Latissimus Dorsi Breast Reconstruction
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anyone had implants post radiation?
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Deb, I just had exchange surgery where I had tissue expanders removed and implants put in. I had 33 rounds of radiation in fall of 2011. The radiated skin is very red, not pretty to look at. But my breasts are pretty close in symmetry with the ld flap on the left. Mastectomy both sides.
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deb333: i had implants done on 1/3 and had previous radiation. it failed. i had to have them removed on 1/30 due to bilateral infections. let me know if you have any questions regarding that. i should not have had that procedure done with previous radiation but i trusted my PS.
loribach....i am a plus size girl....very tall and bigger.....i would be considered "obese" but i'm very shapely so i carry my weight well. my first recon attempt failed because i trusted the PS that was recommended to me. this time i'm making an informative decision. i agree that you should go to whippetmom.....she is amazing. after sharing all my details with her she indicated she would have me consider the LD flap only because i'm bigger......and my DIEP surgeon indicated that the fat that he could use for a bilateral DIEP would only come out to probably be a good size B......maaaayyyyyyyyyyybe a small C.......and again i say.......MAYYYYYYYYYYYYBE! as much as i would love to have the DIEP.....i don't want to go thru a 2nd surgery and all that a DIEP involves to be a size B. no disrespect. i'm 5'10 and samoan.....amazon woman here! a B would be lost on me.
note that being as big as i am and the amount of fat i have.....my PS told me that i would be a good candidate.....DIEP and LD Flap were the two he recommended for me i don't know all your details....but definitely get some opinions and do some research.....don't do anything until you have considered everything. i see on here some women did the LD flap and would not do it again......just remember that not all surgeries work for all women. there are a lot of women who love their LD flap. same with the DIEP. so consider your own situation and do what's best for you. it may also depend on your surgeon......my new surgeon has great credentials and is highly recommended. so i feel far more secure in what he feels is best for me and his success rate.good luck hun! keep us posted!
ally
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deb333 - my original intent for reconstruction was just an implant. (An expander was put in during the MX) But then after I end up having to have radiation, my PS told me I had a 75% chance of failure with just an implant alone. So I ended up having the Lat Flap to bring in more blood supply, plus an implant. After almost 3 years of issues, I had the implant taken out this January. I would tend to advise anyone to be very careful in getting implants in a radiated breast. Many women seem to have very good luck with a LF & implants. But I don't think it would be worth the risk to do just implants alone. I wish now I had done the DIEP with NO implants - all my own tissue. But there's no guarantees no matter what you try! (Hate to be a "downer" - just trying to keep it real!)
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deb333: i had just the implants only put in by a dr who i was recommended to me by my BS......i found out after a failed bilateral TE that women who have had radiation should not have this surgery. there are other (DIEP/LD Flap, etc) surgeries that are better fitted. now i have to go thru the entire process again. i was devastated to be set back. i was disappointed that my PS didn't adhere to this. i would never suggest this procedure to anyone who has had radiation. my current PS is amazing and is willing to do the DIEP (if i'm a good candidate) or LD flap on me which are better for my situation. let me know if you have any other questions. happy to help.
ally
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I was really interested in the DIEP but right off the bat the PS said there wasn't enough of me to do it. The best fit for my radiated breast and delayed reconstruction has been the Lat Flap. I waited a full year before I got reconstruction done and I'm glad I did. My poor radiated breast has been red again, just like from radiation. It is very hard on it...also the radiated breast determines how large you can go...it can only handle so much fill with the TE's. My PS said I was done because the skin was very shiny and it could not take any more. I am bigger and perkier than what I used to be so I am happy. Yes the lat flap side feels weird and I have no feeling on that side...but hey...I survived breast cancer and have boobs again..I'm happy. I don't sweat the small stuff.
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Ally,
I too am a large framed person, and I had a bilateral lat flap reconstruction with no problems. I couldn't do the diep flap because I had an appendectomy in 1996 and the scarring interrupted the blood flow. The recovery wasn't too bad either.
Good luck!
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cgesq: thanks for your input! that is encouraging! my new PS is confident that the LD flap will work great and his confidence makes me feel so much better as well.
hwhranch: i recognize your login.......i'm not sure which forum it was in....probably this one but again, thank you for your encouraging words...and congrats on your surgery! i'm not sure i will be a candidate for DIEP either (definitely for the amount of tummy fat i have to offer! lol!).....but my PS did a doppler in the office of my tummy and indicated that my vessels were very small....you could barely hear the blood pumping on the doppler and he had it turned way up! lol. i have had a c-section, gall bladder and cyst removed in my 48 years so i wouldn't be surprised if i'm not a candidate.....(more testing to come if thats the route i choose) but no worries. i'm just as happy with the LD flap and to be moving towards a whole new "rack"!
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hwhranch - I hear ya! Survived BC and still have "boobs" is how I feel too. Lucky as hell comes to mind too. I didn't tell anyone at my work other than boss and one coworker that I was having UMX with LD immediate implant. Unless you see me naked you can't tell the difference between the two. I'm still a 36 full C small D in size.
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jwilco...did you find a bra that is comfortable on the lat flap site? I can see a bra hitting right where the muscle leaves my back and comes around to front. Anyway I am headed to Victorias Secret this weekend to get a new fit because I feel like I am bigger than I used to be. I need to pull out an old bra and give it a test run, lol.
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hwhranch - I still have tons of VS bras, but unless they were unlined they don't really fit well anymore. I think with time those with some padding (slight padding to prevent nipple show, not the push up kind) anyway, I think those tend to take on your shape so I've gotten some new ones. I went with the Body cotton full coverage. I thought about going to Nordstrom for a fitting but haven't gotten the courage yet. Oh, and I bought a Geni bra, which is comfy too. Used my coupon at Bed Bath & Beyond for that one. But the straps are wide on the Geni bra and the "modesty pads" made me look like Nurse Diesel. LOL
I haven't had a problem with where the bra sits on the lat side, maybe I don't really have much feeling there? Sometimes it feels different though.
Forgot to mention - there is a thread on the site called BRAS 101 and those ladies really know their bras.
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Thanks J. I did go home last night and tried on one of my old B cup bras...it fit but I'm not sure it fits right because I can't really feel how the girls set in the cups, lol. It is very frustrating because I have this bulge over the side of the bra strap right under my arm and I just think it's because of my size and shape...I have a lat flap scar on the very outer edge of my back and you can feel where the muscle leaves my back and goes forward. The bra sets right below this and makes a pooch. I do need to take back off the 8 lbs or so and I know that might help.
But...another question for those that are past their lat flap surgery. I am 4 1/2 months past my surgery and just had my Exchange surgery on March 1st. I just don't know what to expect from this muscle that used to be on my back. When I need to use my left arm to say...pull myself up on something...the strength is not where I need it to be. It just pulls my boob and feels very awkward. I guess this is something I never fully discussed with my PS and just wondered what you gals have figured out as how to deal with a muscle that still responds but isn't in the right place!!!
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I have good luck with multiway bras. They tend to have a wider wing/side panel & that really helps to keep the lat muscle flat & smooth. I sleep in a VS Body by Victoria Multiway. I wear an underwire 24/7. I prefer molded cup underwire bras. They seem to fit better.
I am a bit farther out that you, hwhranch (7/11 & 8/11 for my lat flaps) & I don't have the strength issues, but my left side will distort only if I am really torquing my arm/s to try & open or twist something.
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That's whay happens to me...opening a jar is a very strange feeling. Thanks for the tip on the multi-way, I just looked at them and they do have that wider side panel I am looking for. Just need to get one fitted...Thanks DLL66!!!
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Good luck, hwhranch! Hope you find something that works for you.
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I know I have said this over and over.....for those going LD flap route, make sure your PS has done several hundred. My particular PS had done over 2,000. I am very happy with my decision. My breasts are symmetrical and I have had no back issues. My incision is short and slanted and is covered by my bra. He also did a prophylactic nipple sparing mastectomy on the right. I know a lot of women think the LD flap is mainly to have the muscle to provide fullness in place of where the breast tissue was, but in all reality, it is the skin that is needed and in order for the skin to remain viable it has to be connected to the LD muscle which provides the blood supply. The LD muscle is used to fill in when there is a defect from a lumpectomy. In my case. I had a wound vac and had no extra skin there to place a tissue explander under. Radiation causes the skin to lose its elasticity, so another reason to need a LD flap. Same for any procedue, research, research, research and if you get bad vibes from one doctor, get another opinion. One PS I saw told me he would try a TE and if that didn't work he could take "some stuff" off my back later. I got out of there as fast as I could. It didn't take a rocket scientist to see there was no skin to be stretched what so ever. He never even looked at my other breast.
Best of luck to those embarking upon breast reconstruction.
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hwranch - that weird distortion/pulling may be from the pec muscle not the lat -my other side without the lat does that when you flex/move your pec muscle in a weird way
question - for those who have had few problems with this surgery did you have that burning sensation between your shoulder blades? its there and kinda runs up my neck - its a burning/ache feeling. Please tell me that goes away. My lower back is FINALLY starting to feel better and now I'm dealing with this. Surprisingly with all my pain/discomfort issues i do not feel any real limitations - i can do almost all my yoga poses, lift, etc like before - most of the animation/weirdness for me comes from the pecs
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nurseonda10: thank you for your advice! its a great confirmation! i am working towards that surgery due to a failed TE only surgery.
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I have been very happy with my Lat Flap....the modified radical mastectomy and radiation left me with some kind of flap as my only option. Again, the Lat Flap is what worked best for me. I love my surgeon and I am not having any problems...just trying to get used to the "new" me. Not everyone will have the exact same procedure as all body types are different and all mastectomies are different.
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Hi ladies. Has anyone done self examination after bilateral lat dorsi reconstruction. I have found a lump on my left side. It is approx 2cm. My gp has referred me for an urgent breast clinic appt. As you can imagine I am shitting myself and really hoping that it is just scar tissue/ fat necrosis. Has anyone else had something similar!
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Lydia, I can see the urgency of having it checked out. I can also very easily see it being scar tissue or just an issue with the muscle itself? That's my opinion and I'm going to stick to in until you tell me they found otherwise!!!
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I am trying to stay calm but very difficult! I keep telling myself that it will be scar tissue. I just hope they hurry up with my appt. trying not to think negatively! Thanks for your positive vibes x
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lydiaj96 - shortly after my lat UMX I felt a small hard bump under my skin on that side. It felt exactly like the original small hard lump, like a little piece of uncooked rice or bb. I too felt like crapping my pants and had a mild panic attack at the BS office. She immediately sent me next door to the women's center for an ultrasound. It was fat necrosis. I will pray it's the same for you.
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lydia - praying its just fat necrosis - did you have a fat graft transfer done at any point??? boy this roller coaster never ends, please let us know what they say
hugs and good thoughts your way
can someone answer my question about the upper back burn/ache - did you have it, did it go away
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Rozem - I had that burn/ache for awhile...almost like my upper back was tired and strained. I'm coming up on my 1 yr anniversary since surgery and I very rarely get it anymore. The more I exercise (just walking and light weights) the better it seems to get. I also try hard to watch my posture as I notice that it's worse when I'm slouching. But, it continues to get better and better...so much so that I forgot to think about it until you mentioned it! Hope you feel better soon.
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No I didn't have a fat transfer just the flap. Am hoping to hear about appt today. Haven't told my kids so trying to stay normal
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It is very hard to do breast exams on a LD reconstructed breast, as there is so much scar tissue and fat necrosis. I know my BS said that I should worry only if there is something right under the skin, as there is no more breast tissue in that area and anything that would show would only show in the margins. He sad that it would look like a grain of rice or pea caught right under the skin. I know that at least for me, there was only about 3 mm of skin thickness on my BC breast and around 4 mm of skin thickness on my non-BC breast that can be felt.
There are only a couple of documented cases of recurrences in the flap itself and I think they were both TRAM flaps.
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Happy with Lat Flap, but still feel a pull when opening jars or reachig up. Not worrying or bothersome, just a bit annoying that I need help to sometimes do basic things. As for bra sizing - I suggest heading to a store that does bra sizing. Nothing against VS, but the mostly young girls there don't know how to do it. And to get a good fit, the sizer needs to be with you (thus see you). It can be a bit much for both parties, so make sure you have someone who is comfortable with reconstruction. One month post UMX I went to a lingerie shop (not the tacky kind, but a discrete shop that specilized in UMX and MX bras. WONDERFUL!) After the 1st revision so before I had a nipple, I went somewhere else and the sizer got uncomfortable which made me more uncomfortable; she left and I left with no bras. Eventually I got up the courage to try again and headed to Nordstroms (the first shop was rather expensive and rather far). I told the sizer up front about recon and she was not at all (outwardly) bothered. I left with two beautiful bras that fit perfectly; it took a while and we tired various sizes and styles looking for the one that provided the fullness necessary 'hold in the lat side'. Again, I can not stress enough to get professionally sized by an experienced sizer. Our breast shapes have changed. I went from a 34/36 C to a 38 D (but maybe like a huge percentage of women I was wearing the wrong size). After sizing I then went to Target and VS and bought the correct size/shape. World of difference.
Teresa
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fitzdc: Thanks so much for the info. Also, it is encouraging to hear from those who are happy with the LD flap and I am so sorry for those who are having ongoing problems. I am scheduled for April 2 and I am beyond ready. I was scheduled Feb. 7 but came down with a nasty cold. I was then rescheduled for March 7 and my dear father-in-law died that week and his funeral was on March 7. Needless to say, I was getting rather bummed out. My radiologist likes his patients to wait a year after finishing RADS before recon...I was going to be a rebel and wait 10 months...but it looks like he gets his way after all.
Blessings to all
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thanks jen - that is encouraging ! you ladies are awesome
sunny - good luck with your surgery
lydia - praying for a positive outcome for you!
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