Latissimus Dorsi Breast Reconstruction
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As stated above, look to those with 'good' outcomes from latt flap. I went on youtube and found a video of a gal who documented her double latt flap experience. I had my R side done 12/2019. So far I am happy. I needed it due to thin skin (rads 15 years ago) and issues with wound healing. I had an expander put in 3 weeks ago and had my 1st fill today. I had no other flap options and if this fails I'll have to go flat. My surgeon is hopeful, as am I.
Jaybird ~
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My question relates to the Lat Flap breast feeling hard and sore when being handled and massaged.
I had radiation on my left breast in 2016 after a lumpectomy.
In 2018, I was re-diagnosed with DCIS in the left breast in late 2018 and had a double mastectomy as a result (right breast removed as preventative measure).
I went through breast reconstruction with the Latissimus Dorsi Flap (under Lat muscle) & silicone implant (over chest muscle) on my left side because of the radiation and implant on my right side (under muscle).
My surgeon recommended the Lat Dorsi flap for the left because he said that the radiation would affect the elasticity of my skin and could lead to complications, infection and possible failure.
The implants I went with were the Allergan Inspira SSX 800 in the right side and Inspira SSX 700 in the left Lat Flap side. These are the Smooth Soft Touch type implants.
I ended up having a revision surgery in March 2020 just before Covid because the Lat Flap left breast looked very misshapen compared to the right-side implant alone.
Aside from some fibrous scar tissue on my right implant alone side (caused by relocating the implant pocket in a revision surgery), I am satisfied with the look and feel of my right side. It has a natural squishiness to it like a natural breast. My surgeon advised me that I'd have to live with the fibrous scar tissue.
The left Lat Flap breast is another story. It has been almost a year and a half since the exchange surgery, and it is still very hard and sensitive. It is pretty close to that hard rock feeling of the expanders.
Has anyone experienced this?
My surgeon just tells me that I went with firm implants, but my right side does not feel like this.
My right feels quasi-normal and not painful when I press on it.
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SpankyG,
I can't help too much, but I have lat flaps on both sides- cancer and non-cancer. My non-cancer side feels soft and more “normal" than the cancer side. I had a very bad hematoma after my biopsy, then the surgeon had to go back in around midnight after my mastectomy/reconstruction to check some bleeding (which I suspect was related to that hematoma). Then, I had another surgery to remove more skin and a wedge of tissue on the cancer side for a close margin. The cancer side does not feel like the other side. It does not hurt, but it does have a very firm area. The whole breast is not firm, however, and they do look alike.
Anyway, I can't say what is causing the firm feel of your breast, but based on my experience, I don't think it is the lat flap itself. It may be related to the rads, but I can't say. Maybe you will get more responses.
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JO-5, so glad you shared your experience with Spanky. Spanky, I’m sorry your surgeon is insisting it is the implant, because it seems like you are in the best position to be able to feel the difference between the two sides. I wish I had some suggestions, but other than stretching, I just don’t know. I’m so sorry. This process can be incredibly frustrating.
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Spanky
It could be the muscle that was tunneled is pulled too tight or the motor nerve needs to be cut.
My surgeon loosened up my LD flap during one of my revision surgeries. And also released the motor nerve.
That said I still feel slightly tighter on LD flap side, but not nearly what you are describing. I do have a ‘nervy’ sensation on LD flap side when touched or pressed upon. I wouldn’t call it painful just sort of an icky sensation. I see my surgeon regularly and we agreed to wait things out since I’ve had so much surgery and I feel like things are improving/ still settling.
I wasn’t radiated so I can’t speak to if this is a factor. I did do a lot of PT work on my LD flap side and continue to do the work on my own. Maybe a therapist in your area that works with breast reconstruction patients could be helpful? Otherwise if you don’t feel your surgeon is listening it can’t hurt to seek out a second opinion. It has been quite a bit of time since your last surgery.
I hope you get some answers and relief to the issue. Keep us posted!0 -
Spanky- Unfortunately I cannot say what is causing the issue. I am scheduled for surgery in 3 weeks. The one thing I can say is I agree with possibly seeking another surgeon...I had my surgery scheduled with one surgeon and went for a 2nd opinion because I wasn’t convinced. After working with him I was at ease and felt he had the best plan for me. After meeting him I spoke with a few of his patients who I was introduced to from people within my circle. (It’s crazy how we all know someone who has undergone BC and recon but what are the odds you find a few who have had the surgery you’re scheduled for with the surgeon you chose) I spoke to them, asked a billion questions, saw their results and was like yep this is the surgeon for me. But the icing on the cake was when I went to my annual OB/GYN appt. I told her I was having surgery I named the hospital and the surgeon. She looked at me and said you will be fine he did the same thing to my niece.
Continue to reach out to our sisters and get their advice, seek out a 2nd or 3rd opinion. I thought I had the right surgeon but had a feeling in my gut I needed to re evaluate things. But after finding PS #3 I knew I had made the right decision. Hugs to you.
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Spanky - I don't get on the boards much anymore, but I do believe that the LD Flap side is going to feel harder depending on the amount of muscle used and the angle of the muscle attachment to the chest wall. Both of mine feel hard and I've had multiple kinds of implants switched out over the years. Nothing changed that firmness regardless of implant. This might not be helpful, but it has been my experience.
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Greetings all. I had my surgery in October of 2018. Left side without any reconstruction. Initial healing was ok and went well. Since then though, my continuing issue is an extreme back ache, left side, whenever I am vertical for over 2 hours. The ache becomes quite unbearable at times. To alleviate it, I lay down and after a half hour to an hour, the ache subsides. I try not to take pain meds for it as it occurs almost daily. Am wondering if anyone else has experienced this and if my getting a back brace may help. I am going to get one and will report back.
I also have some left shoulder...discomfort...and body cramping occasionally. I maintain you need a new language to talk about cancer treatment side effects <g>.The shoulder is like when you pull a muscle (?), hard to describe. It also sometimes affects my bicep area. More like cramping than pain.....
Thanks for any feedback.
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I know it's been awhile since I posted my question regarding how firm my LD Flap side feels but I wanted to thank SuQu31, JO-5, CBK, Imkopy2 & westieluv for their responses.
I still have the same issue and was going to address it when I went in for the nipple reconstruction in early January. The Covid numbers were surging in Ontario so I opted to cancel the surgery and am waiting for the next lull to get that part of the recon completed.
CBK I know you mentioned PT in your posting. Has it made a marked improvement for you because my husband keeps telling me that I should be looking into that further.
westieluv, it is good to hear that my choice of implant is not the cause behind the hardness of the LD Flap side.
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SpankyG
I went to PT for range of motion issues, shoulder instability/pain and general upper body strength. PT helped with range of motion and shoulder pain. Although PT thought my ROM was pretty normal going into therapy. Shoulder pain is gone.
Sadly I don’t think my upper body strength will be the same as it was pre BMX. But I continue to strength train but I’m just weaker on both sides (I only had LF on one side)
Let me know if you have any other questions.
Best!
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Spanky- It’s been awhile dive I’ve been on here but I had a single LDF in January & I’m scheduled to have exchange on Wednesday. I do PT for sift tissue manipulation & can I say what a difference! You want to make sure of 2 things...first your therapist should have knowledge of breast cancer therapy and recovery also you want someone who practice the Graston technique. This is where they use a metal tool for manual manipulation of soft tissue. It will also help to desensitize your scar if that is an issue. I have noticed a huge difference since I’ve started
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Thanks Imkopy2 for the reply. I'll have to look into that Graston Technique Therapy.
So just an update from me as it's been awhile since I've been on the forum.
In March I had the nipple reconstruction performed by my PS. The right side was successful but the left side failed and has been a long time making any progress in healing. My PS said the failure was in all likelihood due to the left side having had the radiation back when I was diagnosed the first time in 2015.
Anyway the PS does not think a second attempt is worth it so has suggested the 3D Nipple Tattooing and areola for the radiated side and areola tattooing for the right side. I'm disappointed because now I have the "nipple pokey" on the right but flat on the left. If I'd educated myself on the failure rates when dealing with radiated skin I'd have opted for the 3D Nipple Tattooing right off the hop.
I have looked into Acellular dermal matrix (skin substitutes made of collagen, like AlloDerm, NeoForm and DermaMatrix) being used to form the nipple. This process seems like a mini implant that would create the nipple under the skin. I don't see much information on it relating to it's use in Canada and my PS will likely advise against it for the same reasons that he does not want to give the left side another try with the nipple reconstruction.
I also have heavy fibrous scar tissue on my right non-radiated side. It's like a lump right where my cleavage is. My PS said there was nothing he could do about it as it was created when he had to move the pocket over for my right implant. It appears that he initially placed it too far apart from the left side. I'm frustrated that he can do nothing about it.
Finally, I'm completely regretting get the right implant placed under my chest muscle. It is sore and always feels stretched and the animation of the breast is just completely ridiculous looking. It also seems to impact my strength. The left is fine because that side the implant was placed over the muscle and then the Lat muscle was placed over the implant. The left side is hard as a rock but I'm used to it now.
I'd really like to get the right side implant changed to over the muscle but I'm afraid of going under the knife again and I'm unsure if my PS would be supportive.
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Sparky G if you're on FB I recommend the Latissimus Dorsi flap group…the ladies there are a wealth of info which may be able to help you. I saw my surgeon Thursday for a post op follow up. We talked about nip recon…he even said himself if for some reason I was not happy with it he could remove it because he has had some women who were unhappy after doing it. Based on his response I'm guessing you may need to find another surgeon to balance you out. Possibly your current surgeon isn't comfortable reversing nip recon. But if you've had tattooing already done this may be part of the issue. Hugs to you
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Hi, 2Tabbies! May I ask how you are now a few years after surgery? I am scheduled to have a mastectomy next week with reconstruction using the Latissimus dorsi muscle because. I don't have enough fats on my stomach. I've been reading a lot of horror stories about the reconstruction with the Latissimus dorsi muscle though, so now I am second guessing my choice.
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