Latissimus Dorsi Breast Reconstruction
Comments
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Calyso and all,
The recent research on weight lifting has been widely misinterpreted in the media (and even, unfortunately, by some of our doctors and nurses!) What it DID show is that weight lifting -- if done with specially-educated trainers, under the care of well-qualified lymphedema therapists, while wearing custom-fitted compression sleeves and gloves, and undertaken in very slow and careful increments -- did not make their lymphedema any worse. At least not most of them -- a small percentage had to drop out of the study because of new swelling. The lead author of that study, Dr. Kathryn Schmitz, has published an article about "Clearing Up the Misperceptions" in an effort to prevent women with lymphedema from jumping into this without understanding the precautions. It is available at the National Lymphedema Network, along with a copy of the study article and even the specific weight-lifting routine that was used. It's all available here:
http://www.lymphnet.org/lymphedemaFAQs/weightliftingLE.htm
Great information, and wonderful to know that with care and good management we can continue to regain strength and health through beneficial exercise.
Stanzie, there are a number of things that can both trigger lymphedema in those at risk and cause swelling problems for women who already have it. Yard work, being strenous and seasonal, falls into the category of stressing your arm. Since we are ALL at risk for lymphedema following bc treatment (and the risk remains for life), a few simple lifestyle changes can reduce your chances of ever having to deal with it. Here are two websites with good lymphedema risk reduction information:
http://www.lymphnet.org (See their position papers on risk reduction, exercise, and air travel)
http://www.stepup-speakout.org/riskreduction_for_lymphedema.htm
Knowledge is power!
Be well!
Binney0 -
Stanzie - I'm guessing that the hours I spent doing yard work (raking vigorously & piling rocks) induced the lymphedema. I just over did it... Now I'm more careful. Live & learn... The hard way!
Take care, CalypsoGirl
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Linda - thank you. No I wasn't big to begin with. I was a small B and had hoped to just be a full B. I think one side is still small B and the other is more of an A. So ??? The worst swelling or whatever it is is on the Pmx side which is the larger side . Wore a old bra today which is a B and didn't really fill it out on the large side. But yes they do sag which isn't very nice.
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Barb R,
I do not look forard to the drains again either but I try to look at it like this: Those drains serve a purpose by getting rid of all of that fluid. If the drains were not in place the fluid would accumulate and cause a lot of discomfort and possible infection and opening of the wound. I agree that those drains are uncomfortable and a pain in the butt!
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Stanzie, I'm having LD flap with implants on June 4th. I had a bilateral mastectomy with TE's on 1/28/09. I had rads and then waited 6 months before my PS started the fills. After 2 fills the TE on my left (rads) side poke through my skin and had to be removed along with all the skin that was spared during my mastectomy. The right was fine and we continued fills, now I'm having LD flap with implants on both sides. My PS told me she will put in two different size implants because you have to consider the muscle from the LD flap. She insist that the difference in size will not be that noticeable. How long ago was your LD flap? Now I'm starting wonder......how much of difference. What does your PS say about the size difference?
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He seemed quite surprised by the difference in size. But them tried to explain it away by saying my breasts weren't even to begin with (3 biopsies taking out tissue will do that). I go back to my breast surgeon next week and will be interested to see what he thinks since he sees tons of reconstruction. I'll then go back and talk to my PS and see if it is worth doing something about. It is just so disappointing and frustration as having my breasts be the same was part of the reason for having the double mx.
When you say she said you have to consider the muscle from the LD flap - I get that but it would make more sense since I'm right handed that that muscle would be larger and therefore that side would be the larger side but it isn't.
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Stanzie, just to keep in the back of your mind should your doctors not identify other reasons for the swelling, breast lymphedema is possible in a reconstructed breast. It's called "truncal lymphedema." There's non-invasive treatment available to reduce both the swelling and the risk of infection:
http://www.stepup-speakout.org/breast_chest_trunckal_lymphedema.htmBe well!
Binney0 -
Stanzie,
When my PS said she would use two different size implants I took it as she would use a smaller implant on the side with LD Flap (because of the muscle from my back is used) and larger one on the side with just a implant. (no LD flap) Maybe I miss understood her, I will have to get more details from her during my pre-op visit.
Having the same size breast was a big part of my decision to have the mast. as well.
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My PS used two different sized implants- one for the side that had an LD, 400cc and one for the side without the LD, 600cc. The amount of muscle taking up space must be considered. JUDY
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Stanzie- I am serious- my back scars are pretty darn low down my back. I have a pretty good size dog-ear on those scars too. Just can't wait for the exchange. After all this time I am getting sore and uncomfortable again. WTH? I look a little square when naked but the girls are pretty nice all things considered. But the hard shelled feeling needs to go! Yes, my back looks nice and firm with no bumps or lumps. I am not bragging just thrilled to feel better about myself after dx and bmx hell, I was sure that would not be likely.
I was very lucky to get a PS who is very much a perfectionist. I really think I will look as good as possible after recon. I also have not done any particular exercises and have not had range of motion issues. I am active and try to do stretches here and there when I remember. I am very blessed with this recovery so far. But my emotions are starting to rear their ugly head. I am prone to getting teary eyed now that I am somewhat close to the exchange and the "end" of this bad dream. I held up well emotionally for so long but it is harder now for some reason.
Oh well, 2morow is another day, albeit a rainy day in New England! You and Cindy are making me jealous. My DH is originally form Savannah. We got engaged and then married there. We live in Mass. but have talked for years about moving south. Neither of us likes cold weather. You ladies enjoy the heat for us! Hugs to all♥
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Hi Everyone - Well I had my 2nd appt with the PS. They took he stitches out of my back and some from the breasts today, and left a few stitches in. I still have 1 drain tagging along. I don't even realize it is there any more sometimes. I got 60cc in the left breast and 50cc in the right breast. So far so good. Only the needle prick hurt. My next visit is Wednesday.
Kaiote - I don't know how much I won yet but I do know it was at leat $300 so far.
Cindy
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Interesting...... now my double mx used the lat muscles on Both sides - so in my mind he was dealing with two empty shells and two back muscles and two implants so...... shouldn't they be the same?
I will look up the lymphadema site - I'm open to any possibility I just think and feel (literally) that the implants are two different sizes.
My back is still sore and I use a pillow to drive and to sit in any chair that isn't heavily pillowed and yes still I take ibuprophen when I get those tingly pains so for me yes healing is still going on. My back scars are still pretty red and ugly but I think in time they will be fine.
faythmne - congratulations on the radio show win - very exciting. Are you in pain from the fills? I didn't have any but have head all the pain from others.
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Stanzie -
No pain from the fills so far. Some discomfort but I haven't taken any pain pills yet and it is 11:30pm here now. When she inserted the needles for the fills that wasn't any fun, but quick. She said she could numb the area first if I wanted her to but I figure why more than 1 poke. The first time I tried the TE in August last year the PS at that time (different PS) put them in with 250cc right from the beginning, now that hurt. My back feels fine, I just need to get rid of this other drain as it bothers my shoulder blade sometimes. The area between the breasts is tight and I need to massage it a little. Ok I have just had some sharp pangs in the breasts. What's that all about??
Cindy
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Faythnme,
Those little jolts of pain are your nerves regenerating and finding different pathways. It is a good thing because you are healing and feeling is coming back to those areas.
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Does anyone know how to print out your own posts? This is turning out to look like my journal.
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I have 375cc implant on Radiated side and 350cc on prophylactic side. I have bi-lat LD flaps. Rad side has 25cc more which is not much but it does look a little bit bigger. Don't know why the bigger size. The rad side is rounder and firmer but I think my PS did a great job and did the best he could with a previous rad side to work with. I have style 20 Natrelle by Allergan smooth round high profile silicone implants.
When I went in for my first fill my PS injected some lidocaine before filling. It hurt sooooo bad. I thought I was going to die from the lidocaine. I cried when I left his office. I must have been allergic to it..he could not give me an answer as to why I had such pain and I have not found anyone else who had that experience. The next time I told him to just give me the fill without numbing with the lidocaine. Piece of cake....
As I was expanded my clothing started feeling like sandpaper rubbing on my chest but that subsided after a while.
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I horrible reaction with lidocaine also - Seems like they should have some other alternative as well.
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Hey there ladies - When I had my first fill on Wednesday, she just inserted the needle into the TE (left side). Yeah it hurt a bit. The right side just felt like pressure. The PS said she could give me something to numb the area first. I told her no thanks all I need is 1 poke. Its a temporary pain anyways.
Stanzie - by the way I won $600 on the radio contest.
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Cindy
WOW $600 buckeroos....that is great....congrats to you
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Linda- love the new pic! JUDY
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Judy, How you like my brows by Earleen? I love them!!
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Faythme - Wow ! I think you need to buy something special just for yourself and getting though all this with the money - something you wouldn't normally ever think of getting for yourslef but something perhaps you have always wanted!
Linda, your eyebrows look fabulous! Wow, she is very good and you look so pretty!
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Well Stanzie, I actually put this ring on layaway at Fred Meyer's before I went in for surgery. It was normally $400.00 but was on sale for half the cost. The ring came out over a year ago during Breast Cancer awareness. Ever so often I would go in to the store and looked to see if had dropped in price. Apparently I've missed some other promotions on the ring. When the sales person told me they had layaway and all I had to do was to have it paid off by August I was good to go. The ring is beautiful. It's a pink sapphire in a heart shape surrounded by crusted diamonds. So when I get the money from the contest that is the first thing I am going to go get. After that I am not sure. I will probably put it into savings so that I don't make any rash decisions. So I am very excited.
Now the next thing I need to work on is getting my days into order. It is 12:31am and I just cleaned up the kitchen and I should be sleeping. I went for a walk today, probably about a mile all together. I picked up some lunch on the way back, ate and then took a 2 hour nap. I will be making attempts to walk a little each day to regain my strength. I think it will also help in the healing process.
Linda - Did the swelling/thickness under your arms eventually go away so you don't feel like a linebacker?
Saturday I am going to my daughter's baby shower. It will be the first time out of the house for more than just an appt or a walk. There's going to be several people there and I am hoping to see my grandsons if they come up from Portland. Maybe then this weekend will the time I get my sleeping back on track and hopefully be able to return to my bed as well. Been sleeping on the couch since I got home from the hospital.
I feel like I am babbling here.
So I will say good morning and have a fabulous day everyone!!0 -
Linda: From what I can see, they look great! She gave you a good shape and they look even...
I don't know why everyone insists on their being even!! It would be so much easier if you could just do them without regard!! LOL!! enjoy! Hey everyone, this is what good permanent makeup looks like. Not like Groucho Marx eyebrows!! JUDY0 -
Thanks girls for the compliments on the brows..I give all the credit to Earleen..she is a doll!!
Cindy, I felt like a linebacker until I had my exchange surgery but I think it was from the expanders extending to my arms. I had never felt my arms rubbing against my breast before and I did not like it. I told my PS that the implants better not be close to my arms...
Glad you are doing well and getting out.
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I had lat dorsi flap on the left (cancer) side in November and the right in February. Both surgeries lasted about 5 hours and I was off work for about 3 weeks (developed shingles in week 2 both times). I have a revision scheduled in June.
I thought the Feb surgery would be my last and I was so excited to be done with it and now I am facing another surgery and struggling to be positive.I did not go through all of the pain to end up looking like this. And one of reasons I did both was that the PS told me the results would be much better than if I had to do the other one later (and I would have according to the biopsy). They certainly are not a matched pair.
I have limited feeling on my back but no discomfort. It is puffy at the end of my back scar, a small mound that is very unattractive. I do have occasional aching in my armpit and below. On the positive side, my range of motion is really good (yes, I can do the backstroke). I am doing much better physically than emotionally at this point.
I JUST WANT MY LIFE TO RETURN TO NORMAL AFTER 18 MONTHS OF THE WORRY AND STRESS OF DEALING WITH CANCER. Pardon my frustration, but it sure feels good to get it out and I know all of you will understand it.
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Fathymne - good for you! I told myself I'd buy something special for myself once it all was all over..... so hopefully not much more to go.
The stuff/swelling under the arm is really annoying.Look forward to talking to a doc about it.
Karla - I'm so sorry you have to go through more surgery - What will you have done for the revision? I too braved the swimming pool and found i could do way more than I thought but my stamina isn't there yet at all
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Revision will fix the "sink hole" that forms when I flex my chest muscle. PS tried to fix it when he did my right breast by unattaching the muscle from the bone but that did not work. He said he will have to redo whole thing, put in a bigger implant and this time put it behind the muscle wall. Will also add more tissue for support? Honestly, when he said another surgery,I got brain buzz and could not focus on what he was saying.
About the only exercise I truly enjoy is swimming. My first day in the pool I could not even make it across without my back freezing up. Six weeks later, I lap for 50 minutes with a combination of strokes, emphasizing building up my chest muscles. If you enjoy the water, it is a great way to build yourself back up.
Thanks for the reply. Was a bad day and I needed to vent. Better today and will be even better tomorrow.
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Hi all, thank you for your replies to my post - just wanted to let you know I have just been given a date 1st July, to have the other breast removed and double reconstruction using implants and Lat dorsi muscles.
Woohoo another step on the journey .....0 -
I have a question about a lat flap surgery by PS is proposing. I've have chronic cellulitis concentrated in part of my radiated breast for about 6 months now. The implant was replaced twice, and right now I have a tissue expander My surgeon wants to remove the expander, cut out the scar tissue and focal point of the infection and do an immediate lat flap to bring in healthy tissue. While it makes sense. I've never heard of anyone doing a lat flap until the cellulitis is healed, usually by removing the foreign body and giving things a rest. Have any of you heard about doing it this way?
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