Latissimus Dorsi Breast Reconstruction
Comments
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I am going to be very honest here. After discussing with friends and family and not being sure which way to go, it was finally the posts of someone on this board who convinced me to go the LD way. She was praising so much how wonderful this procedure went for her, how fast she recovered, how little it impacted her day to day life, that I decided to go for it. 9 1/2 years later, here I am. Never to recover, a shadow of who I used to be, struggling every day with disabilities.
Don't get me wrong. I am not trying to guilt trip anyone. But it's hard to realize how much our posts here can influence someone in taking decisions that may make or break the rest of their life, on top of everything else.
This procedure is one of the most invasive reconstructions, with the highest potential of morbidities. And should be chosen only for extreme cases. It's irreversible.
After so many years they finally started to acknowledge how much it affects the spine (not noticeable in one or two years, but much later).
How much higher is the percentage of women left with diminished strength and range of motion than initially touted.
It's a major muscle. It exists for a reason. Take a small muscle from a finger, and in time the finger will become crooked. Not in a year, maybe not in two. But it will.
Simple logic.
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I know people have different experiences with all aspects of treatment, and I guess I did kind of make it seem too easy. I was lucky enough to not have complications, and through a lot of hard work I've regained just about all my ROM and strength. I can only give my own opinion based on my own experiences. I'm sorry if I painted too rosy a picture and I should have said, Get the opinions of experts, and your doctors. I'm hoping I won't have troubles as the years go by, I know I will be at the gym trying to keep everything going. It is a major surgery, and a major decision!
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Hi Calli.
I'm in your camp. As well! So much to say about my experience thru all therapies. Lat flap was not remotely my difficulty in the chain of events.
That said there are different degrees of lat flap surgeons expertise, it is a surgery that can be done with little recon expertise. But those that are well versed and can get you up and running post surgery with little difficulty should not be discounted in conjunction with extensive PT.
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You do realize that by your signature, you both had unilateral LD reconstruction, not bilateral, and that makes a huge difference?
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I’m acutely aware that my lat flap was a one-sided affair🤣! It’s not something I would have opted for outta the box! Nor do I strongly advocate for it one way or the other. I simply state my experience thus far with the procedure.
Omg Jo that is such a huge incision! My whole lat muscle was used for the flap, I asked my PS post surgery. But my incision is only a few inches vertical on my side. Huh!
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Wow, Jo what an experience! Really amazing, you have incredible strength! What you had to go through to save your life is a testament to your strength and the abilities of your doctors. Awful that a treatment for cancer can cause cancer! I really feel incredibly lucky to have gone through all my treatments so relatively unscathed. My scar on my back is a thin line, about 9 inches from shoulder blade to just above waist. God bless, Jo and all who have had such complications!💖 Hopefully as time goes on, with P.T. and stretching it will loosen up and give you some relief!
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I appreciate the comments of all of you who have gone through LD reconstruction. One of the great things about these boards is that they provide an opportunity for everyone to share their experiences, and we all come to this with different circumstances and expectations. I read your comments and your signatures explaining your history to help me see what may be in my future. I hope everyone will feel welcome to share their stories - good and bad - otherwise, I'm afraid there is not an opportunity for people to make well-informed decisions. As for me, so far, so good. I have completed the fills in my tissue expanders and I'm in the waiting period before scheduling the exchange surgery. One thing I've learned is that my mother was right again - good posture has been very important for my comfort. My best wishes to all of you!
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I had to have a mx/uni LD flap because of a local recurrence post-lump/rads in 2015.
I had a nationally renowned PS who specialized in LD flap do my uni LD. I was hesitant about the surgery, but she talked me into it. I had used her for my lumpectomy years earlier, and trusted her. I have been a competitive figure skater all my life, and still skate now despite my now Stage IV situation. The PS vastly underestimated my need to twist my body while on the ice, and just how strong my back is from over four decades of skating.
My PS's nurse told me, after the surgery, that "their younger, fitter patients have more trouble with this surgery". I wish he had mentioned that prior to me going under the knife.
Right after my surgery, while I was still in the hospital, my PS told me that my surgery was a very physical one for her, and that she "had trouble getting my LD to move".
She also told me that I didn't need any PT, and that I was her only patient who has ever had any problems. She blamed my issues on prior radiation, the mx and nerve damage, none of which are major contributing factors in my case, IMO.
Almost four years and 13 PT people later, I live in constant, extreme tightness, restricted movement and some manageable pain.
It feels like I have a rock duct taped to my chest, with the duct tape extending all over my side and back, along with a metal rod digging into my back between the shoulder blade and the back scar, extending around my side.
It is like a low grade form of torture. The only thing that takes the edge off are Botox injections in my back, which are administered by a neurologist. She thinks my muscles are in constant spasm from the LD flap surgery, and she appears to be correct.
I think the outcome of this surgery depends very much on the patient's physique and muscle composition, in addition to how much muscle is taken. Obviously PS skill comes into play, but my PS, like I said, is highly skilled, very experienced, and highly regarded. None of that made a difference for me.
My medical team at the time of the LD flap had me skip my annual breast MRI on my "good" side, saying that the inflammation from the LD flap surgery on the other side would affect the MRI. They plowed ahead with a lift on the "good" side during LD flap revision, based on a "clean" mammo.
The lift on the "good" side masked a massive new primary tumor, which quickly spread to my brain. Had I not had the LD flap reconstruction in 2015, the new primary in 2018 would have been caught earlier, and perhaps would not have spread to my brain. We will never know. Perhaps my initial primary in 2007 that recurred in 2015 is the culprit. But based on genomic testing, it appears the new 2018 primary is the more aggressive of the tumors. I suspect the inflammation from the LD flap surgery contributed to the rapid development of new primary on the other side.
I am happy for the women who do well with the LD flap. But my advice to those considering the surgery is this: be aware of the potential outcome of permanent tightness, pain and restriction of movement that cannot be relieved by stretching, massage, MFR or pills. Factor that in to the decision.
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Thank you, Jo-5. As always, many hugs and prayers coming your way.
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I agree with the physique being very important. The numbers seem to show that former athletes (especially the ones into sports developing the LD muscle, like gymnastics or swimming - there's a reason why it's called "the swimmer's muscle") have the most issues. Unfortunately I was in both these sports in my youth. I had immediate reconstruction, the BMX part took close to 2 hours, the reconstruction over 9 - including lots of bleeding that required blood transfusion.
I feel differently. For me it's like there are fish hooks under the skin in the incision areas with the line pulling under the skin from the shoulder blades. Plus the feeling that I'm always wearing a corset that is too tight. My remaining back muscles start spasming and burning if I sit on a chair for longer than 15 minutes.
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seachain, I could use the iron corset and fish hook analogies myself as well. I get burning pain, too. I think we may feel pretty close to the same. If nothing else, we both feel crappy, unfotunately!
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Yes. I just wish you were feeling only as crappy as me, without the other "crappy" that you have.
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seachain, thank you. <<hugs>
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Well said
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I’m new here, I’m a hairstylist and I’m having double mastectomy. I am waiting for a surgery date for LD with immediate implant. I am concerned that the surgery will affect my ability to work. Could any stylists on here that have had the surgery please give me their story and experience post surgery. I’m nervous and the conflicting experiences are confusing me... I know everyone is different, but any help would be appreciated!
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Thanks Jo... just nervous, I’m single and this is my career
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Dixie56,
There don't seem to be many of us on these boards who had LD flap reconstruction, so I wanted to respond, although I don't have much information that will be helpful to you. I had LD flap reconstruction (with tissue expanders) at the time of my bilateral mastectomy. I chose it because that is what my PS recommended, and his reasoning seemed solid to me. As you will see, I also had a second surgery 10 days later because of a close margin. That second surgery seems to be the source of any slight difficulties I had (which were related to range of motion because of the location of the re-excision), and they resolved with physical therapy. I have had no back issues with the LD flap reconstruction at all, but I don't work in a profession where I'm constantly using my arms like you (and like JO-5). I do hope people who have had a good experience, like CaliKelly and CBK, will see this and offer you some information on their personal experiences as well. I'm afraid that those of us who only had one type of reconstruction just aren't in a position to compare what others experience with other types of reconstruction.
I do think you are wise to consider the impact of the different types of reconstruction on your ability to continue your career. You need your PS (and maybe more than one) to be completely straight with you about the chances that this would impact your livelihood (not just now, but later) and what they would recommend given that very important fact. The risk/benefit analysis for you will be very different than for someone like me.
Best wishes to you and as you make your decision and please come back and let us know what you decided.
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Hello Dixie ! I am hair stylist, I had my surgery just over a year ago. I will tell you that for me , I wish I could turn back time. My range of motion has been affected and my shoulder and pectoral area seize up and becomes quite uncomfortable. I don’t know if anyone else has this issue , periodically the muscle under the breast that supports the implant will spasm and it is painful. Similar to a Charlie horse , I assume it is from tension from how it is flapped. I wish I had a better success story for you. Is there a reason why you are not doing a diep flap ? You may have a better outcome , something to think about anyway .
All the best to you , I wish you a comfortable recovery
If there is anything else I can help you with , don’t hesitate to ask
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Dixie, - why did you choose LD?
I have implants on both sides, - one side LD, and one side not. (Radiated side ended up needing LD.) The non-LD side has been more comfortable all along.
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Dixie I am hair stylist I had the mastectomy with tissue expanders and then implants. After some very damaging radiation a few years later I had latissimus flap surgery with immediate implants. Are you having one or both sides?? I have both sides which was a very big mistake. Actually the entire surgery was a very big mistake. I had a lot of complications. Why are you having LD flap? Do you have radiation damage? I will never be able to work full time again. Sometimes I have to use a small step stool just to reach my clients. My mid thoracic area of my back tires very quickly . I was probably off work 8 weeks after the surgery and then went back a few hours a day. Sometimes when bending over to shampoo people I have spasms. If there's one thing I could take back in my life it would be having the surgery
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I am looking fir the least down time, my PS doesn’t like doing the DIEP and doesn’t like the results from it. I was concerned with cutting my stomach muscles anyway. She also doesn’t like the direct to implant because of problems with donor tissue. I wasn’t sure about the tissue expanders because of the pain and down time after the fills. So the lat surgery with immediate implant seemed the right way to go. Now I’m not sure
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Hi Dixie56,
I had a double mastectomy with LD procedure done Jan 2018 on my right side . Direct to implant , no expanders. My left side was a prophylactic nipple sparing procedure with silicone implant.
I had prior radiation on my right side in 2008 I chose LD over DIEP. I had no issues with donor skin- my surgeon is known to be a perfectionist, and did a beautiful job. My plastic surgeon is also a microsurgeon ( very important if you choose DIEP). I had no complications with the surgery . Like you, I didn't want my stomach muscles used.
Did it hurt? Hell yes...would I do it again? Most likely, however I would not do the LD on BOTH sides.... like ever! The recovery was rough for me but doable . Keep in mind, you will need help for a few weeks...showering and dealing with the drains was a pain. I didn't need any physical therapy, I just did the exercises I was given to do at 3 weeks , and stuck to them as instructed. I have full range of motion back. HOWEVER: my armpit is numb, so is my right side of my back where my huge scar is and part of my right side below the armpit. ( your chest will be numb also, which I assume you know this will happen). The scars look good - my surgeon did an excellent job there. So far no back issues...but there are times I feel tight or like the wrap around muscle thing gets "caught or hung up", it's hard to explain. You most likely will have an underarm "loaf of fat" that won't go away completely either. It's just there. I'm not overweight- the plastics nurse would tell me it would even out- then admitted much later on that it won't ever be the same as it was before surgery....
I still need a second surgery for fat grafting on the left side and a tattoo of aerola and nipple on my LD side - I may or may not choose to have that done...I'm not certain yet.
I have a desk job so I don't use my arms like you would being a hairdresser.
I am not in constant pain of any sort....the numbness is most annoying.
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Thank you Krissy37... so many horror stories and so many success stories... which one will I be??? Definitely have more questions for my PS, also want to see if I can talk to other patients that have had this done and get there story. Nothing is booked yet. Wondering if I should be doing just expanders. Such a big de
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Chiming in.....I haven't worked up the courage in 5 years to have reconstruction. The only option available to me is the LD and due to the exchange on this thread I am waiting. So I am half flat with radiation on one side and NO recon.
Being flat does not guarantee you won't still have issues. I have range of motion issues with no reconstruction. I have the spasms, my pectoral muscle seizes up during the day with the "charley horse" as described by CherylMk after her recon. A large area of my flat chest is numb. I have twinges of shooting pain to the area the ALND was performed due to cording. I have throbbing pain at my elbow due to the inability of my lymph system to drain properly. I have to stretch 3-4 times a day EVERY day and do manual massage on my arm.
Why am I sharing this? There is a lot that you need to consider when making this decision....will you have radiation? are your nodes clear? do you need to get a second opinion on the DIEP?
With that said, all surgeries/treatment have the potential to cause side effects. You have to make the best decision you can with the information available. I am sorry you have to go through this at all.
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Hi Joanne, I am in my mid 50’s and am single again since December, so I don’t think I want to go flat at this time. If I was still in a committed relationship and he was good with that decision, I would consider it. Or if I was older I wouldn’t want such a long surgery. Thank you for your reply. I have a lot to think about! I’m also concerned that maybe my skin wouldn’t handle the expanders and so would end up with LD anyway.
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Yes this is a first, I won’t need chemo or radiation. They will take one node and test it at time of surgery. I have thought about getting a second opinion, will have to call my surgeon and see who else is recommended. Thanks for the input
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Dixie, I opted for LD as a last resort. I was not a candidate for diep, and although I tried TE and then implant, the radiated skin was unable to heal 100%, so LD it was for me.
Why do you think your skin couldnt handle TE and implant? Without radiation, I would think you'd be fine!
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Dixie -
I only had a Lat Flap because of poor blood circulation on one side that rendered me needing this so I could complete my reconstruction to my previous healthy breast size. I was insistent on my full C cup!
Here's the problem, in my limited scope and opinion. An LD flap can be performed by a very inexperienced surgeon and I would never ever opt for it outta the box. If surgeon is wanting to do that, it makes zero sense to me.
That said, I do not have problems on my lat flap side except slight strength issues but I've been going through multiple recon surgeries.. which are finished now ...big score ! So I'm hoping to get back to it all!!
My one sided lat flap surgery was the easiest I ever had!
Keep asking questions! Feel free to DM too!!
Best
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Hello everyone, this is my first time posting to any type of blog so pardon me if I do not know the proper language/acronyms. I am a 3 year breast cancer survivor, no chemo or radiation. I had a R breast mastectomy and w/reconstruction/implant. I also had an implant in my L breast. The initial reconstruction was a botched job which now requires me to have a LD Flap surgery. I was (and still am) concerned about the long term effects. I've read so many different reviews on the internet and I'm wondering if this is something I should even consider doing. I do have minimal pulling and my breast is shifting to near my underarm pit
...... I've read some of your ladies' posts and I'm a little hopeful that the recovery and healing might not be as bad as I think. My surgery is scheduled for June 12th. I am 50 years old, my first year wedding anniversary is in August and my husband is super supportive. At times I feel like I'm freaking out about the decision... Any feedback is welcome..Thank you so much in advance!
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Lovly
Why would capsular contracture, implant shifting to armpit, require a Lat flap?
Just trying to understand your botched job and what surgeon wants to do based on your condition?
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