woes as myofascial pain syndrome, which has a lot of overlap with fibro. So if one had both, then things would be worse I think.
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Honestly not sure what would be the connection between the LD flap and fibro. But one thing is for sure that all that scar tissue that is on the lower 2/3 of my back feels horrible and hurts especially in bad weather. I need to go at least twice a year for therapeutic massage for them to "soften" the scar tissue, because it keeps getting tighter and tighter until I feel like I'm in a corset I can never take off.
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Seachain, this article, and others I've seen, talk about an overlap between fibro and MFPS. I had researched MFPS and trigger points, since that had been part of my pain clinic diagnosis post-LD flap, on top of the scar tissue issues.
https://www.verywell.com/fibromyalgia-myofascial-p...
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Oh I have a MFPS point, initially they thought it was from a pinched nerve in the spine, but then they realized what it is. It's located somewhere between the inner edge of the right scapula and the thoracic spine. The only thing that sometimes helps is to get steroid shots right in the knot. Massage didn't help. The shots give me 2-3 weeks relief. Otherwise, it feels like someone stabbed me and left the dagger there. Then from time to time they remember, sneak behind me and start twisting and turning that dagger. But I had that starting immediately after surgery - end of October 2009. Fibro didn't start to manifest until after I finished chemo, in August 2010.
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Also out of all those huge lists of symptoms, I only have two: 1. pain. 2. fatigue (that started with chemo and never went away). That's it. No anxieties, roving pains, or any of the things on those lists. My pain is where it is and doesn't move. Just gets worse or slightly better (when I don't forget to take my opiate pill). Gosh I hope they do approve the medical marijuana in November in our state.
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Seachain, I hope you can get on the medical MJ, too. That really helps a lot of people.
It's legal where I am, and in fact mj in general is now legal, but unfortunately it didn't do anything for me. But I think my situation doesn't lend itself to its benefits. I'm very lucky in that I don't have actual pain much. My trigger points cause tight bands of muscles, my intercostals are all seized up, along with the scar tissue, plus I still have edema, so that all contributes to overwhelming tightness. I've gotten some relief through therapeutic endermologie, trigger point injections, and my new soft tissue guy who I've been seeing for a couple of months. He is the first rehab person I've been to who has had experience with lat flap gals. Since I've started with him, my torso is not twisted post-op like it was (I'm a uni lat flap), and I'm making good progress getting the tight corset/bra feeling to resolve.
My issues seem to be very fascia/scar tissue related. Which makes me think I may have had some issues no matter which reconstruction technique I chose, although the lat flap was clearly not a good choice for me based on how developed my muscle was and how much twisting I do with skating. Even the PS said she had trouble getting the LD to relocate during surgery. It was tight to begin with and it didn't appreciate getting rearranged.
Do you have any sections of your torso which feel like you have duct tape on them? I did, and it turns out that was restricted fascia.
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Hi Jo and girls!
Like several posts, my back (Lat dorsi) muscle changes from 'lava lamp' to 'chinese burn' to 'hard/numb'. I was told several months ago that I should never have been a 'candidate' for this procedure as I am very active and weigh 48 kilos. The PS told me prior to surgery that it would affect exercises such as swimming or tennis, I can understand that but it has (in my case) affected my day to day existence! I work as a Nurse and have to be active at work. Truly regret the procedure but I know we have to look ahead not back. Stopping Femara today as it seems to be irritating the lat mas and my lower back (already osteopenia!). Implant removed and cancer activity still evident ...back to the drawing board but most definitely INFORMED decisions for me here on in!!!!
This Site is helpful and inspiring!
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Hi Bonnie--I know what you mean about daily existence. Putting clothes in the dryer has become such a production after surgery for me bc it involves twisting and bending. I can't imagine trying to work as a nurse.
I was supposed to start zolodex (to shut down my ovaries) and Aromasin post-last flap (I declined more chemo). I tried but found it made the lat flap aftermath worse, so it's interesting you're having a similar experience with Femara.
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nash,
It's not "duct tape". It's like there were fishing hooks under the skin that pull when I twist my torso sideways. That is on the LD prelevation incision sites, on both sides of my waist.
My pain is mainly nerves, 1. from chemo damage and 2. from osteoarthritis triggered by the AIs, mainly in my neck. The only fascia issue I have is the one near my right shoulder blade. The scar tightening on my lower back is just that, scar tissue. It even feels like I have rawhide under my skin in that area. That happened due to seromas. I had huge seromas on my back, asked the PS if he won't drain them, he said no, we will wait for them to resorb, I asked it that won't cause scar tissue, he assured me that it won't. And of course I got massive scar tissue.
I went through all three AIs and settled on Femara that seemed to make my joints ache less. But due to the frequent interruptions I think I did a total of 3 years effective treatment of the 5 years I was on it.
I lost about 60% strength in my arms and hands. Very hard to do any pulling/pushing moves. I do daily exercises with the dumb bells (2 lbs only) to try and maintain the muscles on the arms and back.
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My back scar pulled a lot too but is better since I've been with my new soft tissue guy. I had a fish hook sensation in that it felt caught, but it wasn't a sharp pain.
I had a lot of spasms on top of my fascia restrictions. And lots of areas of tissue that were/are literally stuck, along with skin hypersensitivity.
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Jo, to address your question, I think it's b/c when you are sitting, you are not engaging the same muscles, or at least to the same extent, that you engage when standing and walking. Also, gravity is working differently when you sit.
I feel much better while lying down. As soon as I sit up, the tissue and muscles feel heavy and pull.
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I like your ingenuity, Jo! I hope it is tolerable and that it helps.
Ugh about the loaf.
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Jo,
That pain in your back comes from the remaining muscles not being able to compensate for the lack of the LD muscle. You must have had that LD muscle more developed - not saying that you did any kind of athletic sports but some areas of work can and will develop that muscle, depending on the repetitive movements you have to make throughout the day.
To explain: when the LD muscle gets more "developed", it starts taking a role in holding the torso upright. That is valid not just for standing or sitting, but also for walking or driving, for example. Try this: bring your hand over your lower spine and make a few steps. You will feel that muscle that goes along the lower spine ("erector spinae", the "spine lifter" or "spine holder") and you will feel it contracting and relaxing as you step. The problem is, when the remaining muscles cannot compensate, they will start getting into spasms. That brings in the pain. I have issues with that too, I can go through the day because I take pain killers, but because of that I cannot drive for more than 10-15 minutes at a time - because obviously I cannot take opiates and drive (yes I know many people do that but what do you want, I'm disgustingly correct) so after 10-15 minutes of driving I get such bad spasms in my back muscles that I can't sit and hold the wheel anymore. I am lucky that I live in a neighborhood where everything is at a 5-10 minutes driving distance.
What may bring relief is a muscle relaxer. I was for years on Flexeril and Tizanidine - The flexeril works better but puts me to sleep, so I would take it in the evening, the Tizanidine lets me be awake but doesn't work so good - until after last year's surgery to repair the herniated muscle. They gave me Methocarbamol to take for a month after the surgery. And I discovered that it worked really good and didn't make me sleepy. The only issue is that it's not advisable to take a muscle relaxer and drive. But should help some with the every day problems. Also a heat pad.
I know I do have in plan sometime in the future to tape and post the exercises and stretches that helped me deal with the surgery side effects. Not sure when that will happen but I will see if I can squeeze some time for at least a short video. Some of these were really helpful for me, even with all the plethora of the worst side effects one can get from LD flap recon that I was "blessed" with.
Now the "between the shoulder blades" pain. There are two potential causes there.
1. The thing is, unfortunately, when you add to aging/AI treatment the lack of the LD muscle, that messes up your cervical spine. Due to that, some nerves get pinched, and you may start getting pins and needles in your arms and hands. This specific pain is brought in by nerve entrapment in the spinous process of the 7th cervical vertebrae (pretty much between C7-T1, where there is a "bump" on the spine where your neck flexes when you bend your neck to look down); the exact spot of that pain would be between the shoulder blade and the spine, at pretty much the middle of the vertical line formed by the edge of the shoulder blade.
2. This one again comes from the LD muscle not being there anymore to hold the torso upright and balance out whatever movements you make with your arm. It causes a contraction in the ligaments in that area. Many times it is misdiagnosed as being a miofascial issue, but the truth is that the point of pain is about 1"to 2" lower than the point of the miofascial pain. It is easily found, I was told it feels like there was a "tough nut" there. I have that only on the right side (probably because I'm severely right-handed). What helps me a lot are shots that my pain management dr. gives me right in the middle of the "nut". Also, a massage that you can do by yourself. Take an empty pillow case and a tennis ball. You will also need a chair with a higher back. Put the tennis ball in the pillow case, and, holding the pillow case by the open end, throw the end with the ball over your shoulder, between your back and the back of the chair. By pulling/releasing the pillow case, you can position the tennis ball exactly on the painful spot, then by slightly and gently shifting your position while pressing with your back on the back of the chair, you can give yourself a nice massage to that spot, and it does provide some relief.
I hope this helps at least a little bit.
Day
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Has anyone tried one of those balance ball chairs to improve back posture following this surgery?
I am having back pain primarily from pore posture. Wondering if changing my office chair to one of these ball type would do anything to help me strengthen those remaining muscles.
Anyone???
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I went to see my PS a couple of weeks ago and lat flap was always the solution because I had to have rads. Well, my PS was so pleased with the healing - her PA didn't even think that I'd had rads at this hospital because my skin healed so well. (Not sure how to take that.) I just said that I didn't do anything the hospital recommended for skin treatment during rads.
Anyway, the PS says she can't know for sure what my muscles look like under the skin and how they were affected by rads, but she said I might not even need a flap. But she also said that the flap has the added benefit of bringing more lymph nodes and could help LE issues. I get to have surgery a little early because of the good healing, so that's at least a little bonus. Usually they wait a year after rads. I'll be going Aug./Sept. to get the TEs and MX on right side that couldn't be done earlier.
What infuriates me about doctors is the lack of information they are willing to give you unless you're super educated already and know what to ask. I gave the RO heck for equaling arm swelling to lymphedema and that it amounted to malpractice. I've had one doctor - actually it was his PA, be up front and give me the nitty gritty on a surgery and it's aftereffects. Everyone else just tries to paint the rosiest picture. It's made me incredibly distrusting.
I worry about this surgery, but none of the others seem much better in the after problems department.
My DBF wonders why I'm depressed when he gets "new boobs for Christmas." I wonder if we'll even make it that long.
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Hi Jo,
Finally got to the bottom of problems with the lat dorsi muscle (which consisted of 'lava lamp' sensation, to stiff and numb then to chinese burn.... aagh!!!) it is due to trunkal lymphedema.... with the removal of the muscle, chemo and 2 surgeries affecting axilla I have blockage points for lymphatic flow and drainage. I cannot believe that I mentioned these symptoms to various specialists and not one of them has mentioned trunkal lymphedema which, apparently, is fairly common following breast cancer surgery particularly when it involves axilla and even further so with a lat dorsi - I will see a lymphatic therapist soon for remedial massage and hopefully points to manage, just glad I know what I am dealing with now!
Next problem.....cancer (grade 3) remaining on chest wall and I am unable to take anti-oestrogen pills due to adverse affect on my muscle side (have tried both Arimidex and Femara) further worry is that my medical specialists do not know what to do with me, I am now in the horrible position of what next...? Trying to fiind a female breast cancer specialist in Sydney now to see if they can come up with something!
Grateful for this site girls and for the opportunity to vent!
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NYCGirl - Thank you for the compliment. I had a favorable surgical outcome. I haven't been on BCO much. Life is moving on and I guess that is a good thing.
Bonnie - I did chemo in the middle of a series surgeries and did not perceive any related complications. I do wonder what I'd be left with if I needed surgery for a recurrence.
Westiluv - I did PT before and after surgery. The bands seemed to help strengthen the more minor back muscles to keep my posture straight. My PT said the bands are best for that.
Nash - I realize that I am not a super athlete but I think it is inaccurate to classify me as you have with a number of your posts. I run half marathons and lift weights 5xs a week. At 55 I am doing well. I am posting this so that those women who have not been to the Olympics are not hopeless about their prognosis for this surgery. If I were going for the gold I would not have reconstruction.
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Warrior Woman, there is no need to be facetious. I have not, nor ever will, go to the Olympics to my skating. I did the reconstruction so I would not have issues with a prothesis sliding around when I perform, or issues finding mastectomy bras that work with my costumes. I'm not an idiot. I used a highly competent surgeon who was fully aware of my skating background, who assured me all would be well, as she has had triathletes do fine with this surgery.
Figure skating, along with gymnastics, golfing, rock climbing, ballet etc, is vastly different than running and weight lifting. Especially when done at a highly competitive level for one's age group. That is the point I am trying to get across to people. Running around the block, even if it is for a long distance, is completely different than figure skating. It just is. Running does not engage the torso in the same twisting manner the other named activities do. Most people do fine with this surgery b/c most people are not athletic in the manner I have described. I am not trying to scare people off form this surgery, but rather I am putting information out there for the few who may be in the same situation I am.
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I absolutely agree with nash. This procedure affects your QOL tremendously when you did any performance sport in your past that involves specifically the LD muscle. You don't have to be a super-competitive athlete and be in the Olympics. It's enough to have been in that discipline for a sufficient number of years that made your muscles develop. I had to re-learn how to turn on the side in bed, for goodness' sakes! Even now, with all the exercises I've been doing to strengthen my remaining back muscles, I still have to grab the edge of the bed and pull myself in the laying on my side position. Figure skating and ballet at first glance don't seem to affect the LD as much as performance gymnastics, swimming or rowing might, until you stop and think that these two are all about balance.
People don't realize how fine tuned our bodies are for whatever function they must perform. Do the following exercise (I recommended it in a previous post, just to realize how things work in our back): stand up; bring your hand to the back of your waist, right on the spine muscles. Walk slowly. You will feel those muscles flex and relax. Now think that those muscles are trying to compensate for the lack of the LD muscle, and think what the lack of a very well developed LD muscle may mean for the integrity of the upper torso - movement, pain and all. Not one single muscle in our body works alone (except for our heart and uterus) - there's a whole process going on for every single move we make. And what it can mean when one of those muscles involved in the process suddenly disappears, and what it may mean when the disappearing muscle was the strongest one of all.
WW, to be very honest, I don't think that an attitude of "I did just fine, you all will do fine, don't mind the ones who say you might not do fine, because I did fine" is in any way helpful here. This is a forum where we try to help each other to survive this hellish journey as intact emotionally as we can; I personally think that NOT advising someone of what might go bad is atrocious. Think about all of us who were NOT told about the potential mess this surgery can bring, and now we have to live the rest of our lives with this. I know that I, for one, would feel absolutely horrible knowing that I ruined someone else's life because I did NOT tell them of potential complications. Try to get past the "I did just fine" and see the whole picture of the purpose of this forum.
It's nobody's fault (as patient, I mean) that things go wrong. The same as it's nobody's fault that we got cancer. Just the bad luck of the draw. Let's not make it worse and just try to take care of each other with kindness and support, because after all, we're all sisters (and brothers) in this journey.
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seachain, hugs to you. Jo, great points, and I have no doubt your daily activities developed your lat and contributed to all this. I so wish you find something to help you. Best to you both
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As a follow up to previous message and to end topic on a high note....eventually marginal clearance from Spec in Sydney who interpreted my pathology results in a very different way from Surgeon! Have started tamoxifen and even feel positive enough to book a holiday.....taking nothing for granted having said that
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I also had a favorable outcome with the LD flap and would highly recommend it. I danced competitively throughout my life and had the LD flap done when I was 24. I sympathize with those that did not have a favorable outcome that is very disappointing. I think more than anything there is a possibility with ANY surgery of things not going as planned. I am not as sure that being athletic is the problem at least it was not for me. I still work out and lift weights with no problems. I do however deal with lymphedema periodically. I have hypertrophic scarring on all of my incisions and will be getting laser treatment to lighten and smooth the scars.
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Madison, I am really happy to hear you've had a good outcome with this surgery. Please remember though, that you are very young, and although you've danced competitively for many years, it's not as many years as my 40 years of competitive skating. I was 47 when I had my recurrence and had to have the lat flap. The years and the stress (my mom died of BC) take a toll. My PS stated to me that she had trouble getting my lat to move during surgery. It's just the reality of it and the reality of the anecdotal evidence I've come across talking to a lot of women in this situation. I agree that any surgery may not go as planned, and I may have had problems with any reconstruction option, but I still want to put it out there. If I'd asked my PS pre-surgery if I'd end up feeling like I was locked in a body cast 24/7, she would have said no. But that's the reality of the outcome.
That being said, I am so sorry you've had to be through so much, so young. I have an 18 year old college athlete daughter who was just diagnosed with T1 diabetes, so she's got a similar burden at a young age. And because I am now overwhelmed with the reality of having a sick kid on top of everything else, I am withdrawing from this thread. If anyone wants to ask me for advise or input, please PM me. Hugs to all.
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Madison, I am thrilled it worked for you.
But as nash said, it's different to go through this in your early twenties vs your late forties or fifties. Not only that the body had a couple decades more to change the LD muscle, but also, unfortunately, as we age, our body doesn't have such a recovery power.
I feel very sad that you had to go through this hellish journey so young. *big hugs*
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hello, by now you will have either gone thru the lat flap or decided not to.
I'm wondering what you decided and how it's going.
I had lat flap dec.13.
Pain ever since.
Synth
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