Latissimus Dorsi Breast Reconstruction
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This is a long and difficult and painful journey for all of us, no matter which route we take.
A LD flap with implant will never quite look like your natural breast and if you are older, your natural breast will have taken gravity and done it's thing. If you look at a silicone implant resting on the desk top, you will see it is shaped more like a hamburger than a snow cone. Our natural breasts are 'snow cone' shaped.
Two: yes, this always involves many more surgeries than just one it seems. You do need to trust and like and have a PS that you are comfortable and confident with.
It's always a good idea to go for the smallest implant to suit your body, as the smaller the implant, the less weight put on your superficial skin, your lat flap, and your pec muscle. I had to have a LD flap due to the damage done by radiation. My PS said she would never do reconstruction without a LD flap on a breast that had had radiation. It's been over two years for me since radiation, and my ribs still hurt - found out after rads that I had fracture lines runnng through them.
I had a 2nd surgery after my initial DM with LDflap and reconstruction. It was to tighten up the sling of the lat flap which was necessary due to the atrophy of the muscle and the PS put in a slightly bigger implant to try and equal the other implant. Well, six months later, my LD muscle atrophied more and that boob is slightly smaller than the other. Also I have a bit of loose skin under my arm and at the top of my back scar that bothered me. Luckily, my scars faded to nothing!
Well, I say my PS and she took pictures of my boobs together and showed me and they looked great and equal. She then said 'stop standing naked in front of the mirror and looking for any imperfections' - you look great. And she is right. She also said she would not take the risk of another surgery to take a couple of small nips in my skin and to put in an implant 15 or 20 cc bigger. Before I had had the DM with flap, I had already had breast reduction about 10 years ago and two surgeries for the lumpectomy (one after the original lumpectomy as the scar line was pulling). She said my skin is fragile and she never takes anyone into surgery when she already sees major risks unless the issue is life threatening.
You know what, what she said may sound mean, but she is right. I never had any any complications with my DM and LD flap or the 2nd surgery she did. For that I am grateful.
And no, I don't fill a bra like I used to. A padded one works well but usually I don't even bother as I'm so small - my implants are 225cc and I'm not big - 5' 3" and 110 pounds. If I need something, I wear a short camisole underneath. My breasts are small but I have projection and cleavage. My husband says I look like a teenager. ????? He thinks my boobs fit my body and my BFF, who is a RN like me, thinks my breasts are beautiful. She is 6 years younger than my 60 and says her boobs droop to her waist making her feel like cow waiting to be milked. Next on her list is a breast reduction and lift!
Good luck, and don't let any Dr push you or not listen to your concerns. You need a Dr you can freely talk to. I love my PS, even though she wouldn't do a surgery on me I thought I needed, and she was right!
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Thanks so much for the replys ladies it def means alot coming from someone who knows what it feels like to truley face this choice.... I am 34 and have small children so I want to lower my chances of eve facing cancer to the least possible amount. I also have a huge family history of cancer with BC being the highest. I am sceduled for radiation but hopeful that I can possibly get a skin/NS surgery.... I have an appt with a PS on dec 27th...
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Hi all,
Today is my two week mark for this surgery. I have to admit, I am feeling stronger every day and have not needed more than Tylonol extra strength for the last five days. It was good for me to get off the pain meds because they make me depressed. I am finally healing and feel like I will be ready in March to have my TEs put back in. I am hoping by the end of summer next year, I will be finished. That said, I have learned through this ordeal to be ready to roll with whatever comes my way.
The lat flap surgery was not easy, but after my failed skin sparring,I am thankful I had a skilled and compassionate PS. I think going through the struggles has made me appreciate even more than ever, that the BMX has taken this horrible disease out of me. The lingering psychological effect I feel most is an intense fear one of my daughters or someone else close to me will be diagnosed with cancer.
Hopefully, my drains will be taken out Monday. I am looking forward to the holidays and wish everyone healthy healing throughout the New Year.
Karen0 -
Hi ladies:
I started physical therapy yesterday and feel great! I'm only going to need about 4-6 visits just to get my pec a little more supple and get rid of some of the bogginess under my arm, which is important since I don't have very many lymph nodes left. I encourage everyone to try to find a phyiscal therapist who specializes in treating cancer patients if you can. I am lucky that my friend is the head of the oncological therapy department at my hospital and that she works with all of the PS and surgeons to advocate the benefits of therapy. I am amazed at how few limitations that I have....I keep waiting for it to hurt or my arm to lose its' range of motion, but golf course.....3 more months...here I come!!!
Mimi
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mimi791 - I also play golf and was able to swing a club after 6 weeks. My lat flap is on the left and my PS said I would probably not play again. Guess I fooled him. I started out playing 9 holes - too tired to do the full 18 but now I can play an entire round. If I find I am getting tired, I just skip a hole or two. This is something DH and I can do together and outdoors. You can play again. You just have to slowly start something small like an 8 or 7 iron.
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Hi jo1955:
That is great news! I also have a horse....and can't wait til I can toss a saddle over his back...which I can probably do right now, but my PS threatened to kick me in the shin repeatedly if I messed up all of his work. I only chose the LD recon because I knew of young women who were able to play tennis, golf and swim with it. I think they are using a much better technique than 3.5 years ago when I was first diagnosed. Thankfully, it's too cold up north where I am to tempt myself with anything other than my putter
Mimi
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mimi - By spring you will be back to doing all those things you love to do. I was never referred to a physical therapist but have done stretches on my own that have worked wonders. After several weeks, I used a golf club and did my warm up routine. Now that, I thought was the best PT.
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Just wanted to check in, I am 6 weeks post surgery and had my 4th fill this past Wednesday. Can't tell you how much better I feel, everything is softening up and I can raise both arms over my head without any pulling and hardly any stiffness. I didn't get sore from the fill either, things are looking up!! I will sure be happy when I can get these "baseballs" out of my chest, lol.
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Hwhranch-are you happy with the lat dorsi results after rads? I am not sure what or if I am going to do anything. Just doing my homework and getting others opinions, if you would rather PM me, that would be great.
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Marcie I am happy, my skin handled radiation well but it was still damaged and with a modified radical mastectomy I was running out of options! It felt very strange at first but as the weeks go by it is really beginning to soften up. I came out of surgery with a little tiny breast just from the tissue and muscle that was moved. I was and am still smaller on the right, where we did the other mastectomy at reconstruction but we will get it caught up with fills. Ask me as many questions as you would like.
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hi all
in need of some support...had this surgery done Oct 16th. I am experiencing a lot of lower back pain, now the stuff i am reading on the internet is freaking me out. Like how this muscle is important for us to "stand up well" and that a lot of hospitals in the US dont even do it anymore (im in canada). Can you guys tell me what your docs have told you about muscle strength after this surgery. Are any of you having back issues (not range of motion problems). Did you guys in the states get other consults that told you not to get this surgery? I am terrified that i will survive cancer but be left with debilitating lower back pain
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I don't have debilitating back pain...now I could use a really good massage right now. I do get sore in the back easier but it's the opposite side from the LD. I think if you read back on this thread you will see that this option is frequently used with much success here in the US.
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Thanks hw, hope your holidays are wonderful !!
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Marcie - I am very happy with my lat flap results. I was back to work 10 days after I got out of the hospital. Yes, I did go to work with the drains but that was no problem. I just pinned them to the inside of my blouse. I found some oversized ones that hid them nicely.
rozem - I had this surgery done in April 2012 and never experienced any kind of back pains. When I first met with my PS he said this surgery was the best option for me. I did have radiation and he said my skin held up very well. No issues at all. You can't believe half of what you read on the internet. It can be misleading and tend to freak you out. My best advice to you is have a good discussion with your plastic surgeon. If you still are not comfortable, seek out a second opinion. It does not hurt to do this. In fact, if those surgeons are saying the same thing, that should ease your mind and give you the confidence to proceed. Remember each one of us are different in how we will respond to this surgery and how well we heal.
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Very good advice Jo. Getting info directly from the doctors will help make a decision. Sure we share our stories here and everyone provides good info, but we are all different. I haven't had any back issues since my UMX lat last October. Based on prior surgeries my PS thought this was the best option for me. I am very happy with my results.
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Rozem: I was very leary of this surgery and only resorted to it because my left side(which had radiation from 2007 BC) implant failed after trying recon with implant alone. I am a personal trainer/group X instructor and I work out...a lot...because I love to! Honestly, I think I have experienced more grieving over the loss of my lat than my breasts! Anyway, I share that as background... I had my lat surgery Nov 2, was in hospital for 3 days and off pain meds when I went home. I was cleared to work out ( though I walked every day in the interim) at 4 weeks out. I have been working out and have been doing well (rom). I have tried lat pull downs at a greatly reduced weight than I am used to but so far so good. The only exersize so far that has made me sore has been planks...but I have continued to do them and the soreness is getting less and less.
Depending on your fitness level before the surgery, I do believe you can overcome the lower back issues with a good physical therapy program...it does take time. I understand as even today in the gym, I got a little teary eyed because of my limitations as compared to before the surgery. Hang in there!!0 -
I've got a question: has anyone experienced a rash on the foob and the skin above where they took the lat muscle ( I still have my expander in)? I experienced a rash before but it seems like it is getting worse this time around. I have been putting baby oil/bio oil on all over the skin as it seems like it is always pretty dry...drier than the skin on the rest of my body??
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Rozem,
I was concerned with moving a muscle in the back as well. My PS explained to me that this is just one of many muscles in the back and the body normally does a fantastic job of compensating for the move. I had it done on Sept 7th. I have been experiencing sharp, momentary pulling pains. They are normally pretty bearable. When it gets too uncomfortable, I pop a couple of ibuprofen. My PS said it was scar tissue. Again, scar tissue is one of those things that differs from person to person. I do find myself being more attententive to my posture since the surgery. If you are still really concerned, a physical therapist would probably do well for you.0 -
phew! you ladies freakin rock!
i have my lat dorsi surgery scheduled for 1/3.....less than a week away. i remember 9 months ago when i had my double mast i was thinking how long i had to wait to have my recon surgery done and it seemed like forever. the time has flown by and i'm shocked at how quickly it is upon me.
i decided to catch up in here to see how everyone's surgery was going.....give me an idea of what to expect. and of course, you ladies didn't let me down. i've learned that the first couple weeks will be the hardest (maybe slightly hard....maybe really hard) but after that it will start getting better. i'm not looking forward to the surgery at all....nor am i entertaining the thought of the drains.....but it is what it is and i look at all you ladies and see that i will get through it....no matter what. you are certainly an inspiration.....thank you!
i will need you ladies (because you've all been there, done that) to bounce thoughts and my experience off of once my surgery is done......i hope you don't mind me picking your brains, and/or, listening to my whining.
i've also noted i need big shirts when i get home......sports bras......and patience. anything else?
my hair has finally grown a few inches from chemo (ending mid feb '12) so i was thinking that i'm sure it's going to be hilarious looking for the first week after surgery.......so i have put together a few headbands because i know i will not be fixing my hair for a little while. lol. it just got long enough to use a curling iron and now i have to wait again. lol.
anything else i need to know? besides the drains will suck. they did for me too when i had my first surgery.....so i will suck it up buttercup this time too. i'm hoping to be like the one gal who was able to remove them all after a week! although i anticipate thats not going to be my luck! lol!
thank you again for posting your stories and i pray you all continue to heal successfully.
much love.
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dnadebbs:
eat as healthy as you can, drink lots of water. Take pain medication round the clock the first week or two at least, and muscle relaxants. Staying ahead of the pain actually has the medication working better. Listen to your PS on what you can't do for the 4 - 6 weeks following surgery. I wasn't to drive for 4 weeks, which I didn't like, nor could lift anything heavier than 5 pounds.
At 6 weeks, start with a PT that knows how to work with someone who has had lat surgery and get you flexibility back; 12 weeks, if ok with PS, start with PT some easy gentle strengthening exercises. Follow advice of PS and PT.
It takes time, patience and a few tears. All of this can be very frustrating but worth it. Your breasts and back will be swollen, and maybe even in a month your breasts may not look even. It takes up to 3 months for all the swelling to subside, so don't panic.
Good luck!
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justagirl........thank you so much! i've been reading through everything you've written as well as a few of the others who have recently gone through it. the timeline afterwards helps alot so i don't get too frustrated knowing that what i'm going thru is normal and then anxiously awaiting for time to pass as i heal.
i won't be shy about taking pain medication.......and i'm ok with sleeping the first couple weeks straight....lol! i just want to heal and make time fly by as easily as i can.
i have a PT already set up that is awesome and she's excited to get started on me.......she is also my lymphedema PT and works primarily on BC patients......before and after recon......so i'm good to go there.
thank you again for your help! it truly means the world to me.
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dnadebbs - Just remember that we are all different in our recoveries. I thought mine was kinda of easy. In fact, the hardest part was the drains. I had two and the last one came out at 5 1/2 weeks. Guess that was the trade off for me. I did not need any pain meds in the hospital or at home. I had my first followup with my PS 10 days after surgery and I drove myself!!! After 4 weeks, I started doing gentle stretching exercises and have just about full range of motion. Oh! BTW! The day after my first followup, I was back to work, drains and all. I only work 4 hours in the summer months and could basically sit at my desk and work on my computer. Thought that was better than staying home and being bored. I didn't ask my PS if I could go back to work, I know my body and thought I could do it. I also knew I could go home if I needed to. I manage a mobile home/resort and live on the property so I walked to my office. Best of luck to you and keep up posted.
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Dnadebbs: like Jo said, there are so many different experiences, but like you, I read through everyone's post and found it helpful. I did get both of my drains out within the first week (though i had to get it aspirated a couple of times), but i guess that was my payback blessing b/c when i had my dbx i had them in for 8 weeks:-(!! I am about 2 months out now, I had mine Nov 2, and I am doing very well. I have been working out for 4 weeks, though I was walking every day as soon as I got home (my hospital stay was two nights).
It sounds like you have a good perspective, positive and patient, which goes a long way in your recovery! I would emphasize what justagirl shared: drink a lot of water and lots of fruit and veggies and good protein. Praying for the best of recoveries for you...keep us posted!0 -
i repeat......you ladies rock. thank you for offering everything you can to help make it easier for me. i'm 48.....so i worry sometimes at how my healing will go but it wasn't so awful after the dbl mast earlier this year......but still....every bit of advice helps.
i will keep in touch and continue reading what everyone else offers and pray that God continues to bless us all through this!
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Dnadebbs,
The best advice my PS gave me was load up on protein. He said he had one patient that came to his office after a month and her scars weren't healing and were starting to open back up as the internal stiches were melting. He took her back into surgery and found everything still not healed. Come to find out, she was a vegetarian who did not properly consume enough protein for proper healing. For the first week, I had no appetite...I nibbled at food at best, but whatever I nibbled at was high in protein and I drank plenty of protein shakes (Special K Milk Chocolate). Needless to say my PS LOVES the progress of my scars.0 -
dont' need to tell me twice! consider it done! thank you for the heads up,.....i didn't know protein was so important in your healing process.
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dnabebbs: so you are 48. I was 58. It's the condition your body is in before surgery and the state of your mind going into all of this. As mentioned before, eat your protein which helps healing, low sugar carbs, veggies, lots of water. You are by no means 'old'. Don't let your age scare you.
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thank you justagirl......i just dont' know what to expect so i try to consider everything. you are absolutely fabulous......thank you for helping to put things in perspective!
i won't worry so much.....it is what it is! 0 -
I was 48 when cancer came calling and just turned 49 in August, had 1st phase of delayed reconstruction in November. It's all about the state of mind!
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I'm 48 too! 47 during the surgeries last year. You will be fine. I agree that the attitude is more than half the battle. My advice, other than what has already been mentioned, is sort of vain. But get some button up shirts that you won't ever wear again after this. Jammie tops or dress shirts. Things you won't care if they get ruined by safety pins for drains. I look at mine now and can't even think of wearing my shirts from the "shitty year". :-)
Oh, and I also found it way more confortable to sleep sitting in a reclyner or on the couch. Even with pillows it was too difficult to get up from the bed. Plus, I didn't sleep all night so I was able to let my husband get the rest he needed to deal with entertaining me when I was bored.
Also, my drains were in forever (almost 2 months)! That was the worst part. Back incision didn't bother me.
Good luck!
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