Latissimus Dorsi Breast Reconstruction
Comments
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sunny2 - I do not have an implant. My reconstruction was to correct a significant lumpectomy defect. Whether or not you have implants or TEs will depend on the the extent of the surgery. Discuss all your options with your PS before making a decision on how you want to proceed.
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jo1955: I had a complete mastectomy of the left breast. I also underwent radiation. I prefer not getting an implant but that would mean a DIEP and I simply do not want to undergo such a lengthy and complex surgery. Or, I could go with the TRAM (no implant) which was one of my options but I don't want to loose one of my ab muscles so that throws me back to the LD.
Ugh...there is no simple way to do anything! I could just simply not do but every fiber in me screams, "I want my shape back"
Thanks for the imput!
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sunny2 - If you had a complete mastectomy of the left breast, why did you have to do radiation? Sounds like overkill to me.
With the LD flap you will lose some back muscle. My range of motion is excellent. I play golf and have no problems with my swing.
It doesn't seem like anything in this journey is easy. For me, some days it seems like it will never end.
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Sunny,
I think it might have something to do with radiation. I did not have to have radiation and my reconstruction was done during the same time of my mastectomy.
I chose to not do the TE because I didn't want to go through more than one recovery.0 -
jo1955: As you can see from my signature: tumor size, lymph node involvement, HER2 positive all added up to be agressive in the treament. A BC specialist was in agreement with my onc concerning the course of treatment. I prayed God would give them wisdom on treating me and I am believing that He did.
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I had a TE with opriginal surgery and then an implant 6 months later. I did not have radiation. My ps was not sure that I would need an implant but after the breast settled, I needed a bit of help to achieve symmetry and create more roundness to the breast.
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Sunny-I had my surgery at Moses Cone here in Greensboro. Sorry I forgot to answer that part.
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Sunny2 you and I were probably a lot alike in our treatments. Due to the size and position of my tumor I had to have a modified radical mastectomy and radiation...with a skin saving prophylactic mastectomy to come on my right breast implants are the only way I will get symmetry. Going under the knife next Wednesday.
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hwhranch: Yep, I had Adriamycin and Cytoxan followed by surgery then I had Taxatere and Carboplatin. After that was said and done I launched into radiation. Good grief, I thought, can't they just leave me alone. I made it!!! Now, for the final leg of this journey...recon. I had planned to start this the first week of Dec. but my hubby thought it would be better to tackle it after the holidays...we always travel to see family. I'm anxious. Please keep us posted on your progress. I wish you the absolute best and a very speedy recovery.
Blessings!
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Sunny,
I think your hubby made a wonderful suggestion. You don't wanna have go through the holidays while recovering. Regardless of which kind of reconstruction that you choose, all of them are challenging. Enjoy the holidays free from the hassle of drains, stiffness and being sore.0 -
sunny2 - I too didn't have TE with my LD Umx but went straight to implant. I didn't have rads. I did have implants prior to BC. Not sure if that made a difference in my case or not. Regarding those that feel cold with the implants, I haven't noticed it. But then I'm not saying it's not possible since before BC I had implants, under my breast tissue. Then after UMX I have the implant under my breast skin and lat muscle. Maybe it makes a difference because of the extra tissue? Not sure.
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mine sure don't seem to. To counteract the chill on my chest I feel in winter from the silicone implants I buy inexpensive light weight all cotton tank tops that are cropped below my breasts to wear under my clothes. They are only $5 each here. I even asked my husband to if he could feel the difference and he can. He says they are cool compared to my warm skin. Truthfully, it's even that way in summer but then I don't mind. Could be I feel the coolness more because I am kinda small.
A temporary implant allows the muscle and skin time to stretch to accommodate the permanent implant. The decision of a permanent implant vs a TE is based upon the size of implants you want, your body size and if you have enough external skin.
Me, I'm 5' 3" and 110 pds. My breasts were 350cc. I opted for smaller implants so the PS could do permanent ones with my belief as a nurse being one less surgery, one less risk, less for the pec muscle to support, which it was never intended to do, and since my implants would give me perky breasts with great cleavage, and I wouldn't even have to wear a bra if I didn't want to, my implants were 225cc on the one side and 200cc on the LD side. I had to have a LD flap as my PS said no muscle or skin radiated could tolerate and support any size implant on it's own without the potential of significant risk. And my PS was a no-risk kind of person.
Radiation actually like 'fries' your pec muscle to a degree, and decreases it's strength, as it also damages your superficial skin layer and all that's underneath those rad rays. My ribs still hurt there and my rads finished 2 years ago.
You will have a TE until approximately 6 weeks after your last fill. Some women tolerate large fills every 2 weeks, others can handle only 50cc every two weeks. Each time, you will have to travel to see your PS. So now you can work out the soonest vs the longest this should take. The PS will put some saline in your TE (usually) at the time of insertion. Then you might have to wait 2 - 6 weeks for your next fill, depending on your scar healing.
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justagirl that is some great information. Thanks so much...I was a "B" cup before and am not really looking for much more than that...I'm not after DD's or anything like that. I don't know how many CC's it takes to make a cup size though.
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justagirl: Thanks for the info...I'm with you hwhranch. Not looking to go "big". I'm anxious to see if my PS thinks it's possible to go with the permanent implant at time of LD and skip the whole TE thing.
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I was a 34B when my own breasts were 350. When I chose to drop to 225 and 200cc on the LD side, I'm still wearing the same bra size but not filling it out snugly/fully. Probably a padded bra in the same size would do that but I like to wear the light thin ones.
I will say my implants at the size they are give me great cleavage and they sure are perky! I am comfortable wearing low cut tops and spaghetti strap tops and dresses. Living here in Australia it's just too hot for most of the year to wear more. And I love not having to wear a bra.
The cc's required for a full B cup depend on your chest circumference. I am guessing about 300 cc. One must remember these are silicone, so semi firm (like a teenagers breasts), but the implants are shaped more wider than projecting. Someone said the implants were shaped like a hamburger and that's pretty accurate vs like a snow cone.
A suggestion. Ask your PS to show you implants from about 250cc to 350 cc and hold it up to your chest to compare. Also see how the implant fits into your bra cup. Obviously, the implant with the LD flap will be a little smaller as, even after it atrophies, the LD muscle has some bulk on its own. Now, because of this, don't freak out for the first 4 - 6 months as your LD side might appear to be bigger if the PS has allowed for the downsizing due to muscle atrophy.
At home you could do this. Take a cheap sandwich bag and fill it with a cup of water - that will equal 250cc. Squish the bag closed until it makes a hamburger shape (won't be perfect as its water not the firmer silicone) and hold it to the outside of your breast.
Many women do experience quite a bit of discomfort with the filling of the TE's plus it's another surgery, and another down time afterward, with restriction to activities. I don't know if you can start PT 6 weeks after having TE's put in with the LD flap, but that's what my PS wanted me to do to regain my range of motion and after 12 weeks I could start building up my strength.
I just have felt ever since being diagnosed that I want to do what is needed to save my life with the minimum of risks.
One less surgery - one less risk.
Oh, also the PS and BS didn't want to save my nipples, which I had been counting on doing but when they explained the risk, especially on the LD side with potential lack of circulation to the nipple, and therefore antibiotics and that the implant would have to come out right away.
So now I have 3D tatt's and am very happy. Less risk........
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Justagirl,
You are so right about the hamburger description. I didn't realize that my reconstructed side would match in size to my natural breast but the shape would be different. Its not a huge difference but I can tell if no one else can. I, too, wanted to save my nipple but the cancer was too large and too close for that to happen. The PS will be "creating" my nipple in Dec or Jan and then tatoo the color after it heals.
How long does it take for atrophy to be happen? The top of my foob is not so bad, but the bottom part is like a hard shelf that the implant is sitting on.
By the way, I didn't do the TE's either, for 2 reasons. Like you, I didn't want another surgery. Secondly, my "girls" were a D before cancer. I'm now a C (reduction/lift for symmetry on the healthy breast). Even at a C the PS had to use a 550cc implant. I would have been filling for ever!0 -
Momluke: just remember with being the size you are now, it's less weight on the pec muscle, which was never made to support an implant. My PS said it takes a full 4 - 6 months for the muscle atrophy to take place, depending one how big your muscle is to start with. Mine took the full 6 months, but having that breast a little bigger wasn't noticeable to my husband or BFF, only to me standing naked in front of the mirror.
No, we will never look like we did with our implants, but as I remember nursing women whose only option with a DM in the days of no reconstruction, I am very very happy. I often wear low cut tops without a bra if it is form fitting, and am confident in how I look. I do think it only serves to bring us down emotionally to stand naked in front of that darned bathroom mirror for too long making comparisons. Now my breasts match the rest of my body. I had a breast reduction about 10 years ago from D to B as I used to have to wear double running bras and suffered. So for me there were advantages to even smaller breasts.
I will remind those that are bothering to read this, it is important to start physio about 6 weeks after surgery with your PS's ok to stretch your muscles and regain your flexibility and keep good posture. At 12 weeks, with ok from PS, start light strengthening exercises as your arm on the side with the LD flap will of atrophied. I do a lot of heavy work outside like using a chainsaw, so I need all the upper body strength I had before this.
I believe for me the more I can get back into doing what I did before BC hit me the better off mentally and physically I am. Also beware with the loss of the LD muscle, that lower side of your back isn't as strong.
Momluke, good luck with getting your 'new nipple'. And yes, a 550 cc implant would time much time, unelss you could tolerate like 75 - 100 cc at a time.. And: All of this does take time, but I feel at least I'm here to do it.
Never before in my life had I questioned that I would live until my late 80's until BC hit me at 57. People used to say I looked 20 years younger. 57-59 I felt 20 years older. Now I think I am finally feeling like 'me' again.
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I am really anxious because I have surgery scheduled for Wednesday and now I have a ton of questions. I go in for marking Monday, hopefully I can gets some questions answered then. It is so frustrating because we have had a change in insurance carriers right in the middle of this and I had to delay my reconstruction from September to November. I will just take my Xanax and try to keep calm, lol.
I do find it kind of comforting that the Susan Koman 3-day is going on right now here in Dallas and I keep reminding myself that thousands of other women have gone through this, paved the way for me so to speak. It does give me the drive to follow in their footsteps....along with everybody here.0 -
Just wanted to report that I am able to swim without any issues with my bilateral lat flaps. Yay! First time I have been in our pool in 2 years. Last summer between radiation & surgeries my skin was never healed enough to chance it. Just did 20 lengths of the pool (it isn't that big) doing the breaststroke & the backstroke. Was not sure I'd still be able to.
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DLL66: Your post made me smile
. My heart rejoices with you. I am so ready to take on this recon. I've decided to wait until after the holidays....but, I would so like to begin this process! At least I am ridding myself of the port come Wed.Blessings
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DLL66 - Great News! I know I spent a lot of time in our pool this summer and just loved it. I know how you feel.
sunny - The holidays will be here and gone before you know it. I know you are anxious to get started. Hang in there.
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Well I'm marked up and ready to go for Wednesday!! Really like my PS, he was marking me today and did the left side and then started some on the right...started questioning him about what we were doing on the right and he agreed that I did not need a lat flap done on my right side. Really happy about that. Skin saving mastectomy for the right and boob renovation all the way around!!!
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hwhranch - Best of luck on Wed. Will be with you in spirit holding your hand. Post when you feel up to it and let us know how it went and how you are feeling.
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hwhranch - Best of luck on our surgery Wednesday!
I haven't posted in a while. It's been a year since my lat surgery (10/11/11). For those wondering, I can swim, exercise, lift weights, do housework (ugh) and everything else I did before this mess. I do occaisionally have to move computers at work and I think the lifting is the only time I really notice something on the lat side, but it's more of a puffy feeling than any pain. So I hope those of you just starting down this recon road will do just as well.
This weekend I went to a BC convention for an organization here called Breast Cancer Connections. It's a great place that offers all sorts of support, services and information. It was very inspiring to be in a convention center with so many others that have gone through this BC crap. It was very informative too. Met some nice ladies. Weird though, no one at my table had heard of the lat reconstruction. hmmm..... I'm hoping it was just that they didn't have to deal with the choice and not that it's rare. I did watch a reality show recently (one of those about the bridal shops) and the owner had BC AND she had the lat reconstruction.
I guess sometimes it's good that we have this place to know we aren't the only one going through this.
Anyway, I hope everyone is doing well.
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I had it in 2008 (delayed reconstruction). I ended up having problems because of the amount of radiation I had (stage 3c). Probably wasn't a candidate. I think it was fine and began to heal quickly. I was 55 when I had it done and the only thing I would have done differently was to get into physical therapy right away. Even though i swam and excercised, I think I was too protective of the area because initially eveything is tight (actually still tight five yrs later, but a millilon so much better). I still have some range of motion limitation and a physical therapy regimen followed by some directed excercise probably woul have helped. Good luck.
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jwilco - When I was discussing options with my PS, I asked him why he thought the lat flap was the best for me. He said because the lat flap is the oldest and most reliable procedure. There is a much less chance of rejection problems and you are not under anesthesia for the 10 - 12 hours that is required for the other options.
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hwhranch: you're in my prayers...asking and believing that every last detail goes perfectly and you will heal quickly and completely.
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I had lat dorsi reconstruction on Oct. 11, 2012. After having the drains removed - which was wonderful - the only real concern that I have is the swelling under my arm. My ps said it could take months for the muscle to atrophy and was wondering if anyone else had this problem. Does it really take that long and is there anything that I can do to help that "full" feeling. I love how everything looks and feels and the scars are looking good. I am still wearing a sports bra 24-7. Does that help, or hinder? Thanks.
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dotmom1023 - It does take time for the swelling to go down and the muscle to atrophy. I had my surgery Apr 18, 2012 and I am just now feeling like there is not that "full" feeling. Hang in there - it does get better.
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Good Morning Everyone. Happy to report that I had my last PS appt yesterday - YEA! Had a little spot that was giving me pain problems from where he had to take some extra skin off that was left from the back scar. It got in the way of being able to comfortably wearing a bra all day. Anyway, had a steroid injection yesterday and am hoping this works. It was time to not only say goodbye to my PS but to also be able to close another chapter in this journey. No more appts until next month - that one is my 6 month MO checkup. Hope everyone has a good day.
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