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Latissimus Dorsi Breast Reconstruction

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Comments

  • clwetzel
    clwetzel Member Posts: 11

    Faythnme,

           I am so glad that your progressing well.  I am sure that it will take a few months to get you to 600ml.  Remember they will want to take it slow to allow your skin to stretch.  It all depends upon how your skin stretches and how well you can tolerate the expansions.  Please keep me updated on your progress with the expansions.  I am so glad you had a BM.  I know how uncomfortable it can be.  I used to think it was odd that older people used to be so fixated on a BM but since I have had a bad experience I now understand all too well.  Rest up, I am sure you will be back to your old self in no time.

  • tamgam
    tamgam Member Posts: 83

    Faythnme- Isn't the firmer back great?  I like that I lost the bulge around the bra band too!  It is one of the little "perks" of this surgery.  I was lucky to have the skin sparing bmx with lat dorsi. I only have the flap where my areolas would be.  So just circular scar and a light two inch scar straight across 1/2 way to underarm.  The scars are already pretty faint 7 weeks along and once I get tats I should look pretty normal.  My PS is a god!   But I must say my back scars although very clean and turning very light are pretty low on my back.  PS said they would get hidden in my bra line.  Not sure where his wife's bra bands sit but none of mine fall down nest to the waist! LOL I really do not care because they are healing so nicely and I am much more concerned with looking natural in my chest area.   I did get "dog ears" but PS will take care of them at exchange.

    Hope everyone continues to heal well and see you all on the exchange threads soon!♥

  • Stanzie
    Stanzie Member Posts: 1,611

    Interesting what you say about your back, I was wondering about that. Tamgam - we both had surgery in March, so you can already tell your back is firmer? Are your scars really that low?

     I have small dog ears but have permanet implants in so unless I do revisions to make them the same size then would that mean the dog ears couldn't be fixed or won't disappear on their own?

    Just curious did most of you want to be your same size or larger? I went for my same size -B but the implants are so different I find it hard to compare to what I was. Even my bras all fit so differently like they don't exactly fit into the cups, if that makes sense. And do you all still have the swelling under your arms? 

    Thanks.

  • Faythnme
    Faythnme Member Posts: 92

    Well I see my PS for my post op from the 4th.  I am hoping that she takes 4 maybe 5 drains out.  4 of them have been well under the required level they ask for. I'm feeling pretty good.  It's quite tight of course but doing well.  No need to have anyone stay with this time, but they do come and help me with laundry and if I need to go anywhere.  I even feel like I could drive after this visit.  I probably will get my first fill next week along with the stitches, then I will know better what my pain level is going to be since she didn't put anything in at the time of surgery.

     Stanzie - I was 38DDD when I had my BMX in July.  Now I am a 32 nothing.  I asked for a full D, I'll see how it progresses with the fills.  I might end up with a full C which is probably more comparable to my height (5ft.),

    When I get back I'll let everyone know how it went at the PS.

    Have a great day.  It's beautiful here today in Seattle! Cool

    Cindy

  • Faythnme
    Faythnme Member Posts: 92

    Welcome I am back from PS appt.  I had 5 of the 6 drains removed. After they were  removed the PS came in the room and wanted 1 drain left in on each side.  Oh well to late now.  I'll just have to keep my eye on the back left side for any seromas.  The PS wanted do a small fill and I said are you sure?  She thought about it decided no as it's not typically what she does.  My stitches are still in and so next week I will probably have the stitches taken out and a small fill put in.  She asked if I needed any more pain killers and I said no as I was only using the flexeril and pain killers only if I felt the discomfort was uncontrollable.  She was surprised.  I can always get more when I get a fill.  So far everything is going well.  I pray that it will continue to through all of the fills.

    So this is the end of a good day!

    CindySmile

  • Linda54
    Linda54 Member Posts: 509

    Cindy

    Thanks for checking in with us....wahooooo on the drains...don't you just feel like a million dollars with those things out....of course one still to go but at least not 6!!!!!....keep an eye on that other side.

    My PS added some saline during my surgery so I came home with little bity tities...lol...all of my stitches were absorded except for just a few that my PS clipped.

    So glad you are feeling great.

  • Stanzie
    Stanzie Member Posts: 1,611

    Cindy,

     Wow you just sound like you are doing wonderful! I'm sure that was a surprise when your PS came in and said that but I'm sure it will all be fine. Glad things are going well.

  • Faythnme
    Faythnme Member Posts: 92

    Thanks Linda and Stanzie -  Slept in this morning was so tired.  I was thinking I need to do more stretches do you think it's ok? I've been doing deep breathing exercises.  I wonder when I can start to see a physical therapist.   I watched a video on YouTube about the fills and how they were done. It's good to know my idea of how a fill was done was not accurate. I thought they put in a big needle not the little one shown in the videos. Phew!!! LOL!!!!

    I'm going to try and walk down the street today.  Hiding 1 drain sure is a lot easier then hiding 6.  Yesterday was my first venture out and I was a bit light headed.  When the PS saw me she asked if I was feeling okay.  She said my lips were really light and thought I may be a little anemic.  She told me to becareful to not overexert myself.  All is good.

    Cindy

  • Stanzie
    Stanzie Member Posts: 1,611

    That is true it is easy to overdue. My sister was intown helping me and she wanted to go shopping - now this was my second or maybe third week home so we went. At one point I looked in the mirror - she was trying on things I was just sitting - and I thought oh my I'm so pale I sort of look dead, I think we need to go home and did. So you do get pale with it is too much.

    Now I know all docs are different but mine immediately wanted me to raise my arms straight up 10 times a day. Then after the first few days he said OK now stop. He said he wanted to make sure I had the movement ability but then for the muscles in my back to heal I needed to keep a limited range of motion - he said nothing more that you would move your arms to read the newspaper. He then had me put my hand on his back and he showed my how the Lat. muscle moves when you raise your arm up, out forward or out to the side. He then went on to explain it was like building a model and you glue two pieces together. If you keep moving the pieces back and forth it will not adhere to each other. It will eventually but it will take a lot longer. So he wanted me to not use my arms till the muscles in my back could bond together. I think perhaps the not liftingis more for the chest area muscles and pulling. Basically if you feel anything tug or pull or certainly if it hurts I'd stop. 

    Anyway, hope that helps but again all docs have their own way of doing things. Rest is good and as I was so uncomfortable on my back make sure and rest all you can. 

  • Linda54
    Linda54 Member Posts: 509

    Stanzie

    Where do you live in GA?  I grew up and have family in the Buford area.

    My PS did not give me any instructions on stretching but what your PS told you sounds like good advice.  That may be why I have this tight bra feeling, maybe I overstretched and did not give those muscle time to "adhere"

    Great to hear from you Cindy.  Be careful and do not over do!!....you may feel great but take it easy.

  • Stanzie
    Stanzie Member Posts: 1,611

    I live right in the heart of midtown Atlanta. I'm not sure where Buford is but I think it isn't far. I read that you had revision surgery. How do they do this? I am assumeing they go in the same way as before..... I know it depends on how much revision but I was wondering how long the surgery and recovery might be.

    I do like the PS. The first one I went to is probaby wonder at breast augmentation and straight cosmetic work but terrible in dealing with someone who has bc. It was very tramatic so I was glad to have found the surgeon I did use. Just wish I was more comfortable with the outcome so far but perhaps it will get better. I had my surgery on March 5th. 

     The only thing I did to "over do" was picking up my little dog who weighs about 12 lbs when I wasn't supposed to lift anything over 8lbs. She would just cry to be up on the bed with me so what could I do? Anyway only once did I feel a stong pull and I had some pain for a couple of days and I took it very easy after that. 

  • Linda54
    Linda54 Member Posts: 509

    Buford has the largest mall in GA...The Mall of Georgia....about 30 mins NE of Atlanta

    My PS trimmed off some of the the skin flap from the top and I also have an inch scar on the side where he went in and did some stitching.  It was a pretty simple surgery with just a few days off work.

  • Faythnme
    Faythnme Member Posts: 92

    Morning Ladies -

    Yesterday was interesting.  I walked down to the Bakery and convenience store, it was such a beautiful day I couldn't pass it up.  On my way down there my phone rings and it's my dentists receptionist.  Apparently this radio station I listen to when at work called out my name for a game they have called be on the Payroll.  So I called them back and I get $100 an hour and continue on until the next person calls in.  So I get a $100 for every hour that someone doesn't call.  Not sure where I am right now possible $300.00.  I turned the radio on when I got home and hadn't heard that anyone called in yet.  They start the game again on Monday at 8am, if that persons doesn't call back within 15 minutes I get another hundred dollars.  How awesome. UH? 

    So anyway slept pretty good last night but I had to take some percoset to calm my chest down.  Now this morning it feels like the TE's are sitting on my bones.  Not too painful, won't take any pain pills.  I'll continue with the deep breathing.  The PS did tell me to lift my arms above my shoulder.  I basically just do the exercises in the book they gave me.  The same ones I got when I had my MX.  I am hoping that my first fill doesn't put me down.  Positive thinking right?

     Well it's another beautiful day here in Seattle.  Gonna wash my hair and take a lighter walk.  Maybe I'll take out some of jewelry making stuff and make something.

    Have a great day ladies!!

    Cindy

  • Stanzie
    Stanzie Member Posts: 1,611

    Wow, that is so great about the radio show! How exciting!! Hope no one calls in....

    You just sound wonderful, I'm so glad you are doing so well. What kind of jewelry do you make?

    Linda, well I guess you can tell I haven't ever been to the Mall of Georgia - but of course I have heard of it. So we are really very close! 

  • Diane509
    Diane509 Member Posts: 42

    My surgery Lat Dorsi Flap BMX done on Monday May 10th.

    Right side had the DCIS in 3 places, left side was prophylactic.  Spent Mon-Thu night in hospital released on Friday morning.  Pain was periodically severe at times in the hospital.  I had what I refer to as zingers or "horseradish pain" at the point of where the drains come out of my body and in my armpits.... feels like this rush of stinging burning and then it subsides with a position change or meds.... chest feels very tight ....boobs are warm to touch but hard...softening each day.  I guess there is some saline in there now and he says they will be 2 times this size eventually.  I asked for bigger but not crazy big like Dolly Partons.  The drains are the biggest pain.  You are married to them.  You pin them to your clothes or a lanyard for a shower... we bought a mastectomy cami but I can't get into it yet....over the head with the arms isnt an option yet.... i can reach back to scratch my back and it's a hard reach but I can take care of business in the bathroom...whew....

    If anyone has any questions... email me.... dianesiegel@hotmail.com or post a message to me.

    Hugs 

  • Linda54
    Linda54 Member Posts: 509

    Cindy, We had a contest like that a few years ago.  I use to win lots of stuff on the radio...lots of concert tickets for front row seats...and the best thing was $1000......I recorded my response when I won it (you know they record these things and then play them on air a little later) and I still have  the recording. Fun to listen to it now and then.  Great that you are winning some extra money.

    Stanzie, We are about 5 hours apart. I live in Mississippi now...since 1985. My family lives in and around Buford. 

    Diane,  Sorry you are dealing with so much.  I did not have what I would call pain, just lots of discomfort.  When I went in for my exchange surgery I told the ER nurses to make sure my PS did not make me look like Dolly. Also I did not want to look like Twiggy either...then I said, "ya'll too young to know who Twiggy was....flat as a board...LOL

    I called my drains "puppies"...I felt like a momma dog carrying around her babies.

    I remember one of the things I worried about the most was being able to clean myself down there...I did fine..take care....let us know how you are progressing.

  • Stanzie
    Stanzie Member Posts: 1,611

    Gosh I have never even known anyone to win stuff on the radio - how fun.

    Linda, I'm sorry I think we actually discussed this before, my brain just isn't properly functioning obviously.... now I remember you are in Mississippi. Can't say I might ask you again so I'll go ahead and pre-apologizefor the next time. I wish I could blame it all on bc but I know I did it before bc as well. The worst ones are in person when someone comes up to me and remembers my name and how we know each other and might remember some convesation.... and for the life of me I have no recognition of the person at all. I will remember the circumstance and might even recall her name but just can't put it all together... I'm not That old either.....

    Diane- sounds like you are doing well - it gets easier once the drains are out.

  • Faythnme
    Faythnme Member Posts: 92

    Good Morning Ladies -

    I believe the last drain will come out on my next appointment Tuesday.  Measured 25cc this morning. Right now I am not so much feeling pain but discomfort.  Ive been using the Flexerel for the muscle just not sure if its really doing anything.  It feels like the muscle is flipping against the chest wall on the left side producing some sharp periodic pangs. Not sure what's causing it and I dont believe the flexerel or percoset is effecting it and I don't like to take pills unless its absolutely necessary and it feels realy tight on the left side. I am still in this weird bra they put me in and it's too big and irritating.  It's not really compressing anything.  Well 2 more days and maybe the PS will be able to figure it out.

    Diane - it does gets better.  My PS taped my drains (3 on each side) down covering about 1 inch of the drains.  This worked very well, they didn't itch or were painful at all this time around, which I was very glad because the first go round they did.

    Still not able to reach behind me to do the deed Frown, but at least I am able to from the front just not my choice.  I am hoping come the Tuesday appt the PS will tell me I can take a shower now.

    Have a great day everyone!

    CindySmile

  • kaiote
    kaiote Member Posts: 6

    Hello from New Zealand ladies.

    My first question is to Cindy - how much money did you win??

    I thank you all for sharing your experiences. I do not know anyone who has had this operation so have learned alot from reading and watching the video.

    I had a mx on 24 Nov 08 (3 different tumors) and I am on the waiting list for contralateral mx and double latt dorsi recon due to having the brca1 genetic mutation. They said late June but haven't given a date as yet.

    Does anyone here have lymphedema and has reconstruction altered that in anyway - for better or worse?

    Many thanks Debbie

  • Linda54
    Linda54 Member Posts: 509

    Welcome Debbie from New Zealand

    We are a fine group of sisters who help each other by telling of our experiences and giving our support.  You have come to the right place.

    I am so sorry you are having to join us though.  Hopefully you can have your reconstruction surgery next month.  I cannot help you with the lymphedema question since I have not experienced it.  Maybe someone else will respond or you may want to so a search on lymphedema by clicking on the search button (upper right of the screen) and type in what you are looking for.  Then scroll down the page and find the latest posts on the subject.

    take care

  • BarbR
    BarbR Member Posts: 9

    Hello everyone,

    What an interesting forum! I last posted in Exchange City in March after my exchange surgery. Something didn't feel right and my implants seemed too large. 3 weeks later the radiated side went bad. The incision split and the implant was exposed. They put me in the hospital and pumped me full of IV antibiotics for 3 days. Of course, I lost the implant and that side of my chest looks like Voldemort. My PS had wanted to do the LD on my radiated side. Should have listened to him! Radiated skin needs help! I hope some one benefits from my experience and gets it done the first time Smile

    It's been 6 weeks and I am hoping that my PS will schedule the surgery. He's been putting it off, so I could heal and be "psychologically ready".

    My PS is the one who performed the surgery in the video from Jefferson Hospital. He is top notch and I don't know why I didn't listen to him. I guess it was because my other docs were encouraging me to to give the straight exchange a try. My TE's were in for a year and I was ready to be done with it.

    This disease certainly teaches patience! I thought the year of BMX, chemo and radiation would be the worst but this reconstruction stuff has been a challenge.

    It was great to come here and read about others who have made it through the second round. 

  • Linda54
    Linda54 Member Posts: 509

    Welcome BarbR

    Will your PS be doing the circular LD like on the video?....I was very impressed with the video.

    I am so sorry for your problems.  I had previous (23 yrs) rads and 2 yrs ago I got DCIS in the same breast. Because of the high chance of rejection my PS would not do implant without the LD flap recon.  I don't think he would have done it if I had begged him too.  A few do have success without the LD.  I did not want to have more surgeries than I needed.  I did not have any problems at all.  My last surgery was last August and I had nipp recon with grafted areolas.  I am very happy with my results.

    I am surprised the TE's did not push through the rad skin.

    I hope you get your surgery soon.  Please stay with us and we will help you with our support and to answer questions when you have them.

  • BarbR
    BarbR Member Posts: 9

    Linda,

    I am not sure how he will perform the surgery. My BMX was skin sparing and I went right to the tissue expanders. The radiation came 8 months later.

    My proph side has a beautiful result after the exchange. Except for the fact that there is no nipple, the breast looks real. There is hardly a scar where the nipple used to be. He may have to replace that implant with a smaller one. I doubt that he will end up with enough skin on the other side to make them match.... He may want to do an LD on that side, too.

    I think he will have to do the surgery soon before my skin attaches to the chest wall. I have an appointment this Tues and will find out more. 

    I, too, have the iron bra sensation. I thought it was caused by the TE's and was disappointed that it was still there after the exchange. And now I see that you have it after LD. PS says it will get better. We can only hope.

    Thanks for your support. 

  • Stanzie
    Stanzie Member Posts: 1,611

    Linda - what you said about this type of surgery makes me think you can help me understand why they do this procedure like they do. What I mean is what exactly is the lat. muscle doing? Is it what holds the implant in place? I thought I understood all this then all of a sudden I'll get confused and think perhaps I don't know. I did have the surgery like the video except I didn't have TE - he put in the permanant implants. Everyday that goes by I'm more and more convinced he put in two different sizes as they look more and more lopsided. This makes me so angry and hurt as I don't want to have revision surgery but I don't think I'm OK with looking like this either. 

    Anyway, i guess i get confused when implants are under the pectoral muscles and when they are above. Also does anyone know with skin sparing surgery are the breasts more saggy? Seems like mine sag more than before and wondered if it was the weight of the muscle and implant.

  • CalypsoGirl
    CalypsoGirl Member Posts: 3

    kaiote, Welcome!  Wish none of us had to be here...

    Just thought I'd respond to your question.  I had mx in June 2008, followed by chemo + radiation (5 wks), then April 1st 2010 latissimus flap w/TE.  Last August I started having problems with lymphedema (too much yard work!)... Anyhow, my PS said that this procedure shouldn't affect my lymphedema & so far it hasn't!  I'm still healing & not entirely back to normal... Therefore, time will tell.  I recently heard that some weight lifting improves lymphedema...  Worth looking into!

    Hope your surgery goes well!!  Take care, CalypsoGirl

  • Stanzie
    Stanzie Member Posts: 1,611

    Why would yard work make lymphedema worse?

  • clwetzel
    clwetzel Member Posts: 11

    Barb R,

           I understand what you are going through.  I went for the bilateral breast expanders.  The non radiated side did great and so did the radiated side.  I got expanded beyond the size that I wanted to allow for a comfortable permanent implant fit.  I had the permanent implants put into place.  The non radiated side healed great but the radiated side did not do well.  The tissue was so thin that it broke down exposing the implant.  I have had a total of 3 TE placed and each time the same thing happened.  I was very disappointed.  I almost gave up but because I am very active with scuba diving and out door activities I didn't want to use a prosthesis forever.  I am scheduled for October to have a LD flap.  I am waiting til October because of scuba season.  I am very hopeful that this will finally work.  Each time I accumulated fluid and my radiated tissue just could not handle it.  I have faith that this will finally work.  Hang in there!  I have been hearing very good things about the LD flap, especially for people with radiated tissue.  I would like to recommend some nutritional information that I have compiled for our patients to aid in healing.  We sometimes think we are more healthy than we are.  The recommedations have really helped a lot of our patients so I would like to share with everyone here.  Please see below.  

    Pre-Surgical Recommendations

      

    Most patients ask for recommendations on what can be done to aid in the healing process after surgery.  It is important to be sure to get enough of the following recommendations.  Patients should begin consuming the following daily recommendations at least four weeks prior to surgery and until completely healed after surgery.

      

    Dose

    Role

    Vitamin C

    Max 2,000 mg/day

    Wound Healing

    B-Complex

    1 tablet daily

    Wound Healing

    Multivitamin

    1 tablet daily

    Wound Healing

    Protein

    Females 46g/day

    Wound Healing

    Males

     56g/day

    Fluids

    6-8 glasses/day

    Excretes waste and aids in healing

    Rest/Sleep

    8 hrs

    Wound healing

      

    Sources of Protein:  Meat, fish, poultry, cheese, eggs, yogurt, milk, vegetables, nuts, seeds, grains and legumes.

    Arnica Montana: Some patients have reported a benefit using this product to reduce the bruising and swelling after surgery.  (http://www.alpinepharm.com/  1-888-746-3224)

    Nicotine Use: Abstinence from smoking or chewing tobacco for at least one month (6-8 weeks would be optimal) decreases the risk of surgical site infections and wound healing delays.  Abstinence from smoking also includes exposure to second hand smoke.

  • Linda54
    Linda54 Member Posts: 509

    Stanzie

    My understanding of the LD flap recon is that with a radiated breast (even with the skin sparing) that some of the damaged skin can be cut away and a skin graft from the back can be used.  The LD muscle is tunneled through and is used as a sling for support of the implant (implant placed under the LD muscle).  For a person with thin skin or rad damaged skin no way needs an implant placed on top of the muscle.  Some doctors use cadaver skin (can't remember what it is officially called) to form support of an implant. It is very expensive and (I think) some insurance companies will not pay for it.

    As far as the sagging, did you have large breast and have lots of skin?  If so and if smaller implants were used I could see that you might have a sag. 

  • BarbR
    BarbR Member Posts: 9

    Thanks cwentzel. I am pretty much on that supplement  regimen.

     I can't believe you went through it 3 times. I don't think my surgeon would do it again without the LD. Since I had a slight fever, they put me on IV antibiotics and kept me in the hospital for 3 days after  implant exposure and removal. I am so NOT interested in doing that again, although going through major surgery with drains is not going to be a picnic and I was trying to avoid it.

  • binney4
    binney4 Member Posts: 1,466

    Kaiote, hello, and welcome!

    I'm not a regular on this forum (no reconstruction!), but I do have lymphedema and wanted to tell you that reconstruction surgeries do sometimes improve lymphedema. That's because following the trauma of surgery our bodies produce chemicals that accelerate the regrowth of both blood vessels and lymph vessels. So it does sometimes happen that reconstruction can create an improvement in lymphedema. But there's no guarantee of that, and no way to predict who might have such a happy outcome.

    It's also true that further surgery can create more swelling. You'll want to consult with your lymphedema therapist before your surgery and make sure your swelling is as reduced as it can be in order to ease your recovery and help avoid infection. S/he may also consult with your surgeon about how to manage your lymphedema during and immediately after surgery. Good idea to have an appointment set up for after the surgery too, so s/he can help you regain control and answer any question you might have as you heal.

    Here's a page about medical care that includes suggestions for surgery in the presence of lymphedema -- scroll clear down to the last section on the page:
    http://www.stepup-speakout.org/Emergencies_and_Medical_Care_lymphedema.htm

    Hope some of that helps, and that it's all smooth sailing for you!
    Binney