Latissimus Dorsi Breast Reconstruction
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I have a question for you ladies if you don't mind. I am relatively new to all this. I am having my surgery next Thursday, right side only. Anyway, I went to PS who seems to be wonderful and beloved. I saw his book of pictures and they are lovely. He talked to me about DIEP for about a minute then said I was not a candidate. I can see why actually. I am 62 years old, 50 lbs. overweight, diabetic, not terrible but not 100% controlled. I have COPD from a long addiction to nicotine (quit last year).... So he said because of healing issues and not wanting me in a very long surgery we'd go for the TE then implant route. We spoke on the phone since. I am kind of freaked out about the implant so he mentioned the LAT procedure. I understand I would still need an implant. So my question is, what are the benefits over JUST an implant? Do they look/feel better? Is the difference that much? I would like to minimize my surgery, healing time, pain as much as possible. I would also not want to be miserable with a cold bag of silicone in my chest and nothing else. (I don't know why the idea of an implant with no other tissue freaks me out so). Hence, I don't know which way to go. I have my final appt. with PS tomorrow afternoon so would appreciate any input. Thanks.
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Hi Everyone - just checking in with all of you. So glad to hear that the majority are feeling better and doing well WITHOUT drains! I'm still dealing with fluid building up in my back, so I get drained once a week. My PS also referred me for PT and the specialize in manual lymph drainage, which seems to be a light massage that moves the fluid down. I'm hoping it helps as I'm sick of my back feeling like a waterbed. On a more positive note, my wound issue is improving. I had 5mm of new scar today, so it's finally starting to close up. I can't wait to have it heal and start my fills so I can feel like I'm moving toward the finish line.
I have the dog ears on my back, too. My PS said that it's normal and she pretty much does it on purpose - supposedly, trying to get it totally flat just means the scar gets longer and longer. So, during the 2nd surgery she said she'll "carve them out." Not sure what that entails, but she assured me that it'll be flat again. I'm viewing it as a "side tuck!" Maybe I'll look slimmer once she does that. Bonus!
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bevg49 - From what I have learned on this site, seems that the LD flap is for women that do not have enough skin to stretch with a TE alone. I had a wound vac for post mastectomy infection that adhered my skin to the chest wall. Others have had radiation which causes the skin to harden and loose it's elasticity. Other may chime in with more info. If your PS thinks you have enough skin for TE and implant alone then I definitely wouldn't go the LD flap route since it is a much, much more invasive surgery with a longer recouperation time. I found the LD flap surgery to be very painful for the first two weeks. I was off work for 6 weeks and really didn't feel fully healed until 8 or 9 weeks. The scar on the LD flap side reminds me of a football. I know they will fade in time, but can't imagine the LD flap surgery scars would look better than TE/implant surgery scars.
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bevg49: I can't speak for everyone else, but I will be getting the lat flap surgery because the skin on what used to be my breast (my right side is empty right now because of previous complications) is too thin to get a TE and then implant. I need the skin (and tissue) on the back because of previous complications. I'm not a candidate for stomach operations because I am too thin. As for me, if I could get away with only a TE and then implant I would be jumping for joy. Having to get the lat flap stuff too is a major downer and additional complication. To me it just means more surgery, more recovery, more pain, etc, but it is nearly my only option. However I do understand that lots of people think lat flap recontruction looks more 'natural'. If I were you, I would definitely just get the implant without anything else.
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Thank you so much nurse and sunny. You definitely made me look at this in a different perspective. I was under the impression that the lat surgery would make the end result very much more natural looking and feeling. I guess that's not the case. I am not a very good pain patient, threshhold is very low. I have been diabetic for about 12 years which impedes healing and I'm not a spring chicken (more of fattened cow lol). Seriously, my weight scares me now. I know that also messes with the healing process. The PS suggested TE and implant. It was only after he heard me freaking out, nervous, that he said we could talk about lat flap. From what I hear from you two ladies, it would not be worth the trouble it could cause and I am not going to the beach in a string bikini any time soon so it looking more natural shouldn't be an issue. Thank you for helping me see this mess more clearly.
I'm sorry you've both had a hard time of it and hope you're feeling good soon. My prayers are with you both.
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Bev - I decided on the lat flap route as I did not want just an implant. And not all lat flaps have implants; many women just have the flap. I also wanted the natural look/feel of my own tissue. (My breast moves like a nautral breast now.) My PS thought she could get a good sized breast mound w/o an implant. However, I will need to go back for a very small implant to even out. I do not have the football scar on my breast (I had a skin sparing UMX). Post surgery WAS painful and recovery is a long process, at least for me. But at the end of the day I am glad I went this route - it worked for me - I like the way it looks and feels, I like the minimal scaring on the breast, and the scar on my back is no big deal as I don't really see it.0
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thanks, fitz... that was my thought exactly, wanting something more natural feeling than an implant. It shouldn't really matter. At 62, no one much sees or touches them anymore lol. But the implant with nothing else there just bothered me. I have to have a good talk with PS to decide. I want natural but I also want the easiest possible time of it. I am so worried about the overweight problem and diabetes. I could kick myself in the butt now for now being better about taking care of myself before this. I am worried as can be about LE also. At least I quit smoking as a New Year's resolution. PS says you can always change your decision later on (implant can become flap procedure).
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bevg49 - I had just the lat flap done and it is more natural feeling. In my case, I had a significant lumpectomy defect fixed. Recovery was fairly easy - I'm 57 BTW! Had 2 drains - one out at 2 1/2 weeks the other at 5 weeks. I have full range of motion back. I do have the football patch in the area under my nipple which is the original - LOL!. I will need a bit of revision done - therr are a few spots that look "tight" and PS wants to fix those.
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I've lingered this post for awhile but haven't really posted. Everyone has had pretty much the same experiences. It's such a process and I'm glad that there is a place to go and get information from people that are going through the same things.
I am glad that I had the lat flap done for my BMX. I love that I have breasts that feel real, I even have bounce!!! And now with the nipples done, I feel almost whole again. I have come through this relatively easy. Worst part was the first couple weeks afterward and the incisions on the back along with the dreaded drains. But once that all started to heal and the drains were gone, I have regained all range of motion, back to work full time after 7 weeks off plus Christmas break, so really almost 10 weeks off work. I am exercising again slowly so as not to hurt anything. I am very careful of weight limits still. I'm just taking things one day at a time, rest alot, and follow doctors orders.
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I would have liked any flap surgery to have natural feeling breasts but it was not to be. I went to my last PS appt. yesterday pre surgery (next Thurs.). Because of the fact that I'm a diabetic and overweight and have coronary artery disease and copd, he doesn't want to risk a surgery any longer than necessary or healing and recovery any longer or more extreme than necessary. I am not thrilled about having a plastic thing under my skin but he seems great and he promised he would make me look good in clothes. I'm in my 60's so don't wear bikinis or anything like that lol so I suppose I can deal with it and I'll be happy with less pain and recovery after surgery. I have no choice anyway. If I was younger (when I was 50 lbs. lighter), I'd have been much more upset.
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Bev--I am 46 and already had a previous breast augmentation. Even though I do not have the health issues you have, I decided to do just an implant reconstruction at the time of my bilateral mxs. (I didn't have to do the TE because my muscle and skin were already stretched from the breast augmentation). I am very satisfied with the way they look and do wear a Bikini----do don't sell yourself short!!
I knew going into it, that if I was not completely happy, that I could still do the Latis at another time if i wanted. No bridges burned so to say. I do think that your PS is guiding well and looking out for ALL of YOU in regards to your risks during and after surgery. Wanted to let you know that I am happy with my implant only reconstruction! Will think of you on Thursday....0 -
Uff, thank you so very much for your words of encouragement. Since my PS is giving me no choice, I am embracing the TE to implant reconstruction. In a way, I'm glad to have no choice. All these choices when you get the dreaded C are too much to deal with... To have a lumpectomy or a mastectomy. To get one taken off or both. To reconstruct or not and then how....... I am not too good at making decisions. I remember, as a teen, going to the shoe store with my mom. I could not decide between two pairs. My mother got so impatient with me that she ended up buying me both lol.... In this case, I have a very smart doctor telling me that in my case, the risks outweight the benefits of any other type of recon, so there you have it. He says I will look good in clothes and that's what I really want. So, I'll have to put an end to my career as a stripper
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Well, I am 6 1/2 weeks post op and played 9 holes of golf this morning with hubby. I have not played in quite some time - too busy this past winter. Did not do too bad. The back incision is a little tight but that was about it. I still have some buikiness under the arm pit but not enough to interfere with the swing. So glad I will be able to get back into the game.
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Jo1955 - Good for you! Great to hear you can enjoy golf again! If you continue to have tightness around that back incision, deep tissue massage is a wonderful thing to relieve that. Highly recommended - it also decreases the chance of adhesions from scar tissue. Just thought you might like to know!
It helped me a bunch. 0 -
Jo1955... so glad you are getting back to golf. I am a golfer and have managed a women's league for several years. I have to take this summer off due to my darn back.... spinal fusion surgery coming up next month. Always something! I am thinking of just trying few gentle golf swings in my back yard just to see how my strength is on my lat side. I have that little puff under my arm too, but assume that it will go down yet. My PS pulled another 25-30cc's of fluid from my back again last Thursday, 7 weeks after my surgery. I go back to see him again this Thursday, but there seems to be only a very small amount of fluid building up this time. Cannot believe I still have this going on. At least the drain is GONE! I would rather go back in and get it drained that way than deal with a dangling grenade.
My back is pretty hardened around my scar and I have been having my husband do some gentle massaging. I go back to my LE PT in another couple weeks so will ask her about scar massage. Wish I could reach it to do some massage myself.
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Joan - From reading your dx line I am assuming the lat flap was on the right side. As far as golf is concerned that would be the better side to have it on if you are right handed. I am right handed with lat on left. I thought I would lose some of my distance since the power in the swing comes from the left. I don't think it has hurt that much. I do gentle stretching every day and I can tell if I have overdone it on any given day. It feels like everything just tightens up.
Can't believe you still have drainage. What is up with that? I agree, it is better to have it needle aspirated than carrying around a dangling grenade. Hope this is your last time to need this done.
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OMG, I went to my final pre surg appt. w/ ps. When I told him i was nervous about drains as everyone has said that's the worst part of things, he made light and said they'd be out in one week. Is there something he isn't telling me the truth about ????
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bevg49 - The drains can come out in a week if your drainage is 30 ccs or less in a 24 hour period. I had 2 drains - one came out in 2 1/2 weeks and the other at 5 weeks. What makes the drains the wors part is having them hanging out, taking care of them and I know in my case I could not sleep in my bed for the entire 5 weeks.
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Bevg: my breast drains were only in one week. I know Latis drains can stay in for about 3-4 wks. depending on their outputs. They are a necessary evil but thank goodness only temporary!
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Thanks Uff.... I had a drain when I had my gall bladder removed, long ago, way before the time that started doing that surgery laproscopocally. It wasn't the worst thing I've ever experienced, just creepy and unpleasant. I'm probably being my scared self and looking for things that will be difficult to worry about. I'll get through it but it sure is nice to know that the doc might be right when he says 1 week.
Thanks for the info Jo.... I have the use of a really nice recliner with electronic controls and will sleep there as long as necessary. I have a great tempurpedic bed I want to sleep in though. I got a wedge pillow and a ton of regular pillows plus one for my arm to rest on after SNB.... I hoping being upright on those pillows will allow me to sleep there. We will see.
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bevg - I will keep my fingers crossed that at the end of one week the dreaded drains are gone. From what you are describing, I would give the bed a try.
I have my PS appt in the morning to talk about the revision work I will need. Just a bit of a touch up around the scar. In places it looks tight and does not have a smooth, even appearance. He said this can be done in the office. Will update when I get back.
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Congratulations on the golf Jo. I hope I'll be back in full force quickly too after I have surgery.
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Jo - So happy that you got to play golf. I do a lot of lifting at work and gardening at home. I am so glad that I don't seem to have lost any strength in that aspect, but doing lat exercises with P90X, I can tell and have to use 5 pound weights instead of 10.
Bev - Everyone is different as far as how much the drains put out. I had 6 with LD flap surgery and all were out by day 10. Sure hope this is the case with the exchange surgery as we are planning on leaving for Florida 17 days after my surgery.
My exchange surgery is coming up soon (June 13th) and I can't wait. I don't really feel the TE anymore and have been able to sleep on my sides again, but just ready for the finished product.
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Jo - good to hear your golf game it still on. Always a good feeling to be getting back to normal.
Today was one of the few time I've actually noticed a difference on my lat side, or should I say, non-lat side of my back. I spent the morning using the wet Swiffer thing to clean the kitchen floor. Now I feel it when I move that arm/elbow back. Oh well. I still did it and it doesn't hurt, just noticing something is different.
I'm scheduled for what I hope will be my final reconstruction surgery in August. He will be doing some minor tweeking on the lat side, moving the nipple cirlce over a tad and then...creating a nipple. Ta Da! That will be weird. I'm wondering how that recovery will work. Will I have a big bandage over the nipple area? I hope I can still wear a bra and go to work incognito. I haven't advertised the new nipple or lack of one. :-)
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sunny - Of course you will be able to play golf again. I do gentle stretches everyday. I am gettiing to the point that is no longer feels tight under my arm and the fullness is going away.
Nurseronda - Best of luck to you on your upcoming surgery June 13th. I hope you have a speedy recovery.
jwilco. You are going to do great on your final recon in Aug. You will have to keep us posted.
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Hello,
I would like to hear from some women who have had difficulty with the LD flap surgery. My experience has been a nightmare. DCIS. I was very physically fit, small build, very little subcutaneous tissue. Had surgery 12/14/10 with complete mastectomy on right side with immediate LD flap surgery with implant. Horrible and unrelenting pain. PS who did the surgery would not listen to me. Dismissed me. I finally went to Boston for a second opinion as I felt I was stuck to my ribs. Well, guess what--I was. Had a very large capsulitis from a seroma cavity and my tissue was adhered to my rib cage. Second surgery was 5/9/11. Pain has been a torment and is in my back, side, and chest. Unable to do any activity without pain, and continue to feel the latissimus muscle move in my back, side, and chest with EVERY MOVEMENT, no matter how small. I was a runner, also loved XC skiing, kayaking, riding my Harley Davidson bike, hiking, etc., etc. It took 9 mo to return to work a few hours/week, and 10 mo to get up to 20h/week, and even that is difficult many weeks. I completed 15 mo of physical therapy during April 1012 and continue to do a home stretching program. I have tried multiple meds, massage, pain injections, craniosacral therapy, accupuncture, and now going to a chiropractor who has experience doing some fascia release. I am back running short distances. Bottom line is I am miserable. I went back to the surgeon in Boston 6/11. He did not know what to do with me. He referred me to a colleague in Boston who trained under the PS who invented the implant. He suggested pain injections. I went back to pain specialist and nothing further recommended. PS in Boston recommended PS in Michigan, Dr. Dennis Hammond. Contacted him last Oct, sent photos, and he said to wait a full year from my second surgery. I did and am still miserable. Contacted him and he would like me to fly out.
I want to see someone who has experience with women who have had ongoing problems with the LD surgery. Help!!! Anyone have any suggestions? Any particular PS recommended?
I am new to the website and need to talk to other survivors!!! Look forward to hearing from you!
By the way, has anyone had experience with the Graston technique for release of adhesions? Chiropractor recommending it. I checked out the national website and this has been done for women who have had adhesions after Breast Reconstruction. I am worried about the implants, as Chir thinks I have an adhesion in the pec and in the intercostal space(s?) near the sternum. Metal tools are used. It is also a painful technique.
Thank you!
Lisa58
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Search for posts from Day -I don't think she posts here anymore (after the format change) but she had issues and lots of information. There are a few Lat Dorsi threads in the recon. section.
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lisa58 ~ I am so sorry that you have had so much pain and issues with your surgery. Have you considered going to NOLA? I hear that the surgeon teams down there are doing wonderful things for patients with problems and that they have had success in correcting botched surgeries. Is it possible for you to travel to get the best care?
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Lisa, I actually started a brand new thread for you, and put your post in it. (I just think that 46 pages of any thread is too many pages to go through!) You'll find it in this forum, higher up. I hope you don't mind. Wish I had something to offer other than that, but I don't. I had lat flap surgery but luckily everything went okay.
Good luck.
Trisha
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Lisa58, Sister I am so sorry you have suffered for so long. I was going to suggest what Beth suggested...call NOLA. They have done wonders for women who are having problems with implants. Call them before you waste any more time in surgery and money.
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