Latissimus Dorsi Breast Reconstruction
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Sorry for answering this late - for some reason this thread was not in my threads to follow anymore...
minxie - sorry I can't be of any help. I am waiting myself to get the appointment with a pain management dr. I can't work out as it makes my serratus muscles hurt (all the lower rib cage). I can only do a minimal of yoga postures (forget about any yoga posture requiring support on the arms). I never had, on the other hand, any ROM issues, and was able a few hours after the surgery to lift my arms above my head and have full range of motion on both arms.
I am stuck to percocet that only barely takes the edge off the pain - advil, motrin, ibuprofen are as efficient as a glass of water. If YOU find something that works better, please advise me too.
And now, to answer to the other questions - and please take this as said from my own experience and from researching extensively online.
- If you have skin-sparing mastectomy, and are not looking forward to doing rads, you DO NOT NEED LD FLAP. You can do the simplest way, either TE+exchange (taking a longer time), or one-step with Alloderm (more painful for a while).
- If you have rads, the best is to wait until AFTER the rads to decide what flap you want. Otherwise the muscle/skin of the flap will get affected by the rads.
- VERY IMPORTANT: the more athletic (as in doing sports that develop the LD a lot, like gymnastics, swimming, etc) you were before the LD Flap the more problems you will have. Because the LD is very developed and has a very important part in holding your torso upright. The other muscles will have too much trouble compensating and you will have a very high risk of permanent back pain. Also you will be more unable to do various things (getting up by pushing yourself up with your arms, turn around in bed, etc) than women who were not athletic before, because your body would be way too used to a very developed LD to be able to compensate.
- Also in the same case as above, the bulge under your arm will be very substantial, and the LD will not atrophy properly, even if the thoracodorsal nerve will be cut - the chances of it regenerating will be very high. Also, the bulge might be so big that it will make your arm sit in a wrong angle in your shoulder socket and cause shoulder impingement. You might even have to go to the extreme point where you will need to have another surgery to completely remove the LD muscle flap to get rid of all the bad SE's with the shoulder (I have found a couple of cases).
So, please, choose this type of reconstruction only in extreme cases - if you did rads and your chest skin is compromised and you do not qualify for DIEP. Better take a few months and fatten up for DIEP than do LD flap. There a simple logic - there is NO muscle in our body that does not have a very good reason of being there. NO matter how much the PS is telling you that you won't miss that muscle, trust me, you will
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Here's one of the (very few) studies I've found that show with no doubt that you lose strength with the LD flap reconstruction and how much the shoulder is affected:
http://www.ncbi.nlm.nih.gov/pubmed/20633032
Also look on the right-hand side of the page in the citations - more material about that is there.
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alex56 - I had blmx with lat dorsi and te's on June 1. I love the result. It was the only option for me, but I would do it again. In the last couple of months, I've had a little back pain but as long as it's not mets, it's not anything that would make me say it's not worth it. Everyone's result is different - not trying to tell anyone to do it, but just sharing my results hoping it makes you a little less anxious. Good luck!
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Pink Heart,
This is in response to your question if a Lat Dorsi Flap Reconstruction may aggrevate truncal, arm, hand LE as well as be less successful due to severe cording.
While this is a question for the medical experts, I myself have wondered this exact question, having had a similar thick cord "incised" and current LE of arm. To me, it makes no sense now to stir up my axilla and risk worst scar/pain/LE by dragging a back muscle through it to support a front chest wall implant. So while a Lat Dorsi surgery has been suggested to me, I have declined. I am very protective of the thin skin on the cancer side, s/p radiated, s/p reconstruction with TE--->gummy implant. But some day this issue will probably rear it's head.
Of course this is just my opinion I'm sharing. I wish the best to you, and a happy New Year to all.
Tender
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Tender ~
What about a free flap?
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Question about scar on back - has anyone had 'work' done to make it less bulky? My scar is about 6 inches and 5 inches are smooth, but the last inch seems to be bunched up, it that makes sense.
Teresa
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Teresa- I had LD flap surgery with TEs and then exchange.....I had my PS do revision work on the "dog ear" that was prominent on one side of the scar.... It's 4 - 5 months since that surgery and you can barely see the scar line...really glad I had that last part worked on.....
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Yes. Ask your PS what he/she can do with the scar. It is amazing how they can fix a scar. I'm having a problem accepting my extra skin fold. I always had some loose skin at my lower waist of my back. Seems the lat muscle held up my skin a little on my back. Now one side is more flabby than the other. I'm going to ask if anything can be done to at least make it more even.
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Hi all, just putting in a different perspective...while it is certainly true that lots of things can go wrong with Lat Flaps, it is not a done deal that any of the dire things will happen. There are quite a few sisters on here who have lost no strength at all, are not in any pain, have no "iron bra" and the breast looks great. I'm one of them.
Was I lucky? Apparently so, but I'm not the only one.
Was my PS extraordinary? Unequivocably YES. Dr. James Passaretti of Darien, CT.
I have regained full strength (never lost it); my other muscles did compensate for the lost lat muscle, I have full range of motion, some or most sensation back and no bulge under my arm at all. I was told no push ups, but I could do them if I wanted to. It just distorts the breast in a way that seems not a good idea, so I don't do them. But would my arm hold me up? Sure!
If done well (make sure your surgeon is extremely well versed in lat flap) it can be a very good operation and well worth it.
PM me if I can help you further, but for sure, do your homework on it. Linda54 is on here, she had one as well, is very strong, looks fantastic. Altho she has some issues with the "iron bra" syndrome. (She also lifts weights, which is going to aggravate that). I suspect she finds it worth it. They are some women on here with lat flaps who kayak, swim, etc. It can work out.
Good luck to you!!
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Thanks.... right now I think I am one of the lucky ones. I like the way the breast looks and feels (still need lipo and a nipple, but so far so good!) and only have small issues thus far 1) the dog ear on the scar 2) underarm bulk, but that seems to be getting better each day 3) the tightness on the back, but stretching is helping.
Thanks so much for the answers and the support
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Yes! Thank you for sharing your successful lat surgery experience. I too haven't had any problems. Well, my "nipple" area seems to be a little too far to the left, but I think it will be corrected when I go for my revision. As far as push ups, yes, I too tried and was able to do them. Do I need to do a push up in my everyday life, probably not. But I can do one. I think my body will compensate for the missing muscle. I wasn't an athlete before surgery, but I did workout with weights. I still can. Sometimes things feel weird, but sometimes I think it's the numbness that makes it feel that way.
I feel so blessed that I did ok with this surgery. It was the best choice for me.
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Also, depending on when you had the surgery, it commonly (sensation) does come back. Mine comes in the form of intense itching, followed by feeling back in that area.
Four years out, I have most of it back everywhere. Only the tip of my breast is numb now.
I feel very blessed also. It doesn't always work out, but it did for me.
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I had a great experience too with surgery and results. I wasn't given any restrictions as far as working out and have benefitted from the discussion not to do pushups, etc. I've been trying to do those but on my knees to relieve some of the force. I can live without pushups but tell me more about weights. Why no weights? I wouldn't want to give that up. I'm not a bodybuilder or anything but like to keep my arms in shape. Thoughts?
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I think everybody is different and every surgery is different, but I was told that to lift weight distorts the breast shape temporarily. Since I had very thin skin, rads skin and under the muscle implant, this in my case, is not a good thing! Repeated lifting will eventually (again in my case) permanently distort my breast. I still lift stuff just in general use, and yes, the breast has distorted. This might be specific to me, tho.
I believe others on here can and do lift light weight, but the lat flap can also give one the "iron bra" syndrome and lifting weights can aggravate that if you have an issue with it.
If you PS says OK and you are comfy, lift away my dear!
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thanks anniealso!
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I am trying to get my PS to do some scar revision on the tops of both of my dog ears at the back. He explained that this is like "unfarrowed" ground. The area below it was skinned out when the muscle was relocated. The part at the top of the scar edge is just more bulky with fat pad and tissue beneath it. He can go in and revise it, but he will have to extend the scarline to do it.
Since I am already the receipient of many scars, extending them doesn't bother me. He just seems to think that they are hidden in a sleeveless tank now. I plan to show him at my next appt in May that they are not hidden at all. The fat pads stick out. What's worse, a bulky bunch of scrunched flesh or a scar? What do you think?
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As someone who had a lot of extra skin after massive weight loss, then surgery to remove it, I would probably take the scar over the skin. I still have some extra where my bra strap is, by the under arm area. But it was there prior to BC and compared to what it was years ago, I was ok with it. Not everyone agreed with me at the time for wanting PS to remove extra skin. Well, it bothered me so I did it. It just depends on what makes you feel better, or worse. I think it's a personal decision and will be different for everyone.
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Hey there ladies! Ok I had my nips done on 12/20 and just had the remaining stitches removed yesterday. Thought I was done but in 3 months I will have a revision on the right nip.
The left nip looks fabulous, the right nip....well it's a nub..
This time the PS will do it in her office, no hospital. Then about 3 months after that I get my areola tattoes. I tell you this has been one adventure for 3 years and 9 surgeries later. I wouldn't have done it any other way though. PinkHeart ~ not sure if you will be able to do a direct implant with the Lat Flap surgeries, it will all depend on how much repair your surgeon will need to do. The TE's were not a problem for me. They got filled up quickly then waited 3.5 months for them to settle and then did the exchange. Even that was ok. My pain the second time around was extremely minimal. Everyone is different, but I know it will go well for you.
Have a great week ladies!! Here's to summer around the corner!!! I know spring first.
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Yeah for you!!! So happy for you.
Teresa
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Congrats on the new nipples!
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Faythnme...wahooooo...congrats on the nipps. At least she will redo the one in her office.
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Faythnme~ Thanks for your thoughts. Nips seem light years away for me. Glad you're almost to the reconstruction finish line.
Blessings!
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OMG - Does the back scar ever stop itching!! I remember when I was growing up my grandmother had one of those back-scratcher things. What I would give for that now.!!!
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Fitzdc - Hopefully this means it is healing! Mine didn't last too long, hoping yours doesn't either.
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Thanks... it does look a lot better now so I'll chalk it up to healing - on way to oatmeal bath now.
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fitdz ~ After my bmx & recon surgery, a friend was coming to visit me and asked me what I needed. I said I would give anything for a back scratcher thingy. She showed up with flowers and a back scratcher! Loved it. Still have it ready for use for the next surgery.
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I so enjoy a back scratch after healing from this surgery. It is a little strange when the sensations go from being there, to not, to being there again. I just tell my DH, "keep scratching, cause I only feel about half of it!" LOL
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The itching on the back will go away. I think it's mostly in the "harvested" area where you develop seromas, even when they are not noticeable.
The LD scars for me healed quite weird. That is mostly because with these surgeries I discovered that the scars I get tend to become keloid-like if the surgeon uses surgical glue. The "best" scars I got from the steri-strips. On the LD scars, there were dog-ears towards the abdomen, on the sides of the waist that the surgeon fixed at one of the revisions. For that specific area he used surgical glue - and the main area had steri-strips. You can barely see the "old" scar, and I mean barely see, someone has to tell you what to look for, while the revision for the dog-ears is a very prominent scar. I intend to tell him at the next revision to take out that small area and use steri-strips to diminish the scar. Same goes for one area of the right breast.
As for direct implants - yes, you can have direct implants. I did.
Also, when it comes to distortion from lifting weights - I did not lift weights. My pectorals though used to be very ... don't know how to say, bulky? anyway, very developed. They do cover the top 1/3 of the implants. And it seems that sooner or later, even if I don't lift weights, just from normal actvity, they will push the foobs laterally, no matter how much alloderm sling the PS puts there.
I am scheduled to see the PS today. We'll see. I'll keep you updated.
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I saw my plastic surgeon last week and asked him about any exercise restrictions. He said no restrictions unless my body physically can't do it. Interesting how different docs say different things. I'm still doing push ups on my knees because it just doesn't feel right on my toes.
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ok ladies I have a question. Now that I am near the end of my reconstruction adventure I need to decide what to do with my prothesis. They were so expensive $400 a piece. I want to donate them but then again what if I need them down the road.
Thoughts!!!
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