Latissimus Dorsi Breast Reconstruction
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Hi! Sorry if this question has been asked before. I'm about ten days out from the lat dorsi flap surgery. I had two failed attempts with an implant, the scar on the radiated side kept breaking open. Here's my question, has anyone had painful muscle cramps/spasms after this surgery? I haven't had any pain besides this which kind of hit out of the blue. The cramping is under my underarm, feel like it goes down my arm and in my back. I'm paranoid, just want to know if anyone else has experienced this. Thanks!
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vshow........Hi, yes i also had this sensation...it is very early days for you, it does get easier as time goes on, i promise you have had surgery it will take time for everything to settle down. x
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yes i did...it does settle down, what is interesting is i had it on both the lat and prophy side (no lat) so i am not sure if for me it was just the pecs spasing - the cramping down your back is normal too - i don't know how long it takes to settle, im about 3 months past this surgery and still feel the cramping in my back
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It takes a while for the nerves that had been cut to regenerate.
And then also you can be for the rest of your life with your back muscles spasming because they can't really take over from the missing latissimus dorsi. You will know pretty much about 6 to 8 months after the surgery.
What worries me is that you said it goes down your arm. That means that one of the arm nerves is pinched. I doubt that happened during the surgery, but what is possible is that the bulge under your arm makes your shoulder not sit right, and thus the nerve can be pinched in the shoulder; or, due to the awkward position of the shoulder/arm the cervical spine got misaligned and it pinches the nerve. I would definitely consult a doctor about that, and even ask to see a neurologist. You need to have your cervical spine, upper thoracic spine and shoulder joint checked up. Sometimes it happens that there was already a minor problem in that area, and the LD surgery aggravates it.
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vshowe - yeah, it's pretty early for you. Cutting all those nerves can cause quite a bit of spasming. I don't know why they don't explain all of those things before and after surgery! But don't let spasming go on long term. Some doctors routinely cut the Thoracodorsal nerve at the time of Lat Flap surgery, others don't. Mine didn't. (Might be worth it to find out what your doctor does) My nerve started to spasm so constantly, my breast would jump clear up to my armpit. It distorted the reconstructed breast pretty bad, and pulled my shoulders all out of whack. I ended up having Botox injections in the breast (Botox for the Boob!) and armpit to temporarily paralyze the spasming. It worked very well. In January I had the implant removed, the T nerve cut, and scar tissue removed. Yep - deconstruction! What a bummer! But I'm on the "freak" end of the scale when it came to issues, though. My hope is to do some fatgrafting to fill the crater left by my implant. I learned that my body definitely has a fit over foreign objects in (implant, port), and even on (surgical glue, tape) my body! Good luck, and hang in there. You'll probably do great!
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vshowe - I just wanted to respond to your question and tell you that I had massage therapy done just as soon as my incision healed up and it helped me so very much with my mobility, I never suffered from any cramping or arm pain. I also did specific yoga stretches that I continue to use to this day (I had BC in 2004) and between the yoga and the massage therapy I often forget that I had any kind of reconstruction surgery. You will need to be a little more proactive, but there's no reason to believe that you will suffer forever more with this. I am also a massage therapist and I shot a video recently to illustrate which massage technique helped the most with scarring and adhesions so just private message me if you'd like the link to the video. Hope this helps! xox
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Hello Linda,
I am 53 years old. I am thinking about having the reconstruction /LD flap. My last radation was last July 19th. I spoke with a plastic surgeon a week ago. He said he could do the surgery, yet did I want to put myself thru this with having stage 4 breast cancer. That it would take about a year to get through it. I also have to keep my port in place. I finished chemo in July of last year yet now having to take two kinds of pills in hope that it will stop the cancer from spreading. I have talked myself in and out of this. I just found out today about this discussion group. Any information or thoughts will be of great help in making this decision. Thanks, Marla
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hi Maria
i just had this surgery done about 3 months ago. It is a long. painful difficult recovery for some of us (me). Others have not had these issues but we never know which side we will fall on. Honestly, I would want to reserve all my strength and energy into dealing with the bc instead of doing this (or any) surgery. Surgery/trauma of any kind lowers your immune system plus there is always risks of complications such as seromas and infection (seromas/swelling are common with this surgery) Sometimes they make you stop your meds for surgery (i had to stop hormone therapy 2 wks before and not start until 1 week after) so this is an issue aswell since it looks like you are on hormone therapy or some other sort of oral therapy to keep your cancer in check. I hope these thoughts help but at the end of the day its a very personal decision
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Hi MzMaria - I can definitely understand your concerns about wanting to have your figure back and some normality, but my opinion (for what THAT'S worth!) is similar to rozem - I believe I would also want to reserve all my strength and energy for fighting the BC. Do you know about meditation? I've got a guided meditation on my website that's completely free for you to download. I have known a couple of people who brought themselves back from "the brink" with the use of meditation. I used it myself when I was going through breast cancer and found it to be absolutely vital to my well-being, and ability to recover from it quickly. If you'd like the link to my download, send me a private message and I'll get it to you. You can beat this. Sending hugs your way.
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Oh, Marla, definitely not! You have to keep all your fighting reserves to fight the BC, not recovering from such an extremely invasive surgery!
Can't you have like TEs +implants? your chest skin wouldn't be able to go through that due to radiation?
If you want to have a flap reconstruction, go for the DIEP. The DIEP does not use any muscle and the recovery is way easier than the LD one,
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day...DIEP surgery is not an easy recovery either, I have spoken to women about this and it is months and months aswell. Plus you are under a very long time which means a lot of anesthesic to recover from.
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Thank you for your thoughts.
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I will have to check into the other types of reconstruction. The doctor just said that the LD flap is what I would have to do because of the radation I had. Thank you for your information.
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Thanks everyone for your responses! I feel better knowing that the pain is normal. Other than that little issue, it's been pretty painless. The itching is my worst complaint. I think I had a reaction to the tape; red and bumpy on my skin around the scar. My follow up is on Wed, hopefully the drains will be pulled.
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I remember well that tape. It was so scratchy. And the incesion really started to itch. Buy a cheap back scratcher....it did wonders (after the staples were out of course). Good luck getting the drains out - I had miney for 7 weeks... a long 7 weeks.
And I guess I am one of the lucky ones. Rather quick recovery, not a lot of pain, full ROM. I get that there are many women who suffer after this surgery (just as some women have issues with DIEP, TRAM, implants, etc.) however there are women who don't.
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MzMarla, I am another that does not have the pain or ROM issues with my lat flaps. I had mine done separately & was able to return to my full time job within 2 weeks each time. I did chemo, BMX, rads & then delayed reconstruction.
I personally think that you should do what makes you happy & what will give you the best quality of life. If you feel like reconstruction is doable & your doctors support you, then I think you should go for it if you really want to. Do understand that it could take at least 2 surgeries & possibly more.
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I had 5 revision surgeries after the first one and looking at at least one more.
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Marla - like many women say, doctors seem to encourage those reconstruction methods that they know how to do. For radiated women, DIEP and GAP surgeries are also options if the woman has enough "spare" tissue. The down side to the Lat Flap is for most women, it also involves an implant. Thus the risk of capsular contracture and other issues from a foreign object. Yes, the Lat Flap bringing more blood supply improves the chances of success, but there's still some risk. If I had it to do over, I would have definitely gone for the DIEP - my body hated the implant! So I finally had it removed. Now my right side is an ugly mess, but I had hit the point where wanting the pain to go away was priority #1. There are fewer doctors who are trained in the microsurgery required for the DIEP, so you'd want to find one who has lots of experience in that. Get lots of opinions on your options, and don't rush into anything!
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I agree, do research and find the best reconstruction for your situation. I had a prior lower body lift before BC. So as much as my PS loved the DIEP, he said I wasn't a candidate due to this prior surgery. My choices also depended on if I was getting radiation or not. I think my PS was concerned with the capsular contraction that can occur after radiation and the way it can cause your skin to change so much. Thank the Lord I didn't have to do radiation. I also had a lift and implants prior to BC, so I had a lot of variations to my situation. He recommended the LAT with direct to implant. He went over it with me and my husband for about an hour. We decided it was the best option for me. I think it's rather amazing the results. Is it a perfect match? If I have on clothes? You can't tell. In fact I only told two people at my work. Is it a perfect match naked? LOL...Well, that depends on what you call "perfect". They are very similar, but nothing will be as good as the real thing. But they are a fairly good match.
It's a very stressful time. First you get dealt with the big BC and that and then you have to make this decision about how to reconstruct what the friggin disease steals from you.
I hope you have the time to be able to make a decision you can be happy with, remember that's the key. That you are happy with the procedure that you have.
Good luck!
p.s. I wanted to add that revisions are almost the norm with PS. At least that's been my experience. So expect that it may take more than one surgery to get things settled.
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Why 5 revisions? Does this mean 5 surgeries?
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I can not have the DIEP due to c-sections and bladder surgery. He said he would take donor skin from my back to put on the front due to the damage from the radation. The first surgery would be about 7 to 7 1/2 hours. The first surgery he would also put the expanders in. Then, I think he said in a few months after this he would start filling the expanders once a week. When this was done, back in surgery to make the exchange to implants. The last surgery would be to create the nipple and areola or just leave them "Barbie Breasts". I would like to see what the end results look like of the back. How long does it take to heal from taking skin form your back? What about the nipple reconstruction? How long does this take? I also have to leave my port in. So many thoughts and questions. I do need to visit wth another doctor just to see what is said.
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jwilco...do I understand you had the LAT without TE...Did you have a permanent implant at the time of the LAT or at a later date? I was scheduled for LAT surgery tomorrow but had to cancel due to a stinking cold. My PS says I can wait and have an implant later and skip out on the TE. I have small breast anyway so the LAT will probably come close to matching the size of my healthy breast. He said I could go bigger at a later date if I chose to.
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sunny, I had the direct implant too. what I can tell you is that it hurts. bad. But it's worth it as it skips on one surgery.
Marla, they take and "eye" or "footbal" shaped piece of skin from your back from where it sits atop the LD muscle. My bilateral MX + immediate LD recon was a total of 10 1/2 hours. You are not left with part of your back with no skin - they will take from where the initial incision to remove the LD is, so the two sides will be stitched together. Due to that, you might get "dog-ears" that need revised later.
The nipple reconstruction is the easiest part. I think it took about an hour or so for me (I didn't go for skin grafts, he made them using my own breast skin) and it wasn't really painful as the top of my breast (where he created the nipple) is still mostly numb. Now, 4 1/2 months after that, the left nipple (who looked too big) is the perfect size, while the right nipple (who looked ok) barely has any projection. He said this might happen, as on the right they cut much closer to the skin during MX due to the tumor, while the left being preventive the left more skin thickness. He said he will inject some fat in the right nipple at the next revision. that would be the 7th revision.
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It has been a while since i have been on these threads. I had LD double MX in March of 2010. I regret having this reconstruction every day.
I still have a lot of back pain and not only pillows under my arms but one side is perhaps twisted or the PS took the muscle up from too high and it is too high going around under my arm- but I am in constant pain from that and am totally unable to wear any kid of bra so I'm stuck with looking uniboob like with cammisols with shelf type bras. My tops all have to be lose as it just looks so ugly. He also made them larger than I wanted and there is a dent in one side and on the other a dent near the nipple. I have no projection from the nipples and they look awful. Can you tell I'm not happy with this? The other thing is I do think there are areas that are pinched as I can't sleep on either side without pain shooting down my arms.
I think the website is a brilliant idea. As for the scars a lovely friend who happens to make natural healing cremes has a creme for scars. I have tried it now a little over a week. I can tell you that my scars even from 2010 were still very angry red - within this week they are now reddish pink in the worst areas and in others they are pale pink and disappearing. Also to those who say the back skin is dryer and feels different these cremes are very moisturizing and smell lovely. You guys know her... it is Day. I know! She can do everything! Anyway, if anyone is interested you can PM her or me if you you want to know more. Anyway, it just seemed a perfect opening to share my exerience with the creme and to share my experiences with the LD surgery.
My PS was .... well he was horrible when I went back to him with what I was feeling. Basically he said of course you have no feeling in your back I had to take the muscle that was connected to the nerves. He said he thought he caught up some fat on the one side but it is obvious that isn't true. He said he couldn't fix it with lipo as lipo isn't allowed in BC reconstruction(which of course is totally untrue) he said he could do something but none would be covered by insurance and I'd have to pay out of pocket if I wanted any revisions and it would have to be at another small hospital. Well of course I didn't do that and am still hoping to find someone to help me with all the pain issues and cosmetic ugliness. So far in Atlanta, no one is doing the LD anymore... so not sure what to do. Anyway, I wish everyone the best!
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Yes, I had the lat with no TE. Straight to implant, which was swapped out for a smaller one at my second revision surgery. I had a breast lift with implants prior to BC so I was lucky they worked to try and match my non BC side. At my second revision I had fat grafting, implant swap and other skin tightening on lat side and slight lift and implant swap on my non BC side. Third surgery was the nipple and a bit more fat grafting.
As Day said, no open wound in the back. My lat skin is a circle that is now a nipple and tattoo. The back incision is 8 inches long (hubby measured). It is now just a thin line of a scar.
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Stanzie - I am so glad the cream has wonderful effects! Hopefully within a month or at most two you will have no apparent scars, this is usually the time-frame even on old scars. Only keloid scars can take as long as 4 months - but they still go away.
And yes, your PS was LYING through his nose. My PS is trying all he can to get rid of the bulges under the arm. He did that almost completely on the left side, and will do another surgery for the right one. And guess what? Medicaid is paying. The health insurance is supposed to pay for how many revisions you need. It's up to the doctor. And the doctor complies, if not, you can drop a hint about something called "malpractice".
jwilco - mine was swapped with a smaller one too! I started with a 500 cc and ended with a 400 cc.
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Day - Mine are 339 on the lat side and 280 on the non BC side. I always wonder why everyone's implant sizes seem to be higher like yours. Granted my 280 side is high profilel but he used the original pocke so it's under breast tissue. The lat side is under my breast skin and the lat muscle only.
I'm not complaining though! I still wear a D cup and feel pretty much like me.
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Well, I guess because I told him I wanted the same size (actually with the 400 cc is a tad smaller for some reason). Still a D, like you, even if you wouldn't believe when you look at them, they look like a C maybe. I asked and he said he exchanged them as my skin didn't seem to like the expansion, it wasn't only the implants but also the swelling from surgery. When he did the revision and put in the smaller implant, he took some skin off to make everything tight.
Mine are under the lat, pectoral muscle and serratus anterior. And with an Alloderm sling. They pretty much look like they did when I was 18, no complaints here about that! I only have a small divot that he needs to do more fat grafting on, and he needs to take care of that bulge under the arm and put some fat in the smaller nipple.
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Actually with as horrible of a job this surgeon did I really wouldn't trust him to do anything. I'm trying to find a surgeon closer to me but I know I'll have to go out of state. My deductible is pretty high so am trying to get that money together and hopefully the rest will be covered.
Jwilco- you said you high profile? I'm not sure what that is but whatever I have I have two ridges on my chest where you can tell the implant starts. They really are a mess. And my back scars are not only uneven- two different levels but he didn't use what I thought PS were for- you know the kind of stitches that are less noticable. Well mine are totally irregular some places really wide scars then it goes narrow then wide... very ugly and you can see them even in a bathing suit that goes straight across the back so they are very high up.
Anyway, trying to research surgeons.
Thanks Day will keep using the creme!
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Stanzie, I think you need to be looking at those New Orleans doctors that do miracles! I know that they work with people and can facilitate various financial help. At least call and talk to them.
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