Latissimus Dorsi Breast Reconstruction
Comments
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I agree why would you need an LD flap? I could see if you had lost your skin due to radiation. If there's another option I would definitely try to avoid the flap. There's a lot of complications involved. Some people have been very lucky but some of us have been very unfortunate and had lifetime Rugrats
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To the new women on this thread--absolutely avoid this surgery if there are other options and your livelihood depends on being able to stand for long periods of time and use your arms. I'd also advise avoiding the mx unless clinically necessary. It is not going to save your life. It only has an impact on local recurrence, and even then, is not a complete guarantee.
Yes, people have trouble with just the mx too, but the problem with the LD flap is that while many, many women have great success and zero issues with the surgery, there is no way to know how you will fare until it is done. If it ends up being the wrong surgery for your body type and situation, it is a living nightmare with no way to fix it. Reconstructed boobs are not worth the trade off in QOL, IMO.
I had a very well respected surgeon who specialized in LD flap and sweet talked me into the surgery (I had to have an mx for a local recurrence in a previously radiated breast), when my gut told me to not do it. Worst decision I have ever made. She also did a lift on my "good" side, which masked a new primary bc tumor, which then quickly spread to my brain.
So now I am Stage IV with brain mets, and am in constant pain and discomfort from the LD flap, despite going to a vast array of PT people over the course of several years.
At the very least, if one elects to do the LD flap post mx, have the mx first and see how one feels. At least then one can sort out what issues are from the mx and what issues are from the flap.
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Well update.. went to see my PS again and told her that I am not comfortable with harvesting any muscle from my body if I don’t need to. I will not be having radiation and asked for the direct to implant following my mastectomies. She had had a lot of patients with latent infections and hematoma...and is why she is hesitant... But it what I want to do, and she has agreed to do it! Still waiting fir a date, but will be soon! Thanks for the advice, will keep you poste
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Hi CBK, thanks for responding.
The implant is directly under my skin and according to the surgeon, the LD is necessary to replace the tissue removed during the mastectomy.
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Lovly
What you have described so far is called capsular contracture when the implant shifts to an area it shouldn’t. In your case that’s toward your armpit. This is more likely when the implant is placed over the pec muscle. Most surgeons from what I understand wrap that implant over the muscle with Alloderm to stop the shifting.
But I experienced capsular contracture with a Lat flap and had a capsulectomy. A lat flap is not going to remedy this type of condition.
Maybe there are other factors you haven’t verbalized here, and please feel free to go into more detail or Dm me.
A Lat flap, is usually a salvage type surgery. Like if expander or implant circulation/ blood flow is compromised. This often happens to radiated patients, in my case I was not radiated but the blood flow to that area after my MX was never right. My skin easy too thin, purple in color, and would not support the size of implant I insisted on without a flap surgery.
I again am not advocating for this surgery, I’m merely explaining my understanding of it and my experience during my 2 year reconstruction.
I wouldn’t want you to get involved with an unnecessary surgery. Mine happened to be easeful as well as after but you just never know!
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CBK,
Thank you so much for sharing. The information I provided was all I received from the surgeon. No other complications other than my skin is too thin to do a reconstruction and implant over. Given that I had a c-section and my incision is vertical, he indicated that he can’t remove any fat from that area. Since joining the group, I decided to seek another opinion before moving forward because as you all have stated, I do not want to have an unnecessary procedure when other options are available.
Lovly
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Lovly1,
I just wanted to add my comments here, in case you have not seen my prior post. I had a bilateral mastectomy with LD flap reconstruction to both breasts in December. I had no radiation or chemo. One of the reasons I chose LD flap was because I did not want thin skin and healing to be an issue - not just now, but when I am older, with even thinner skin (I am 55 now). I did not have enough tissue for a DIEP flap.
I also had a re-excision because of a close margin, and to the extent I've had issues, it is due to that surgery and scar tissue. I was well aware of the risks of my re-excision, and I would still make the same choice (rather than have radiation instead). I have had absolutely no issues with my back since surgery. I do not want to trivialize what everyone here has said, because it sounds like they have had very difficult experiences with the LD flap - I just want to post my personal experience. I think the more information we all can share with each other, the better.
I found and read these boards after my surgery and the experiences of everyone here frightened me and made me sick to my stomach with fear (and of course it was too late for me at that point). I just wanted you to know that there are those of us who have had the LD flap without complications (so far). I do not think I'm the only person who had the LD flap as an immediate reconstruction choice, but I do realize it is often used when there already have been complications - I would think it might be difficult in some circumstances to determine whether the pre-existing complications were the source of issues or whether it was the LD flap itself. In other circumstances, I'm sure the source of problems is clear. We all can only speak to our particular experiences, but to the extent you are able to compare your situation to the experiences of women who have posted, I believe that would be helpful to you.
I wish you the best. These decisions we are forced to make are not easy, and none of the options are foolproof.
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I haven't chimed in on this board for a while so I thought I should after reading SuQu's post above. I too have had a very successful LD flap surgery on one side. I didn't have much choice because my skin developed a small hole on the radiated side about 2-1/2 years after my original BMX. While it was a painful recovery at first, it was the best decision and I'm very happy with my end result. Having said that, I have an amazing plastic surgeon and had complete trust in him. Good luck to anyone trying to make this decision.
Kathy
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Ladies thank you so much for sharing and sharing again. I have scheduled an appointment for this Friday May 17th, 2019 to have another opinion. I will let you all know what this surgeon's opinion is and the suggestions he makes. Any suggestions on some of the questions I might ask, based on your experiences?
Thank you all,
Lovly
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I would wonder why you couldn’t reconstruct placing the implant below the pectoral muscle? I’m assuming you are above? Or by downsizing the size of implant, if you are willing. I understand if you don’t want to do either!!
I never wanted diep so I can’t react to the C-section scar comment .
If this next surgeon wants to do a Lat Flap ask him/ her how many has they have done and check around. I knew my surgeon’s reputation/ experience with this surgery FAR before I had to consider it!!
Make sure you are dealing with a TRUEreconstruction surgeon, not some PS that decided to dabble in breast reconstruction !
Good luck Lovly... I look forward to hearing what you find out!
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HI Lovly.
I haven't been on this site in some time but I thought I'd chime in on your posting. I had a successful LD flap 8 years ago. I had a double mastectomy but only had the LD flap surgery on my right breast (the cancerous one). I had a nipple sparing mastectomy on my left breast so it just has the implant. I'm definitely not going to say the whole thing was a walk in the park, but I was able to get around pretty quickly after I came home from the hospital (go to my kids activities). Fast forward a few years and I am much happier with the breast that has the LD flap than I am with the side without it. I'm considering going back and getting the left one done.
Good luck!
Darla
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Thanks for sharing your experience. I have had a double mastectomy with complications on the right due to an arterial bleed right after surgery. The option I have been given is the latissimus flap. One day I want to do it and the next day I say I'll live with it. I'm terrified to make things worse if something goes wrong. So many decisions!
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Ladies, I met with another plastic surgeon for a second opinion regarding my options and my concerns about the LD. I was informed by the second surgeon that I can have a TRAM FLAP, and that my back might not be the best option, given that I do not have a lot of fat on my back. He agreed that my skin is thin on my r breast, however, my belly has just enough fat to get the volume to match the l breast. Upon reviewing my list of questions I had written down, he'd answered them all prior to me asking them.
I canceled my pre-op appointment with the first surgeon who insisted that the LD was the only option. He called me yesterday to discuss my concerns as he was informed that I was seeking a second opinion. He then informed me that he CAN do the Tram Flap even though my incision is horizontal (contrary to what he initially said). At this point, I question his integrity and have reservations about trusting him.The con to the second surgeon is that the surgery could possibly be pushed out to August which I don't want to wait that long. Plus if a second procedure is necessary to increase the volume of the breast, that could take me into 2019 (another $2000 deductible). The first surgeon has me scheduled for June.
Honesty, I feel that the first surgeon may have more experience with LD and the second surgeon has more experience with TRAM FLAP as they both seem to push one over the other one. I meet with surgeon 1 today and surgeon 2 Monday to figure out the next steps.
I like the idea of a TRAM FLAP, as I'll get a tummy tuck
, however, I want the best options from a doctor that has my best interest. This is turning into a nightmare.......
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Hi All,
I hope you are feeling well, enjoying spring and looking forward to summer!
I need your input. I have textured Mentor implants, and the one on the lat side has moved a bit to the side. My PS has wanted to fix it since last year. It wasnt bothering me, so I was refusing more surgery, but with recent reports of added health risks with textured implants, I am considering having both switched for smooth implants. Has anyone had an implant change on lat side??
Also, - have you had mri to check for leakage or other issues?
Thank you for your thoughts.
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AnotherNYCG
I had an implant changed twice on Lat Flap side. Not because of textured implant... what is your concern??
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Hi CBK,
Thank you for your reply. The non-lat side is less complicated, - how was your recoup on the lat side? The ps said it would be about a 2 1/2 hour procedure, then a week of no driving, keeping hands/arms down below shoulder level, and six weeks of limited lifting. Is that what you were advised, too?
Thanks!
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No worries about driving... as long as I was not on meds...which I take very little...never on narcotics with my surgeries
No lifting is standard for 6 weeks.. with any of these surgeries.. to avoid hemotoma...
Lifting my arms WAS NEVER A RESTRICTION.... in fact the opposite..
I am wishing you so much luck!! Feel free to respond or DM me!!
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CBK - Thank you, again!
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AnotherNYCG
You know the first time my PS switched out implants in September 2018 I developed hematoma on lat flap side. I think it really was my fault because I lifted up a medium sized dog, not thinking post-surgery! I wasn’t in much pain and I got ahead of myself. Don’t do that! Because hematoma hurts and turned into capsular contracture!
So I ended up going to PT and he really was awesome in explaining how to get back ROM and strength on Lat flap side! Actually I have more impingement and random pain on non lat flap side. None is horrible though. My body has been thru a lot since I wasn’t menopausal and I had an ooph. And was placed on Arimidex. You can see it all in my bio.
So my second surgery was to downsize implants, capsulectomy, lipoectomy on lat flap donor site, pocket work, AND nipple reconstruction in April 2019. That’s a lot of work!! I don’t think there was more pain on lat flap side than the other. It took me a few days but then I was up and moving quick. I was encouraged to walk and use stationary bike at week one! I took about 3 to 4 weeks off yoga ( allowed to modify poses and not weight bear fully on hands) and a full 6 weeks off from strength training!! Upper body movement was encouraged just not weight-bearing!
I’ve been super lucky and thankful with my Lat Flap , I just haven’t experienced the discomfort and pain others describe in this forum. I work constantly to get strength and ROM back on both sides! Strength is more a slight issue on lat flap side not ROM ! ROM is both sides and I think the new “normal” from the BMX although it continues to improve. Since I do yoga a lot I actually notice ROM on Lat Flap side superior in certain poses. Going to discuss that with PS this week!
Anyway trying to give you as much info as can. I wish you well. Please reach out with any questions you may have.
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TE exchange after my lat flap! Woohoo! I cant wait! My lat flap has been successful so far. Need to do some extra stretching exercises,but not bad so far! Can't wait for my final surgery in a few weeks !
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Heatherautumn
I’m happy to hear you are doing so well! And you will be happy to get those boulders out! Talk about getting a weight off your chest!
Did you develop an accumulation of scar tissue at lat flap donor site? I had mine lipo’d off but now I have a tiny maybe inch long scar that is very thick. My PS injected it with a steroid yesterday to soften the scar.
Wishing you best of luck on your exchange and moving forward. It’s a really big step.
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So glad to hear that you are happy with your LD. I am having mine on Sep 3rd. I had bilateral lumpectomies done in early 2017. In 2018 I had reconstructive surgery twice and ended up with an infection in the left breast. In January of 2019, I got a new breast surgeon who sent me to a new plastic surgeon to take care of the infection. I am so happy with the new doctors. Between the 2 doctors, they decided that there isn't much breast tissue left in the left breast and will be completing the mastectomy and the LD at the same time. Looking forward to this next chapter. I believe she's putting in a spacer first so I don't know how long I'll have to have that before she does the implant.
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Hi. I cannot possibly read over 200+ pages so I will apologize now if this has been answered before:
BMX, 4/2018, nipple sparing, expanders. Failure of R expander due to skin infection. Previously radiated R breast 14 years prior to BMX.
L expander to implant. R expander removed 6 months ago now healed. L implant slight capsular contracture to be addressed in the future.
PS wants to do lat flap R side due to damaged/radiated skin w/expander. I am not a candidate for any other flap procedure.
My 'spared' nipple is good/healthy but I suppose I will lose it with the lat flap???
I'm just wanting to keep something back from my 'before BC' days. Gawd I miss my breasts.....
THX for input!
Jaybird
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Jaybird - I have a bit of history a couple of years old. I have a left lat flap due to a failed diep flap in 2014. My right diep flap survived and looks amazing. I have my nipples on both and sensation they have survived multiple surgeries, tell your doctor how important it is for you to have it survive!!!
Since I had lat done in 2014 the procedure has been improved. I got sad and tired of surgeries and quit after lat flap without any revisions. In a bra I am perfectly symmetrical, but not without. I am thinking of going back as soon as I lose the weight I have gained. I want to see if they can put my muscle back and just give me a fat flap from some other body area.
Vivian
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Hi,
Sorry for the double post, but I thought I'd also post my question on the LD thread. Is there anyone here who had LD flaps over implants and then had the implants removed? I had bilateral MX in 2009 with LD flaps and silicone implants. I am now looking at getting the implants out but I want to get some idea of what cosmetic result I can expect after this procedure. The PS I consulted was very vague, just kept telling me I'd be "flat."
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Hello , I had a LD on my left radiated side 1 1/2 years ago and had silicone implants in. I had them removed about a month ago , I am flat with no indentation really , I am so happy I had them removed, they were never comfortable for me. My PS removed all the radiated skin that was discoloured also, and replaced it with the graft from the LD surgery.
I feel great in my body now , I never really did before , I would say I look about the same now as I did post mastectomy, I delayed reconstruction for approximately 3 years .
Hope this helps
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Thank you CherylMk. I don't think I have much confidence in this surgeon. He didn't have any photos to show me of post-explant mastectomy patients.
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Hi Vivian,
My lat flap surgery is set for Dec. 18th. I've been watching videos on you tube so I have a good idea of what to expect. Spoke with a past PT and she allayed my restricted range of motion fears. I will do my exercises and PT!
I do have both nipples but no sensation in either one.
I will tell my PS how much I want to keep that nipple. lol!Jaybird
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Jaybird,
Good morning. Once you heal, you will be fine. I am able to swim with same range.
Remember my surgery was 5 years ago. Sometimes I will get a muscle spasm if I am doing like major yard work. or hours of repetitive movements. listen for body signs of how much is too much.
Nipples....there is a new re sensation surgery . Not sure all details. Look up Jaime Flores, plastic surgeon. He is my plastics. He is performing these surgeries with very good success rates. Maybe download for your surgeon to read.
I wish you a speedy recovery, check in and let me know how you are feeling.
Vivian
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Thanks Vivian!
Do you have his website or office name? I'm a flight attendant so I can travel anywhere!
I'll assume you never lost initial sensation? I did loose some sensation (about 50%?) on my R nipple with my lumpectomy 15 years ago. Did not realize that I'd loose all sensation with a BMX! Jaybird
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