Latissimus Dorsi Breast Reconstruction
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Westieluv,
You asked about follow up:
I have a BC friend who is very low risk for reoccuence, so doesn't need an oncologist. She has a BS and PS (from a teaching hospital in Chicago) and the BS will follow her every 6 months for 2 years for reoccurance-which was reassuring. Myself, it is the oncologist.
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To Newbe6 and the others asking about long range issues with Lat Flap:
I still have range of motion issues with my left shoulder. I have not committed to the necessary Physical Therapy to regain it due to my Mom's cancer and helping her. I will do it after nipple recon. I also have an area of pain on the right side under my arm and at the edge of the flap on that side. I believe it to be edema or possibly some truncal lymphedema that has come up from time to time when I wear a very tight bra band. There is no way that you will be able to go back to weight training immediately after lat flap. After implant exchange, you still need to heal up again before going back to weight training. I will be going back to work outs including some modified upper body weight training in about another 4 weeks. Don't rush it. Moving skin flaps with muscle is major stuff. You can't treat it like a bandaid surgery. Time to heal is critical.
I have iron bra feeling only at the end of the day now. I know that my lack of good posture contributes to the pain and if I was better at keeping proper posture throughout the day, I may never feel the iron bra.
Be aware that not all surgeons place the flaps the same. Mine are elliptical shaped and now the incision line is in the middle of my foobs. I have seen MANY, MANY variations of flaps.
My back scars are long and a little puckered at the top. My PS will lipo that out at nipple recon and also do fat grafting from there and my tummy to inject in my left foob to even the size out. My right is definitely bigger than the left.
I'll update photos again when I can find the time.
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Hi Ladies - I wrote this yesterday but apparently it didn't take or I forgot to submit. In any case..
Here are few suggestions:
For those having pain in their scars seek out a physical therapist that specializes with cancer patients. Mine helped me out a lot and prevented a lot of scar tissue in the meantime.
Exercise - don't push yourself to quickly. Start with the exercises that the doctor gives you to prevent frozen shoulder. I took a class of pilates for cancer patients and was shocked that I didn't have as great a range as I had thought. It totally made a difference. This will also help with the "iron bra" effect. Be sure to massage your breasts as well it will help also.
Fat grafting - Don't know enough about it. I know when my implants when in they did some fat placement. I now have 2 fat necrosis nodules. One is painful on and off, the other doesn't hurt. They will be removed when I get my revision on the right side.
Rolls under the arm - I have a very slight roll under my arm. My BS was impressed with the PS and how much she had minimized the roll. I think it has a lot to do with the stitching and placement of the latissumus muscle.
Westluv - I hope your mother is doing well and yourself as well.
Newbe6 - I don't have many complications at least I don't believe I do. I'm not happy that I have foobs but I am happy that I am alive.
I get to see my grandkids grow up and my children mature. I go through periods where I wish I had my own breasts back, but what are you going to do. I don't have cleavage and it looks like I might have a uniboob {lol}. I try to find some humor in my situation. I think it helps me deal with what has happened. I have also seeked out group sessions at Gildas Club, it really has helped as well.Well these are just my thoughts and ideas. You must do what you feel is best for you. Be positive, live your truth and be happy!
Cindy
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Newbe6~~I just came across your post asking for info on endiscopic recon proceedures. Do you mean LD flap recon with TEs without any back incisions? That's what I had done about two years ago. If this is what you are looking for, feel free to PM me.
Bobbi
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Have a great weekend everyone!
Cindy
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Mom has her BMX scheduled for Tuesday morning. Meeting with oncologist was a real downer. What a boatload of crap she is going to go through.
I am doing fine. Just trying not to overdo. My incisions are fine and I believe I am starting to get a little drop and fluff.
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Hello I am new here and am brca1 positive. Hope I did the right thing by removing potential bad tissue for the future. Its just over a year from removing my female reductive parts - they took everything and then in December of last year I did the double profolactic removal of breast tissue with expanders. My right side took a while for the scar to look like it was going to heal and now 9 months later you can hardly see where I was cut. My left side well thats another story. Four days after the surgery the expander shifted towards my arm pit and I had to wait two months to heal. Mean while I filled on the right side. I had the 2nd expander surgery in February and was thrilled to see how the new position felt normal and I did not have the pressure I first felt on my heart. BTW I am a large gal and have the right expander filled to 800 cc's and I look like half of what I use to be! A month later I noticed the skin on the newly replaced expander was turning shiny and a bit red and then the incision area began to bubble immediately I saw my PS. He said that he needed to open the incision a bit to see how far the infected tissue was. So off I went hysterical as you can imagine and an hour later sat on the surgical bed with no left expander while watching the entire process :-( . I was lucky and the cavity healed really well. After a week of daily nurses coming to the house to pack the open cavity I got sick of them coming and learned to do it myself. I healed wonderfully probably due to the consistency of my doing it rather than a number of different people each taking a different approach and allowing me to have some sort of life while healing. Funny the 7' long gauze filled the cavity and it was not so bad. So to make my long story short I am going to have a latissimus dorsi muscle flap surgery in October (if all continues to go well) on my left side and I am scared to death. PS tells me that because I have excess skin on my back he may well there is a slight chance that he can get enough skin to cover the area that normall would be expanded to match my right side in one step and put the implant in rather than a smaller expander and then put the implant in on my right side! How wonderful would that be I say to myself.....one less surgery to think about. My December surgery I was putting out 100 plus cc's a day right drain was pulled at 75 cc's after 6 weeks in the er because the drain stitch wore out and the suction no longer was good. My left was still in when I went into surgery to replace the shifted expander and I came out with a brand new one removed after one month. I am aware of the procedure, have watched surgical videos and can't imagin how I am going to come home and heal. I have no family in the area to help and would like to be as prepared for home as possible. I have learned that no two procedures are the same and everyone heals differently but when I had the hysterectomy I was well prepared and healing was easier because I was set up. Can someome either direct me to an area here where I can get info for after or share what helped after you came home. If only the left side is operated on I am told I will have two drains in the back and one on the breast. How in gods name can you sleep with drains coming out of your back?????? I cant lie on my right side because the expander sticks out and have been told to keep on my back. I purchased two v shaped pillows, have the body pillow and many other regular ones some firm some soft. I look forward to hearing what I may expect because I am tired of everyone telling me not to worry everything will be fine......want to yell at them "have you been thru the surgery yourself!!!!!?????" Appreciate any hints. I am so afraid and have no where to turn please help! Thanks so much.
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whatsnext, sleeping with a drain in your back is not a problem. I had a lat flap done 7/19 & still have my back drain. I work full time, so I am moving around a lot & still producing a lot of fluid. I sleep on my back with a wedge pillow.
Beth, sending my best wishes to your mom!
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whatsnext: Maybe read through this entire thread. There is a lot of good info in it.
I want to all you wonderful woman what has happened to me in the last few days. I went to my PS with my list of ?'s from this thread--ie what to expect afterward LD, etc.. The meeting went poorly--he didn't think I should be asking so many ?'s. A few days afterward, I had a consult with a 3rd PS, and the only one who does endoscopic LD, and he recommmends just putting the TE back in w/o the LD! He also says if I WANT LD, he can do it endoscopic. . I liked him and he has 19 4 star reviews on vital (so I am going to him)! If anyones want his info, PM me. This was the good news.
But there was some bad. I went for my annual pap, but for the first time I went to a specialist--onc gyne. Just to see what he would think about screening for ovarian cancer. He screened me with CA125 and ultrasound, and found something of concern in the lining of the uterus. So I have a uterine biopsy on Mon
. Apparently, high estrogen level is a risk for uterine cancer. Comments or experience? 0 -
Yeah, I keep reading about endoscopic lat flap, but the only doctor that I know that does it is in Nevada. I can't find any surgeons in any of my research! This must be a VERY new thing.
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I am now four weeks out of surgery and the so called "edema" in my armpit has not gone down.The more I read, the more I think that I will be stuck with a boob in my armpit. As Cindy said, in so many words, I just count my blessings that I am alive and well.
Whatsnext, I can not imagine going through the surgery without anyone at home to help. You are supposed to have someone with you for the first 24 hours home and I imagine you know that. Reading that you have no one to help makes me sad. I would bet if you created a post stating "ARE THERE ANY GALS HERE IN the _____, Massachusetts's area, I NEED HELP with post-surgery care", you would find someone or even many willing to assist. I have been on bco for nearly a year and have found SO many breast friends who live very close to me. I had my lat flap 4.5 weeks ago and am still draining. I lost my cap, am using a qtip but it is draining fine, still running over 50ml. I DID NOT have any drains in my back, only the side and stomach. Also, the one in now is on my stomach and I have been able to lay on my belly for short periods of time. I pray that you find help with your upcoming surgery, prayers to you!
Beth, glad to hear about the drop and fluff! I will be thinking of your Mom on Tuesday, hang in there and take it easy.
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Boob under the arm:
I too have a flap of skin and fat under my arm where the PS drew the LD muscle through and it goes all the way to the LD scar....where it stands out more after stripping the muscle and fat from there. It's kind of gross how my ribs stick out on that side. My son said I just can't wear a bikini top at our home pool even.
Anyway, my ps said when she does the revision of the LD implant next month (it's dropped down as the muscle atrophied) she can get rid of the skin and fat under that arm and back but it's necessary to wait 6 months for all to settle.
So there is something that can be done about the extra fat and skin under the arm.
The edema will go down with time. Raising the arm above your head as you watch tv and massage with lotion from wrist to armpit will help.
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thanks Debbie. I am anxious to find out if my armpit also inflates after gettting a 2nd fill tomorrow... i can feel the saline when I poke the armpit area, I have a feeling that the muscle was not pulled in far enough but heck, what do I know, I am just a bc patient! And sorry you are not able to wear your bikini top but I think it is best to keep the sun off the incisions anyway. I think my bikini days are long gone lol, i hope you get back in yours!
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Whatsnext--first let me say I hope you can find someone to come help you. DorthyK gave you a great suggestion; asking for help on these boards. I encourage you to try. I would be there in a heartbeat if I lived close.
I found sleeping in a recliner was the best for me. Easier to get up and down and less pressure on the drain sites. After lat surgery it's hard to use your arms for much, can't leverage yourself out of bed, etc. Make sure that around the house you have everything close at hand: toilet paper, side tables, dishes you will need. You won't want to have to reach for anything for a few days. But this condition passes quickly. There are some stretches that you can do right away. Ask the PT in hospital to show you. I found showering the first few times somewhat a challenge. Ended up tying a shoelace around my neck to hold the drains. Have a good thirsty towel handy because it's hard to dry your back. Don't try shampooing for a bit. Go to your salon and have it done, hopefully you can find someone to take you.
The first two weeks are the hardest. Stay in hospital as long as possible. Oh, just a thought: have you checked out home health care? Perhaps a nurse for an hour or two a day would be of help.
I'm probably forgetting some important tips for you as my surgery was two years ago, now. I hope others chime in.
Best of luck,
Bobbi
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Whatsnext and all ladies ~
Here is a suggestion for {anyone going in for surgery}. Before you leave the hospital ask the nurse or dr for the oxgen nose tube they give you and take them home. When go to take your shower you can clip the ball around the tube and they hang there freeing your arms up. That's what I did for all my surgeries that involved drains. The balls have tabs and so that is very helpful.
I have plenty of posts on here in regards to my experience with surgeries and BI-Lat Flaps. So please feel free to read them.
Sept 20th is hopefully my last and 9th surgery in regards to my reconstruction. Nips or not, Lipo for fat replacement or not? Thankfully I have up to the surgery day to decide those. If it's just the revision on the right side I am good with that.
Have a fab day!
whatsnext you can always PM me or anyone if you wish.
Cindy
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It's been a long day. My Mom had her BMX. She is resting comfortable in her hospital bed. Surgeon could not get port placement in the latest trend position under clavicle to central line, so they had to dissect a vein coming in from her arm/shoulder and position it directly. She had 6 nodes removed on the right and 2 on the left. Pathology on nodes will be back Friday, but no obvious signs to the surgeon. To top it off, the pathologists at Siteman Cancer Center are not sure of her HER2 status. They question the result from the other pathologist and are running their own hormonal panel on the tissue they took out today. We'll get a confirmation on triple neg or not by Friday. She will still require chemo due to tumor size which stages her at 2b without node involvement.
I hope all ladies in various stages of recovery or surgery with Lat Flap are doing well today. I feel good and will go back to PS in late Sept to look over things and schedule my fipple surgery.
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Hi!
I'm wondering if this has happened to anyone else...about 3 weeks after exchange...my implant migrated to the axilla and eventually into the back...Yikes!...I am wearing an underwire now instead of the surgical compression vest...My PS hopes that in time the tunnel will fibrose. Haven't read about this complication....
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Wow docmomof3 this makes me want to go to an underwire and pronto!. I had not heard of that complication, but wouldn't it mean that they didn't construct the pocket side so the implant could move in that direction?
Someone else with more knowledge about this will come along soon.
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I've heard under the arm but not the back. I personally think it has to do with how the PS stitched your pocket. Mine don't even go to under my arms because of how the pocket stitched. I would question your PS again. Waiting for fibroses doesn't make sense to me.
Anyone else?
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Hi,
I had BMX with Latissimus Dorsi on August 9. I've been reading through some of the posts and find them helpful with some of the things I'm experiencing. Seroma, tight back, etc. I'm only 2 1/2 weeks out, but does this get better?
Joyce
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Joyce,
You're just a baby at 2 1/2 weeks out. It will get better - it takes time, being gentle with your body, and physio-therapy. If my ps hadn't done the lat flap on my radiated breast it wouldn't of supported the implant.
My BMX was March 5th and I only have fine lines of pink for scars. The only weirdness is the football shaped piece of skin on the lat flap breast as my back skin doesn't match the breast skin. Plus, all will look better after the PS does an adjustment next month, as one implant is liking to go outward toward my arm and the lat flap one has sunk down - all to be expected...and then sometime I get nipples and tattoos.
Seroma's are normal, the ps can drain them or if it's a small amount your body will reabsorb it and the tight back will lessen. As soon as all of your incisions heal, start slathering a nice rich creamy lotion on all your incisions twice a day. It sure helped me.
Good luck!
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Hi Debbie,
Thanks for getting back. It's just as the pain is subsiding that I'm noticing all of these other strange sensations. In particular is how tight and tingly my back feels. It makes sense seeing as they've moved as this muscle around, but I'm just not quite knowing what to expect.
Would anyone have a site that gives good information on recovery from this operation. My surgeon has not been very helpful in providing after care information. I asked if she had anything such as a handout, but she does not.
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joyceva
As for the strange sensations, it did take some time for my back to start to feel normal again. If you think about it, the underlying muscle has never had rubbing sensation on it before since the Lattissimus Dorsi muscle covered it. I had to build up a little bit of sensation resistance....and eventually it feels very normal again. The numb sensation in my back is almost gone now. I had lat flap in March of this year.
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Hi all! I keep "surfing" between the different threads...new to this one.
To make a long story short: 6/28/11 I had BMX with immediate recon (implants). Ended up with major necrosis of the skin on both breasts and on 8/18/11 I had the dead skin removed and implants were replaced with TEs.I noticed a spot on my right breast that looked a lot like necrosis...and today I saw my PS, who confirmed that the skin won't make it. I am devastated and exhausted emotionally and financially (because I've been out of work for so long). So now I am scheduled to have a latissimus flap surgery done this Friday. I made a quick decision (between the lati and TRAM flap) and I don't know if it was the right one..I'm sitting here now thinking what about just delaying the whole thing? Take the TE out and just don't do any recon, is that possible? I just want to give up...any advice is helpful! Thanks
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miasanta200,
I had a lat flap to one side with my DMX in March and am very happy with the results. With the lat flap 1/2 of the muscle is still attached where it normally is, so the blood flow is only 1/2 interrupted. I had no complications.
You have been through so much. You would not be giving up if Friday you decided to take the TE out and do nothing else right now. A breather. To get yourself emotionally, physically and financially more stable. The road of breast reconstruction is not short and often stretch's to two years or more.
Does your dr have any idea why you got the necrosis? Did he start you on antibiotics right away?
Sounds silly, but I would list on a piece of paper the pros and cons of going ahead with reconstruction now versus delaying it or not doing reconstruction at all. There are women here who have had implants, were unhappy and had them removed. It's your choice!
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Hi Miasanta ~
There is absolutely nothing wrong with taking a break from surgery. I did exactly that after I had necrosis on one side and then the TE's didn't stay in on one side {it didn't actually pop out but you could see it}, that was a regular type of recon using only the pectoral muscle. I decided at that time I am done with surgeries. I told my PS take them both out and I am going to take at least 6 months or so to heal. That was Sept 1 2009. I went to a different PS and on May 4th 2010 {1 day before my birthday} I went in and had a bilateral Lat flap done. It went very well. Barely used the pain medication had a few drains that came out pretty quickly and started my fills by the end of the month. I am very glad I waited. I had my exchange in Nov 2010 and I am going in at the end of September for my final surgery. I should only be out for 2 weeks then.
I do highly recommend that you seek out a group specific to cancer patients. Not just breast cancer but all kinds of cancer. If you have a Gilda's Club in the area they are a very good source. That is where I go every week here in Seattle.
Also be sure to do the exercise they gave you when you left the hospital. Exercise is important as it helps keep your range of motion open. It takes time but you will get back there and feel better. I still have my moments but everything is coming along smoothly.
My whole story is in here somewhere {I actually started the thread}. So come back with any questions. There are carrying women on here that will lend you an ear anytime.
You can always PM anyone as well with questions if you do not want to post it here.
Until next time, have a wonderful day!!
Cindy
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justagirl: Hi! My PS doesn't know why the necrosis happened, the blood supply was cut off, I suppose. And yes, I had antibiotics in my IV after surgery and Keflex 4 times/day for a week when I got home.
Thanks to you and Faythnme for your support
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miasanta2007, are you still scheduled for surgery tomorrow? Good luck!
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misanta200...: also forgot to say, yes there is some weakness with my right arm after cutting the lat muscle, but not noticeable except on super heavy lifting and then if I use my left arm too, it's okay. No problem with housework or hanging up heavy stuff on the clothesline, like a wet blanket.
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I went back to the gym today for my first official "weight training day". I need to do some exercise modification. There are many machines (Nautilus) that I can no longer do because they engage the lats. My chest was jumping all over the place. LOL!
Has anyone worked with a trainer on modifying their weight training so that you are not engaging the lat dorsi when you want it to atrophy? I think I may need to write a book. There is little to no information out there in exercise land about how to recover from this surgery and still be a gym rat.
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