Latissimus Dorsi Breast Reconstruction
Comments
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I, like jwilco, had a UMX, LD flap recon with no TE but straight to implant. I could not be more pleased. I have had no issues. I am so sorry for those who have. I refused free flap options for several reasons...one biggie was the extended surgery time. My hubby had done a great deal of research, along with myself, and he too preferred the LD flap option. When I made the decision it was based on a lot of prayer and the sense of peace that followed. Blessings to all!
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Thank you SO much, justagirl. Your advice, based on your personal experience, makes a great deal of sense. I will ask my PS to write an order for PT. I need to have patience and expect that it will take time and effort, but it will pay off in the end.
Since the implant on the opposite side also needs to be swapped out (it was removed from the market a while ago), it's a great opportunity to down-size those babies to take the pressure off the pecs and the back. Thanks for that advice, too.
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I was trying to describe how my reconstructed side feels to my hubby and it dawned on me the reality that I can't get that feeling of "freedom" that you would normally get from taking off your bra. I feel like I am still wearing a half of bra on my reconstructed side.
Lol....just an observation!
Good night my fellow BC sisters!0 -
Just wanted to weigh in on this subject. I had a bmx with lat flap reconstruction last summer, and thankfully, have had no issues. I am sorry for all of you that are having problems, but I am glad that this option was available for me. I am a large woman and so just doing implants was not an option for me. Neither was either tram or diep flap, because I had had 2 c-sections and an appendectomy so the blood flow in my stomach area had been "rewired" and would not have worked.
Whereas my surgery was long (10 hours) and I had 8 drains, once my initial healing was complete, I have been fine. During the surgery, my PS inflated the TEs to a sufficient size so that I never needed any additional fills. I have not lost any range of motion nor strength in my arms. I reguarly go to the gym and have no pain problems. I did have numbness in my lower back from the nerves having been cut, but they seem to be regenerating. My TEs were switched out for implants in Feb, and I am very grateful that my body has adjusted well to these procedures.
As others have noted, nothing about this bc "journey" is easy or fun. All types of surgeries have plusses and minuses. If I had to do it over again, I would definately opt for this type of reconstruction.
Best of luck to all!
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cgseq-I too am a large woman with previous abd surgeries so the option for LD was because of the size of implants and need for more support than the pecs and skin. I haven't heard from many who were given this option for this reason. With the population increasing in size, obesity on the rise, these women need viable options available when considering reconstruction. DIEP, TRAM, etc are options for those who can do it but not always available for different reasons to the obese or large woman. Glad to hear you are doing so well after a year. I am now 13 weeks out and now awaiting exchange to silicone. Have a total of 800cc (finished Monday the last fill). Can't wait to get this done as it is really crampy, talk about the "iron bra" feeling! But I look good in my clothes and with the weight loss the size is about right. Thanks for your experience hope to feel as good as you in a few more months!
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Apparently ps is not recommending doing the LD on the non- radiated side. Wants to do the other side once I heal from the ld surgery. Ready to get this over with. Can't sleep too worried.
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Kc2009: Seems like here women have a double mastectomy with one side just being a straight forward mastectomy with a permanent implant or one to fill if the pec muscle and skin has to be stretched, and the LD flap on the radiated side.
You do not want double LD flaps if you can help it. Losing one LD muscle is enough. I get pissed off enough with one LD muscle gone due to the lack of arm and back strength I have and my mild scoliosis tries to worsen so I do stretching exercises daily or I start to have more lower back pain.
With the loss of the LD muscle you will have to watch your posture to extend your chest out, and your shoulders back and downward. It's so easy to hunch forward like a curled postion and this is not good for your lungs, back or your posture.
I would ask your Dr why due two surgeries separately and have you put under anesthesia twice rather than do it all at once.
My PS said she would have an assistant. The breast surgeon made the incision on the non LD side and did the mastectomy and then the PS did her thing and put the permanent implant in (I went small to lessen the stress on the pec and LD muscle and skin) and sutured me up. Then the PS made the incision on the radiated side so the breast surgeon could go in and get the breast tissue. Then the PS made the incision to cut away the LD muscle from along my back, made some incisions to tunnel the muscle under my arm, fashioned it into a sling for my implant, put the implant in and attached part of the cut LD muscle end to the front of my boob (football shaped). I had 6 drains, a 71/2 hours surgery and no complications.
A year later and you couldn't even see my scars unless the light was perfect and you were looking for them.
This way you will get it all over with at once. Re-cooperate once and then do PT for flexibility and six weeks later PT for strengthening. Otherwise you will have to do all the PT twice!
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I have almost completed my reconstruction surgery now after a having a Laiissimus Dorsi Flap operation,and implant. I find that my breast jerks about when I move my arm, the surgeon says he can cut the muscle when he does the next stage of reconstruction, but it could cause problems, so I am not sure what I should do. I have searched the Internet to find out problems that could affect me but cannot find any Info at all. Can anyone advise me, it is now 9 month since my Lat Flap operation and I am doing quite good now so do not want to undo any thing by making a wrong decision. Maur.
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maur
i had the nerve cut (its the nerve they cut not the muscle) didnt make anything worse and the pulling/jerking did get better for me
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Maur - the jerking of the muscle should lessen with time. Mine did and now 2 1/2 years later it still sometimes does it 'circus' act but mainly when I'm tired. Blood flow is better if muscle isn't cut. But usually they only cut the nerve but mine is intact and it's the nerve that makes the muscle react. Am happy to hear you are doing 'quite good'. Do lots of research before just going along with something your PS says....
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My PS left my thoradocorsal nerves intact.
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Rozem is just speaking her truth ansd it happens to be the truth of many of us, no not all..but saying that God/faith is missing from her heart is a terrible thing. Breast cancer is a very difficult and different experience for us all but what sometimes bothers me is we have to be so rosey and postitive about it all. I totally believe in the positive mind set, humor,love laughter, faith etc, but have never been able to talk about this and go to a group and scream.."THIS SUCKS!!!! I wanna break some dishes i wanna rail at my body for betraying me i wanna scream at someone something..WHY!!!????' we all want to be postitive and show family and friends we are strong and we will make it. I used to have momentary 'freeze' atacks when I would be walking from one room to another and just be stopped in my tracks with shock and fear..Id breathe and then move on but it was clear my body was saying theres more to this and there is little oppportunity to share it. I am grateful to find this site and blog..I have been living w issues for 18 yrs, one of the unlucky, never knowing I was not the only one. NEVER for 18 YRS!!! I now have spasms (poss shingles?) and they are interfering w my redo surgery..to remove the implant, and reduce the good side..I am ready for it but afraid, and hope all else subsides before the date..please allow the so called 'negative' to be here, start a new thread if its too much but it needs to be said, and we DONT need to be judged..its been a very long, painful road for some of us..
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sorry..a bit late getting back on here w that last post..
anyway, agree w justagirl, PS seem to think we want larger, mine said 18 yrs ago he wanted to up mine 20cc so Id have better cleavage..a word i had NEVER used..and got a staph infec after that and you all can read the rest somewhere here..so..IMHO I am an OTA and agree, tho an option, any logic of 'lat flap' totally escapes me..now..back muscle to chest??!!!
then? I wanted to be perfect me again and didnt ask enough questions..ASK QuESTIONS!!
I just chked w my insurance about getting PT after redo..called the doc to tell him, got a message back that he says 'he wont sign for it because you wont need it '..WHAT????!!! wont sign for skilled nursing either..oh well, he just needs to be a good surgeon, Ill go to my primary for PT..am pretty disgusted here in FL w recent med care..poorly done ekg led to cardiol appt (heart is fine), misread xray said I have a comp frx of spine..MRI just proved NOT..just ridiculous, take me back to MA..Brigham and Womens..after all this maybe I have Shingles but no one has suggested it..
Ive been a mess so..hope that 7/15 surgery is my lucky day!!! still processing reemerging anger after all these yrs..
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Where in Fl are you, msdebbie?
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im in Melbourne but had all done 18 yrs ago in MA..the best IMHO ;>)
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Melbourne is very pretty! (I'm over in the Tampa Bay area.) Good luck with your upcoming surgery.
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Ok, I will weigh in for a positive experience, for the most part. I had shingles before my surgery so had pain from that and then had a horrible reaction to something and my back broke out in pustules, so I was in a lot of pain. After all that nonsense went away, I was pestered with drains for about 5-6 weeks, but after that everything was fine. My surgery was in November, left side only with a TE. I had my exchange surgery in March and am getting my nipples on July 2nd yay!! I had to go LD, because I had a tram for my right side last January and of course that is a one shot deal. I would say I have all my strength back and am able to do anything I want without pain. I love the results. Originally, my PS matched my right breast to my natural left breast, but after the second mastectomy he matched the left to the reconstructed right. He did an absolutely great job.
I'm sorry others have had problems, but everyone's experience is at least a little different. If I had known last January I would be having a second mastectomy the same year, I probably would have done LD on both sides. I would not have been able to do a tram on both, because only one side of my abdomen could be used, because I had an abdominal hysterectomy scar.
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Cat24-Wow you have had a lot of surgery! I am glad to have it done all at once. Glad you are happy with the results and have no pain! Good luck getting nipples done!
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Cat, Having had both types of reconstruction surgery, you are in a unique position to compare the 2. Which was the easier procedure to recover from and which gave you less issues, in terrms of both long and short term problems?
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Thanks for your reply It was helpful
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Thanks for your reply, I like the 'Circus' comment that is exactly what I feel like. I am going to ask for an appointment for more info before I make a decision. Thanks again for your comments.
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You're not calling me out on anything, DLL66. Do your research. Lat flaps are an old fashioned, reliable form of plastic surgery primarily u.sed by PS who don't know how too perform microsurgery. It's a type of plastic surgery that was done for salvage purpose, when nothing else could work.,It was also helpful for women who had previous lumpectomies and radiation. John Hopkins stopped performing this surgery on bc patients several years ago, so did several other top hospitals throughout the country.
No bull......Women, do your homework. You can do a lot better than an LD flap.0 -
I have to dissagree with your comment. My PS is a micro specialist. He performes many DIEP as well as LAT and other recon, not all breast related.
Please do not make people feel they are "stupid" for their decision to get this surgery. It's just a blow to someone already in turmoil from this discision in the first place.
Ladies, if you have questions of your PS, ask. If you feel you don't want to do what they recommend, get other opinions. But don't let people scare you. It's your body, your decision. Not all are the same. Not all results are the same and not all the PS specialize in the same procedures.
Yes, do your research, but don't think that this is old school.
Sorry, but I had to speak my mind on this one.
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I agree jwilco. I had my LD done for my UMX in September of last year and outside of some occasional tightness (because the muscle still thinks that its in my back) I haven't had any major issues. I have decided that if I should ever have the right Breast removed prophylactically or because the little booger decided to develop in that one, I will do another LD to build the foob.
I am truly sorry that many have had a rough time with this Surgery but the truth of the matter is....many have not.0 -
my PS also does microsurgery, in fact at this facility they stopped doing TRAM years ago and replaced it with DIEP - I wasnt a candidate due to insufficient body fat. However, i really do believe that in my case my PS just likes the LAT when he cant do DIEP for women who have had radiation. He does TUG/SGAP but really persuaded me not do go that route because of complications from the donor site (rippling etc). Ha! jokes on me since my donor site complications have been way more than any one had anticipated. So, no, I dont agree that they push LAT if they are not micro-surgeons. I think PS like it because it is reliable - but like i told him in a VERY LONG LETTER - no woman would trade a boob for a lifetime of pain. I am very happy that many of you have had few complications. I only hope those of us still suffering find some relief -
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It is incorrect to say that the lat flap surgery is done by surgeons who don't know how to perform micro-surgery (in spite of what the web-site for Johns Hopkins says) as this surgery involves micro-surgery! My PS does do other types of surgery as well and the lat flap. The lat flap worked for me.
From the Johsn Hopkins website -- note the last sentence stating that there are no physicla limitations with the surgeries performed. Huh, perhaps all the people who have had DIEP, SGAP, SIEA flaps and experience physical limitation issues post surgery should know about this claim.
- Flaps – Flap procedures are done by plastic and reconstructive surgeons who specialize in microsurgery. During flap reconstruction, a breast is created using tissue taken from other parts of the body, such as the abdomen, back, or buttocks, or thighs, which is then transplanted to the chest by reconnecting the blood vessels to new ones in the chest region. Due to the high level of skill required for microsurgery, as well as the equipment and staff needed, these techniques are available only at specialized centers
Most breast centers are still performing flap surgery the "old fashioned" way if they do not have surgeons with these skills. These older procedures (TRAM Flaps and latissimus dorsi flaps) result in the patient sacrificing either her abdominal muscles or her upper back muscles. While those procedures were the best options decades ago, today we know that there is a higher risk of hernia, weakness, abdominal bulging, and limits on physical activity with these older procedures. There are no physical limitations with the more sophisticated procedures performed at our Breast Center.
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fitz - what they are saying is that because they are not sacrificing muscle with the newer procedures there are no physical limitations (beyond healing issues) which i do believe to be true. There may be things like scar/wound healing, infection etc as with any surgery but "hernia, weakness, limits to physical activities" is a complication with TRAM (hernia/buldge a big one) and LAT (arm and shoulder strength) -i mean our bodies were born with these muscles, i doubt they have zero function and can be replaced as easily as they lead us to believe
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I understand what they are saying, however I find it to be a bit misleading to say there are no physical limitations with surgery. Surgery is unpredictable---years ago I went in for what I thought was to be an easy appendix surgery and eight hours and 3 weeks in the hospital later I was home. I am sure if they did a study there would be someone who does/did have physical limitations after a DIEP of SGAP. And yes, I know there are more limitations with a lat flap.
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I feel when i was first dx, it was such a shock' overwhelming emotions, i was not aware or even heard of LD surgery
I was going to have an implant only.....that is what i decided i was talked out of this as was told LD was permanent...and i would have a better visual outcome and no more surgery. i had a real strong feeling inside me gut feeling not to go ahead with LD but ahead i went ....so wish i had listened to my inner thoughts..this surgery is a nightmare......3.5 years of pain, have recently started to use a TENS machine which helps.
Really wish i had found this site earlier before surgery, possible outcomes should be explained prior to surgery, QOL is so important constant pain is a constant reminder and so so tiresome xx
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kaza: if anyone has radiation to their breast, then most definitely they will need some kind of additional support to assist the pec muscle in keeping the implant in place, regardless of size. I thought if I had 225cc implants I would not need the flap but PS said pec muscle's integrity was zero thanks to radiation. I had the LD flap and just a mastectomy on other side as I had Stage ) BC in that breast. I'm glad I did it, as when I read the pathology report on my radiated breast tissue they removed the first comment was it did not have the firmness of regular breast tissue, and looked like I had had radiation! It's taken 2 1/2 years for the ribs under the radiated side to stop aching with just rubbing cream on twice daily.
Again, now there are many methods to help support an implant......and the procedure, if not done by a PS who is dedicated to doing it right and doesn't encourage you or let you choose too big of implants, I do think you can have more success and less pain.
Implants do not have to be as big as your natural breasts as the silicone is firmer and will never sag. I know women who are a 32B with padding before mastectomy and a 32 DD without padding after getting implants the same cc's as their own breasts were...and many are unhappy.
The increased weight will put an huge strain on your pec muscles and the LD flap and also on your back, especially your upper back and make you hunch your shoulders forward, which is not a pretty look.
Kaza: you could have a pinched nerve but I can't figure out any more without knowing where your pain is and when it occurs or if it is all the time (sometimes the RN in me can come up with suggestions more than me as a DM with lat flap woman) or the LD muscle could of been twisted or threaded through too high under the arm and more in the armpit which has nerves running though from chest to back.
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