Latissimus Dorsi Breast Reconstruction
Comments
-
Cindy now yes I would just like feel back to normal. But to be honest when I chose the surgery it was more for vain reasons. I didn't think so when I did it, but looking back yes. I didn't like how my first set of implants looked there were lots of ripples. The radiated implant was hard but no harder than it is now. I wanted to look like I looked before breast cancer. I realize now that is just not an option. I wish the plastic surgeon would have told me that then. He talked a good talk and made it sound like I would have breast like the Victoria's Secret models LOL. Of course I signed on the dotted line very fast. Wish I would have gotten more opinions and took it a little slower.
0 -
seachain, Bonnie, and tangles... I'm so sorry to hear of your pain and complications. I almost feel guilty sharing my update...
I had my follow-up appt today. Tomorrow makes two weeks since the surgery. I'll be honest, my time has been so easy and pain free, I wondered if she actually did it right. Today the drains were removed as well as the steri-strips. The PS... she looked me over front and back, turned to her nurse / assistant, threw up her hand for a high five and said “I knocked it out the park!"
Well, that was reassuring, but I know from past experiences of a PS' self assessment of my early surgery results... it remains to be seen!
So, just a while ago, I thought to go look myself. Even with the ugly stitch lines still healing... OMG! That radiated boob looks SO MUCH BETTER! I'm excited.
She explained what she did and it may be why I'm having an easier time. First off, my MX was skin and nipple sparing. She said I had the skin, it's just that the radiation had tightened it so much causing the ugly, tight, frankenboob. Though she marked me up before surgery, she said she just cut open the skin at the previous incision and let the skin do it's thing and open up to where it opened up. She then only took the size Lat dat needed and that was less than she'd marked up and smaller than most other lat dat surgeries she has done.
She assured me she will get the bulge out of my upper pec, the upper pole. I'm wanting amore natural slope to a boob with some projection. It already looks better, but if she can fix that, man I am going to worship this woman and speak her name every opportunity I get.
She has been so refreshing. She listens and she gets it!
0 -
Maureen, Cindy et al, at the risk of sounding like a broken record: Get many highly recommended opinions but make sure they do micro surgery. Although DIEP is most popular there are other methods. If you carry weight in your thighs the TUG (which I did and am very happy with,) or PAP which is muscle sparing, are two possible solutions. The GAP can also use your upper or lower buttock. I was very close to doing the LD but remained flat on my radiated side for nearly 4 years until I was mentally ready to take the leap that felt best for me after TE failure. Please know that radiation, even if you had no side effects at the time, can create or add to many complications with reconstruction including implant or TE failure. The LD can help with that problem but sadly, as many have said, create numerous other problems. Wishing everyone good luck, good health & healing and freedom from discomfort.
0 -
Not being a private practice PS and being in a University center is no guarantee either. The idiot who performed my LD when I didn't even need it (no radiation) is in a University Center. He pushed for it because he needed a bigger portfolio of procedures of this type done.
He ruined my abdominal obliques in the process too and when he went two years go to fix that, he ruined my lower abdomen using a canula for obese people (he wanted to graft a bit more fat in a dimple on the right breast, didn't really need it) and leaving me with a long horrible deep "tunnel". Then he was trying to push for tummy tuck to fix it. I started cussing at him and ask him if he was sure that Medicaid would cover it? He spluttered that no, he didn't think so. I told him he should have thought about trying to make more money BEFORE he tried to do this kind of blunder. I guess I was the guinea pig for him showing to some resident how fat grafting is done or something.
I'm too immobile and too disabled and too alone right now to sue him
Yes, we are allowed to talk about doctors on here. Mine, his name is Christian El Amm. If you're in Oklahoma and need breast reconstruction, and anyone recommends him, RUN. RUN FAST. RUN FAR,
0 -
I just got back from my appointment with my PS, I am 5 weeks post final rads. I had a BMX with tissue expanders and a nipple/skin sparing on the non cancer breast followed by chemo and rads. The expanders are currently filled to 360 cc and not big enough but she needed to stop before rads. She wants to give the rads side another month and then start filling again. I am not happy with the way my breasts look. The cancer side after surgery was higher than the other side to begin with and rads seems to have pushed the TE up even higher. On the nipple sparing side, the nipple is not in the correct position and the expander sits lower. So she is suggesting I have the latissimus dorsi flap procedure with round smooth implants. She thinks this will give me the best look. I am so scared to have that big of a surgery. I read a few posts here and it sounds like many of you had a bad experience? I don't know what to do.
0 -
OCDAmy, - Is it suggested that you do LD on both sides or one?? Where are you located? Can you get another opinion?
I found one side to be do-able. Many people feel the same. Unfortunately, some have serious problems, as can happen with anything.
0 -
OCDAmy, I really see no reason why you would have such a potentially disabilitating surgery. What you're describing can be done with the Alloderm sling and fat grafting with a mastopexy of the other breast. Don't be worried about the implant sitting too high, it takes a few months for it to "drop and fluff", we've all been there. Mine were right under my chin and I wore an Ace band for about 3 months to help them drop and settle. I have ultra-high profile round Mentors.
Now if you REALLY need a skin pad, then do a DIEP. It's the least potentially disabilitating reconstruction as it doesn't use any muscle, just the fat from your tummy.
A lot of PSs do the LD because they don't know and aren't able to do the DIEP, as the DIEP requires microsurgery. Valid for other types of reconstructions too. Or they need to increase their portfolio in that procedure,, like my POS did.
Change the PS. Seems to me like she's not capable to do another type of procedure and is pushing you to do it because of that. Honestly at this point I'd be wary if she would propose something else after suggesting something like this.
0 -
OCDAmy, you may have read about my recovery a few posts up above. Your situation is similar to mine. I also had nipple and skin sparing BMX and radiation. The skin sparing resulted in her having to use less lat Dorsi and we think that has contributed to an easier recovery. By the way, what you don’t like about your radiated side AND none radiated side, also sounds just like me! My PS is also going to work on my non radiated breast when I go in for the TE on the LD side. The nipple is sitting too low and the breast has a hamburger bun look. IMO, it needs more projection.
0 -
OCDAmy,
Nothing wrong with a second opinion. I do like that you have a female PS. From the very beginning, I was told I did not have enough body fat for any flaps. I did NS BMX with immediate tissue expanders. Had expanders swapped for implants prior to rads. Oh, i had alloderm, too. The radiated side never dropped. It was like a Frankenboob is the upper pole and transitioned down to a tight, angry pointy thing! Had another surgery to clear scar tissue, swap radiated implant with a smaller implant and had some fat grafting to smooth things out as well. Waste of a $5600 Insurance deductible, basically. No real change in the appearance. That particular PS never mentioned LDF. In hindsight, I’m wishing it had been presented as an option from the jump.
Do ask to see pics of other LDF’s the PS has done. I didn’t have to ask. My new PS broke out her album. She has done several following radiation and several where radiation wasn’t done. She made me feel it was my best option to achieve a much better result and from the looks of things so far, I’m happy.
0 -
Sugar Cakes, thanks for replying. I don't know what to do. I like my PS, and don't want to switch. She is suggesting this as an option and gave me a bunch of information to read before I see her again in April. I will ask about photos when I see her again. I think she suggested it because I was complaining about the high breast and the low breast and the nipple being off and she thougth the LDF would give me the best result. She doesn't think I have enough stomach fat for the DIEP on both sides. I feel at this point I would rather just go with the implants and see how I look rather than jumping into this big surgery although you have me thinking maybe the opposite is true. I have been through so much I don't know if I want another big surgery and recovery on top of that.
0 -
I think we can all agree the LD flap gives consistently good cosmetic results. The problem is that if one ends up in severe discomfort and pain from the surgery, it's permanent. There's unfortunately no way to know how one will fare until one does it.
From my experience and from other women I've talked to, the more athletic and fit one is, with little flesh to spare on the back, the worse the surgery will go. There are other variables as well, such as how large a flap is taken, how the muscle is dissected, whether the nerve is cut etc
My PS is very well respected and specializes in LD flap. I've had nothing but problems.
0 -
I had bilat lat dorsi reconstruction in May 2016, implants in Nov 2016 and revision of bilat dorsi recon June 2017. I would think long and hard about this surgery. I'm nearly disabled now. My back is encased in nerve damage, scar tissue. The surgery itself, horrible. I'm a very small, thin woman, my back burns and aches 24/7. the tightness and pain is unbearable. I've been on pain meds since May 2016.
0 -
Maureenb- I would consult with NOLA before I compromised both sides of my back by using the LD muscles. Have you seen the results NOLA gets when they correct other PS’s botched work? That’s all I needed to see/know. I had my BMX w/ immediate DIEP there and am very happy with the result. They look and feel like my originals did before kids. Very good experience there and I’d recommend them to anyone looking into recon. Feel free to ask any questions or PM me.
0 -
Wow. After reading all of the problems some of you have experienced. I’m scared to death for my daughter. She has a fantastic PS who put in her tissue expanders at the time of her double mastectomy. He had told us he needs to get her as expanded as possible before she starts Rads then will not do the exchange surgery for at least 6-9 months later. He said he’d have no other option than to do the LD procedure when he does the exchange, because she is so small 102lbs, although hoping she’ll have a little more weight back on by the time that happens. She’s usually 110-115 (5’3”), but still small at that size. He said he’s had great results and prefers it to other options anyway. He hasn’t had the best results from that.
He’s a great PS and women come from other states to our small town area for him to fix problems other women have experienced with other PS and breast reconstructions.
So with that said, is there anyone here that has had a positive experience and if so please speak up or pm me. I had read some of the first posts and then added this thread to favorites to follow. I have read a few ladies that are very pleased, but reading DON’T DO IT from the ones with problems is scary when it’s her ONLY OPTION especially since we found out she was going to have to undergo radiation treatment to the left breast and lymph area now.
I know those with problems tend to be more involved on here and much more vocal because I seem to be the same way. My daughter is just 31 and my DH and I are her caretakers. She lives with us. So any good experiences are definitely appreciated and much welcomed.
Thanks ladies.
~Sammi
0 -
hi simmplysammi, I had my ld done 6/2017. I have great results. I too has to have it because I'm smaller frames. Normally I'm 115lbs but after this diagnosis I dropped down to 108. ,, I did not have enough skin to get not even the tiniest implant so had to get the lat flap. I had my exchange last month. My breast are still small. I'm at best a small B. I was a C cup before. But PS could not stretch my non lat flap side any more as my skin is so thin. But I have zero complications. Just wish my breast had a bit more symmetry but I've heard that's can be fixed. Good luck to your daughter.
0 -
Thanks Hopefull. Heather was a big C small D depending on her weight. She got this from me. I actually had a reduction myself over 10 years ago now. I was small 5’1” and DDD. Always had back problems and shoulder pain.
I was and am hoping because they did skin sparring and although she was a good C that they’ll be able to get as close to her original size as possible. But I remind her, if the doctor would have I would have gone down to a B when I had mine reduced. (Just in case she can go back to the same size).
Wish I could donate my extra muscle or fat for her! She has and all you ladies have endured so much. We have no genetic factors for her breast cancer diagnosis. This has been a super hard time for her.
The PS told her with radiation it’s going to be a while before he’ll do the exchange surgery on her too. We were praying for clear nodes but unfortunately that didn’t happen although she had clear margins and significant reduction in the main mass and other areas were gone. After as large as it was apparently it not only shrunk it broke into 2 pieces on 12mm and 8mm which it a huge difference in the size starting out, it grew on Adriamycin & Cystoxin but the Taxol zapped it apparently. We’re so thankful.
Anyway, thanks for letting me know there is hope smaller ladies to have a good outcome and not be disabled. She’s modeled and always been in great shape physically. She loves to exercise and I am going to have to discuss the muscle loss issue with the PS.
Are your back scars very bad? I think being 31 is an advantage for her with regard to healing well but also sucks in a lot of ways
0 -
SimplySammi, there is unfortunately no way to predict how your daughter is going to do. Like I said, my experience has been that this surgery is not a good one for thin, athletic women, especially athletes who twist their torsos a lot such as I do as a competitive figure skater. But for every woman I've talked to in that boat, I'm sure you can find another one who has a similar body type who has done just fine. Situations are not apples to apples, unfortunately, so there is no definitive way to extrapolate others' experiences and apply them to your daughter's and get a guarantee .
I am on my third bc diagnosis. I had a lump/rads in 2007 when I was 38, did all the chemo, etc, then had a local recurrence on Tamoxifen in 2015. LD flap was my only reconstruction option, and I did not want to do it. My PS talked me into it. I now have a new primary on the "good" side that is requiring neoadjuvant chemo, which I just started, and will require radiation due to positive nodes. That means I am down to LD flap as the only option on that side (although I am going to go talk to two other PSs next week to see if they are willing to work with radiated skin and pre-pec implants). If the LD flap is the only option, I am basically screwed, and will have one flat side and one excruciatingly uncomfortable LD flap side, which will now have been done for nothing. I'd rather just be flat.
All that being said, it is hard to sort out what issues I am having just from the mx, what issues are from the implant, and what issues are from the flap itself. My PS went direct-to-implant, and my lat was so tight that she had trouble getting it to move (her words). Perhaps if I'd had tissue expanders in that would have helped. I went for a second opinion, and that surgeon described my flap as a too tight bungee cord. So basically I feel like I have a too tight bungee cord strangling me on the LD flap side, with an implant shoved up into my pec. Perhaps I would have had issues just with regular implants. My back fascia got so screwed up with this surgery that I have to imagine any flap surgery (DIEP, TUG, etc) would have had a similar effect on my body. I was just not a good candidate for reconstruction due to the natural tightness of my muscles and my physical activity level, which is extremely high and unusual for someone my age.
So I think the take away from all of this is that any reconstruction option can have issues, as well as just the mx itself. However, this article is a good one to read as far as explaining potential LD flap issues in a clinical manner. Please pay attention to the part that says 50% of patients will experience tightness and numbness. For many, the tightness is not normal tightness that is relieved by stretching and massage. It is more like being locked in an iron corset forever. Read up on post-mx "Iron Bra", and the LD flap can be like that, except it affects the entire torso when it does, not just the chest.
http://www.livebeyondbreastcancer.com/rehab-take-h...
0 -
Oh Nash, my heart goes out to you. What a rough road you have been down. As soon as we saw Heather’s first BS and was told of the pathology report we spoke about her options. While we don’t have the genetic predisposition, Heather decided from the start that it was off with both sides. One reason was her mass came up fast and large. Although it was rated Grade 2 and in addition she had multi focal spots in other areas of her left breast although the right was healthy. (The lump was painful so she actually wrote off getting it checked sooner because she thought it was a caffeine lump) They recommended neoadjuvant chemotherapy because of the main mass size, to shrink the cancer, when it grew on AC DD we decided to take her for a 2nd opinion at Vanderbilt. She was 2 treatments into Taxol by this time and it finally felt softer and a bit smaller, so Vandy oncologist said stay the course for now but if it starts feeling larger again and no responding to bring her to them (3.5hrs away from home) and they’d get their BS specialist on it and get it out. Fortunately, the Taxol continued to work and she fished 12 weeks (although got neutropenia and missed a few weeks so she ended up only finishing chemo January 5, 2018.
We changed BS because some issues with what she was told by her original one. We did so after hearing wonderful things about the new BS she ended up going with. Don’t get me wrong I have been going to her first BS for years myself and love her personality but, we felt she wasn’t as detailed and forthcoming with everything. She didn’t spend a whole lot of time explaining anything and always seemed rushed. We just wanted Heather to feel as informed and comfortable as possible. The PS she had is amazing as well. They both spend as much time explaining the what’s and why’s, risks and make sure all questions we could think of were answered before we left the appt. We’ve had no problem with them getting back to us very quickly if we call for any reason.
The point to my reply was really about Heather’s decision to move ahead and with removing both breasts at the same time. She decided on no nipple sparing either. She just didn’t want to take any risk of reoccurrence, although nothing is 100 as we all know. She also figured that it’s better to have the same surgeons taking care of both sides would look better for her. So that’s where we’re at. I have the link you attached pulled up and appreciate you responding to me. Going to go read a while. I pray things get easier for you and at some point soon. Blessings
~Sammi
0 -
Thank you, SimplySammi. Yes in retrospect, I wish I’d had a dble mx in 2007 with implants, as I had clean nodes at that time. That had actually been the recommendation at the time, but my kids were 5 and 8 and my mom was dying of bc, and I had too much going on then to deal with a bigger surgery. And I was more focused on possible mets rather than a local recurrence or new primary. Alas.
I’m glad that Heather is having a good response with Taxol, and I think you guys are doing all the right things in terms of researching all her options. She will probably do just fine with the LD flap—many, many women do. It’s just that none of the issues I’m having now were ever mentioned to me as potential problems, and it’s only now that I’m coming across articles like the one I shared with you that address the dibilitating tightness etc.
Good luck to you guys, and please keep us posted!
0 -
Just as I scoured the Internet about my particular BC diagnosis, the chemo drugs, the surgeries, etc... more stories are shared about the negative experiences. Let’s face it, people are more likely to share the negative just as we do with restaurants and movie reviews. I am happy with what I have experienced just shy of four weeks after LDF surgery and I do wish someone had presented me the option before, like before last’s years $5600 out of pocket expense for a revision that resulted in no real improvement. Grrrrr..... My previous PS obviously didn’t do LDFs. NEVER mentioned it as an option but had immediately told me I didn’t have enough body fat anywhere for various flaps. My current PS... I love her! I found out about her on another bc.org message board about her reconstruction work with implants above the pec. She quickly told me that wasn’t an option for my radiated Breast, but LDF was. I first saw her back in October and came close to scheduling the procedure that first week of November bc she had an unexpected opening in her schedule. That’s how comfortable and optimistic she made me feel. Michelle Roughton at UNC Memorial Hospital in Chapel Hill, N
0 -
I got scared about losing my lat muscle too. I know I would regret doing something cosmetic that caused me pain or made it so I could no longer do the things that I love, like throwing the ball for my dogs, skiing, wakeboarding, hiking, scubadiving, kayaking, and trying to stay reasonably fit at the gym.
I just feel so ugly every time I look in the mirror. Its such a painful reminder of the horrors I have been through and I wish that my breasts could at least look "not scary".
I am now looking in to the Breast Center at New Orleans and considering a SGAP and removing the implants. Will keep you all posted.
0 -
Thanks for sharing your doctor's name and your positive experience. I am assuming she can do all kinds of procedures and not just the lat flap? I may call her for my fourth opinion.
I've had two in Atlanta say Lat Flap.
Breast Center in NoLa is saying SGAP and remove the implants.
Wonder what yours will say?
Anyone have experience with SGAP or NoLa?
0 -
The thing is, that even if you don't experience immediate issues due to the LD muscle missing, common sense dictates that you WILL experience issues down the road. As I said, it comes more and more in evidence that the lack of the LD muscle as muscle supporting the torso upright, in time - over years and years - causes deformation of the spine. For some, it takes longer, for some (especially the ones who went through long-term aromatase inhibitor therapy and experienced the skeletal changes that can be a side effect of it, like osteo-arthritis) will experience them faster.
If strips of skin can be removed and transplanted or fat grafted, when you take the largest muscle of the torso and remove it, the whole functionality of the body will suffer. For some sooner, for some later.
I know we all want to have hope and I know how hard it is when you feel yourself looking like a monster - I looked like one myself for a full year - but you also have to think about the future - and hope for a future. And better a future where your fake breasts might not look fully natural but you CAN lead a normal life, than beautiful fake breasts and being caged in by your own body's inability to function normally anymore.
Think about i t.
0 -
pictures aren’t allowed here (which frustrates me!) but their are some beautiful ones and more positive experiences on a LDF Facebook group I am a member of.
I wish I knew about LDF as an option a year ago.
I pressure washed my porch, patio and patio furniture today. My friend asked, really Sophia??? Should you be doing something so strenuous this soon?”
The thought that I couldn’t or shouldn’t never even crossed my mind! I don’t have full range of motion with my arm, buts it’s gotten much better with simple exercises and I’m determined to get it back to darn near 100%
0 -
Sugar, - Happy to read that you are doing so well! Terrific update!
0 -
This page has scared me to death! I don't know what to do. I want implants but with my radiated breast, I am not sure that is the best option.
0 -
Sugar, nobody said that the esthetics aren't ok. As I said, in my case, my foobs are gorgeous.
I'd still give them up in a heart beat to not be disabled anymore.
I was like you, 8 1/2 years ago (also 48) and sure I'll get there. Just sayin'
0 -
I am 5 years out from my bilateral lat flap procedure. I was athletic before the procedure and have modified my life by not doing any of the swimming, tennis, rowing, climbing or anything that engages the chest and back muscles. Easier said than done. You have no idea how many normal daily activities engage the latissimus. I still struggle with a full cart of groceries at the market. That one, you can't avoid.
Having said that, I am experiencing ongoing back pain. The remaining back muscles just can't compensate for the relocation of the latissimus and the rest of the entire muscle groups struggle to keep me erect in my activities resulting in stiffness, tension and pain.
If you want this surgery, you need to be prepared for the commitment and expense of regular deep tissue massage and myofascial release. You also need to be able to afford the help of therapy appointments to get yourself mobile and keep yourself mobile. You must modify your activities.
Today, I weeded landscaping that included raking mulch back, pulling rocks and weeds and replacing all with new mulch. That clean up will cost me physically tomorrow. I will swell up like the Michelin Tire Man. I will awaken this evening with a boa constrictor feeling around my underarms going to the front chest wall. I will have VISIBLE swelling from under my armpits around to the front chest wall. It will last a few days.
Something that I have discovered over the past years - abdominal strength matters! While the back is weaker and there is less muscle there to compensate, it is vitally important that you build phenomenal abdominal muscles. I'm not talking about revealing a 6 pack....but the muscles being engaged under the fat wall are there to help hold up the spine when the back is not doing a great job of it. Also, posture and paying attention to your posture while sitting and standing can make a difference in building up the muscles that are remaining to help support you.
Sometimes we have to search for ways to heal ourselves. My journey on that path of healing is ongoing. If you have a suggestion or experience in healing, share it. Everyone can benefit.
0 -
Just a clarification. I have now had 12 surgeries total....from bilateral mastectomy, multiple complications, bilateral lat flap recon, revision after revision after revision. My last surgery was December 2017. No plans for any more surgeries.
0 -
Thank you so much for sharing your story. You have definitely made me think twice about this procedure. I am not going to proceed with the Lat Flap. I am looking at some other options. I wish you all the best and hope that all of the issues plaguing you will show some improvement.
0
