Latissimus Dorsi Breast Reconstruction
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Hi!
I am having my Latissimus Dorsi Flap surgery tomorrow morning. I had my double mastectomy with expander reconstruction back on 23 Dec. The left breast (non-radiated) did great and looks pretty darn good with just the expander in there! The right (lumpectomy w/radiation 2011) didn't fair so well. The silly thing is rock hard and not expanding. Actually pretty ridiculously painful too! Just finally getting over the mastectomy/reconstruction this past week and I thought it a bright idea to rush into LDF tomorrow! Soooooo just want to be done with this whole thing and in the pool with my son this summer!
I will be happy to post when I come out of my surgery. Well, as soon as I come around from the massive amounts of Oxy I plan to have in my system the first week!
I have read/researched great things and bad things about the surgery/recovery. YouTube has been great for research. UCLA, John Muir and Mayo Clinic have some great stuff on YT concerning the the LDF surgery. Bottom line for me is I have a good appreciation for my PS and oncology team in general. I am a retired veteran, a stay at home mom and have great medical insurance. With the exception of a bad experience with the genetic company that did my BRCA gene testing, I have been blessed. This of course has been a tremendous help in my attitude toward surgery and recovery. I am not going to die from breast cancer. I will be alive to raise my child and that puts everything in perspective for me.
:-)
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Has anyone had any problems with this surgery on their radiated side?
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freeyourmind - I'm 4 weeks out from doing this on my radiated side and am doing great. The first couple weeks were rougher than recovering from my BMX but, then again, that was 3 years ago. I've found that time heals my memory too.
let me know if you have any questions.Hugs,
Kathy
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I am a NERVOUS WRECK. I am totally expecting this to be worse then my mastectomy last year. I just keep telling myself it will be temporary just like the past surgeries. Pain will go away. God I pray this is the last time I am sliced open!!!!!!!! 48 hrs now and counting.............
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Good luck, Tangles - you are in my thoughts and prayers!
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I had a lat dorsi with TE done in September. Although it really wasn't that bad, it was more difficult than the mx. I was a uni, so still had one arm to do stuff with!
The hardest part was having no muscle ability on my surgery side. The week after surgery, I couldn't even slice a tomato. Opening large doors was almost impossible.
It takes some time for this ability to come back, and now it's all good.
Wishing you all the best! Keep us posted!!!
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Hi Ladies...I am one week out from my MX with LD flap reconstruction. My doctor did the LD flap "scarless-ly" so I do not have any incisions on my back. Also the PS was able to get an implant in at the time of surgery!
I am amazed at the recovery process. I have only needed Tylenol once a day for the past 3 days! My shoulder does ache a little and the drains are annoying. I also have some lumps under my arms which I think are just the muscle that was pulled through and do feel like I'm wearing a really tight bra. The surgery was difficult but do-able! Best wishes to all you ladies! 0 -
fourtangs how do you have no scar on your back. I have never heard of that????? did you have a bilaterial flap?
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Hi Tangles! The PS accessed the LD muscle through the mastectomy site and pulled the muscle around under the underarm area and then attached it in place. It is not commonly done. I even had trouble finding much about it with a google search...although if you do google "Scarless latissimus dorsi" articles come up that my surgeon authored. The PS travels the globe teaching this method of LD flap reconstruction. The up side of this "scarless latiss" is the fact that there is no incision on my back and therefore no need for drains (on my back) and lessens the risk of infection. Currently I am 9 days out and do feel really "bulky" under my right arm and right side under the underarm area (hope that makes sense). I am right handed so I think that accounts for the bulkiness on the right side. I can't begin to say how happy I am he was able to get an implant in!!! The left breast looks really good...the right is a little lumpy and misshapen but I am hoping once the muscle settles down it will also look good!
It was a hard decision to make however....I really didn't like the idea of messing with my back muscles...but really didn't "love" any of the reconstruction options! How are you doing? Saying a prayer for you tonight!
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tangles- amazing what they are able to do. So glad you didn't need scars on your back and straight to implants! Glad all is going so well, I still have some bulky feeling under my arms, mostly my left, but it does atrophy and go down over time. Just added nipples today, fairly simple procedure in the scheme of things but just tired and a full feeling but relatively pain free. Anxious for my week postoperative appt to see the end result. Many hugs while you recover!
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mamasixtaz- How exciting to reach the nipple stage of reconstruction! Do you mind sharing how they were reconstructed? Did they tatto them on or did they take skin from else where and make a nipple? I hope you continue to feel good! Yesterday I felt fantastic....I did lots of housework and today....I'm totally exhausted!
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How did your surgery go Tangles? I hope that you are recovery well
Kathy, I'm glad that you are doing so well! I am 4 weeks out also. My radiated side is still really swollen under my armpit and I have a ton of tiny purplish veins on my new breast. I have lots of patchy dry spots all over my chest. I've been using an oatmeal moisturizer and coconut oil, neither seems to help.
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I was wondering if anyone else has experienced this.... I am 4 weeks post bilateral dorsi lat flap with TE's. When I touch one of my new breasts, my lower back (under my incision) moves! It's so annoying! I told my surgeon about it he said that was impossible. Thanks!
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I am scheduled to have a BMX with lat flap reconstruction on March 21. I have DCIS but just found out I am BRCA2 + hence the BMX. I'm getting really nervous about choosing the lat flap. Apparently I don't have enough abdominal fat (or fat anywhere, according to my PS, although I never considered myself particularly skinny) for a TRAM or DIEP and my PS will put in a small implant with the flap so I won't need tissue expanders. That's what really appealed to me -- getting the whole thing over with at once. Here's what I'm nervous about:
1. Use of my arms and back -- how limited will my strength and motion be in the long run (I know it will take some months to heal, get my ROM back etc, but after 6-12 months will I be nearly back to normal?). My PS said I won't really notice the difference but is this true? I don't go rock climbing or play tennis but I do an amazing hip hop dance class three days a week that I love and that requires all kinds of arm motion (those of you who dance hip hop will know what I mean!) I was actually thinking of bringing my PS a short video of my class to see if he thinks I will still be able to do these kind of movements -- is that crazy??
2. Tightness -- lots of people seem to complain about that "iron bra" feeling after surgery. Is this more common with lat flap? Are some people more susceptible than others? I have DCIS so hopefully won't need radiation unless they find something more in my final path report (that's my other fear, but won't go into that now!) How long does the tightness take to resolve? Anyway to prevent/lessen it? Does it prevent you from exercising?
Any help with these questions is so appreciated! I don't really know if there is another/better option? It seems like tissue expanders might spare my back but they have their own issues.
Thanks so much!!
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gabrielaM, I think you will be able to hip-hop dance just fine! The true test for me was when I attempted to swim (recreationally) & found that I was still able to with blilateral lat flaps. I am 2.5 years out from lat flap surgery.
The tightness should lessen over the course of a couple of months. It is pretty noticeable at first & to me it felt like the newly relocated lat muscles would contract every so often. Now the only time I feel any tightness like that is if I am suffering from allergies--my chest feels really tight then.
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Hi!
I am home after a week's stay in hospital after Lattisimus Dorsi Flap reconstruction. Not going to lie, in some significant pain despite Oxycodone every four hours. I can take up to 2 pills in the four hour period but I am keeping it at 1 pill. I am trying to avoid an addiction. I had a double mastectomy with expander placement back on 23 Dec. So I have already been on Oxy 2 months straight.
The reconstruction surgery was only on the right side as the expander failure came about from the radiation/lumpectomy on the right side. As I understand it I was text book surgery this time. The first surgery proved tough as my pectoral muscle was godzilla-ish in nature! The surgeon tunneled the muscle under the arm pit and around to the front. That is where all my pain is coming from, the arm pit. I feel as if the pectoral muscle is contracting and contorting and twisting mad crazy under the arm. The back feels normal, a certain amount of tightness. Really tolerable back discomfort. Sleeping sitting up. I have about 8 pillows around me. Lots of bum pain from sleeping and resting on my bum all day! Going to try to lay on my left side tonight? Doing a walk about around the large kitchen twice a day. Came home Friday night and needed my husband to bathe, toilet and walk me about until this morning. Again not going to lie, there was some crying and screaming in there the first couple of days home. Some crazy texting to friends too!
I have my in-laws here helping with my son and school. My sister (a pilot) is in town thru Thursday morning. So I am feeling good about support. Is this something I could do without support? He'll no! I would have a nurse in here if not for family support. I am a strong woman who has been thru war or two and I could not do this on my own. I worship the woman who could!
I have to say that if it weren't for the radiation, I wouldn't have to deal with any of this!
So I will check back in here and comment throughout my recovery. Hope my sharing helps someone! Please ask questions! I would like to know I can help somehow!
All my best to you all
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Interesting as my PS told me the exact opposite of your PS? I had the tunneling of the flap under the arm pit vs. removal from back with placement to the front. My PS said that the brain doesn't know the muscle has moved so it thinks the muscle is still in the back. The nurse even joked that I would have some new party tricks to show off once everything settles down. Youtube it. There is some great stuff to watch on there!
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Does anyone know if the tighness is worse with the lat flap than a plain old implant? I assumed that either way the tightness is because you are placing something (TE or implant) underneath a muscle (latissimus or pectoral). I've heard people with regular implants complain about tightness too but I was wondering if lat flap is worse or more likely to cause this problem. I guess either way it gets better with time. Which leaves the question of back weakness with the lat flap which you shouldn't have with an implant only. It's really hard to decide but I have another 2 1/2 weeks to think about it.
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fourtangs- I am so glad to reach this stage too! What a year! I was able to watch the process and he used an origami type of technique. He cut the skin in the flap to make a flap of skin still attached to blood supply and then tied the ends together and then cinched it together in a purse string to fashion the nipple. Youtube has it very similar to the way my PS did it. I still haven't had the unveiling as all are covered with dressings. Will take them off and take a real shower on Wed AM.
gabrielaM- It is almost a year ago I had my bmx with LD recon and I am able to work and do all that I did before. Still notice tightness after a long 12 hr shift as a nurse but I believe anyone would even after bmx with implants. It is a big decision to make so ask all the questions to your PS and BS to make sure what is the best for you.
BRCA2Gal- Hope you feel better each day...it is a rough recovery but it sounds like you have a lot of good support . I really depended on my son and daughter for help that first couple of weeks and until those drains were out. I think the hardest thing is letting others take over and just do the things that need to be done and not feel like you need to be in control of it all the time. Rest, rest, rest, easy to say but hard to do when in recovery mode. Even with this minor procedure for nipples, I am more tired than I thought as I only had the day off of surgery and returned to work as though nothing happened. Well, it is still surgery and I probably needed to take another day off to rest! It needs time to heal and the body to recover. You would think I would know after 3 surgeries (now 4) in less than a year!
Many (((HUGS))) to all!
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They keep the muscle where it is because it still does its function of creating a pouch and mound in which to build the boob around. They actually kept the same flap as well, so they basically just transferred the fat and tissue to make a new breast instead of the implant. Since the implant is gone my arthritis in my joints is almost completely gone!! Yay!
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Wow fortangs no back scar! I'm so impressed with medical technology! GabriellaM back weakness is not bad with a normal day work. My small grand children are here for a week, with all the lifting, playing ninja turtles, Lego , ect. my back is sore!! I'm sure you will be able to enjoy your hip hop . When I go running I swing my arms all around to "loosen" up. I have no problems. I plan on lifting a kettle bell soon to help increase back strength. BRACA2gal, slow and steady on the healing, I'm sure we all had some pretty rough nights when crying was the only option! Happy you have plenty of help too. Mamasixtaz. Wooho on new nipples. I think it makes a difference how about you? I will require a fat transfer procedure and then tatto, can't wait till all done? Kudo's to all hang in there
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freeyourmind, thanks for asking. FIrst I have been on in a week. This surgery was MUCH LARGER then I ever expected. Maybe because I had bilateral. I have NEVER been in so much pain in my life. I am 8 days out now and still regret doing it. No amount of looks could make this worth this much pain. I am also have to go daily to an hyperbaric chamber to receive oxygen therapy as the radiated flap still looks very angry.
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Oh tangles!!!! I am SO SO sorry you are having such a rough time! I'm at a loss for words! Hang in there. I'll keep you on my prayer list!
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Tangles - It was a rough surgery for me too. By week 3 I was doing much better. I am now 6 weeks out and doing great. The only part that is driving me crazy is my tissue expander. I'm completely expanded now and my exchange surgery is April 4 so there is a light at the end of the tunnel. Keeping my fingers crossed that time will help minimize your pain as it did for me. Just remember, one day at a time.
Hugs,
Kathy
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OMG tangles! This is a very barbaric surgery, I'm so sorry for your pain and discomfort.. There is nothing we can say to make your feel better, but please know that every day it will get a little better. Your daily trips in a car must be excruciating, I hated riding in cars for the first month! Feel better :-)
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My back is killing me from laying on it, but if I am up for more then 5 min my back is killing me. This is TERRIBLE!
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tangles - have you tried a recliner? I actually was in a recliner, even for sleeping, for the first 2-1/2 weeks after surgery. I had a tough time getting back into bed for the entire night. I hope it gets better for you soon.
Kathy
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I am glad this thread is here; I had BMX Jan. 29th, with delayed reconstruction, and saw my PS Friday for follow-up/pre-op visit. My LD flap surgery with TE placement is tentatively scheduled for mid-May, and I am struggling with deciding 1) whether to do it, and 2) whether I want this PS to do it. He has been very thorough in answering my questions, but for some reason I have a strong reluctance to commit to the surgery, and I'm trying to figure out if that has more to do with the surgery or with the surgeon. I've decided to see someone for a second opinion (I would really prefer not to have this huge surgery if it's avoidable), and am hoping that will help me decide. I tend to heal well and bounce back pretty quickly, but I'm intimidated by this surgery, much more than I was by the BMX. Since surgery, I have been surprised by my adjustment to my new landscape; I expected to really struggle with it (and did before surgery), but I've actually been fine with it. I'm wondering if that's kind of a honeymoon-period thing, or if I'll continue to feel that way long-term. (Only one way to find out, right? lol)
I'm not sure really what I'm asking, if I'm asking something--I guess I'm wondering not only how you knew your PS was "the one," but also how you knew s/he wasn't? With my colon cancer, I have "fired" a couple of doctors (for lack of a better term), and I'm not sure why that seems different with this PS. (Sorry for all the rambling!)
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aunt Paula. Typically this surgery LD flap is recommended only if radiation, or compromised integrity to surgical area has occurred. I knew I liked my PS because his patients are willing to come to the office to show his work in person. ( I am now one of them)he explained everything to the tenth degree. Being a nurse I grilled him. I could tell he was getting flustered with all the questions but he kept answering with the utmost patients. Most important he has an amazing first assistant that available 24/7, she stuck with me through thick and thin. She would call on the weekend just to make sure I was ok. I never felt alone. Good luck with your decision! @ tangles I also spent two weeks in a recliner post surgery . Very helpful. Hope you feel better soon!
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I haven't had radiation, but he said that my pectoral muscles are very small, and that without the LD flap he is concerned that the TEs/implant would fail. He has answered my questions, but when I asked Friday to see photos of completed reconstructions similar to mine so I'll have a realistic idea what to expect, I wasn't very satisfied with his response. He brought in a handful of jump drives, chose one, and proceeded to show me several TRAM flap (are these flaps? I may have that wrong) reconstructions, and a total of one of "my" kind, with what seemed like some hesitation to me. I asked him if for some reason he was concerned that I would not be a good candidate, or if he was concerned about the likelihood of my getting satisfactory results, and he said no. I found the hesitation (or what seemed like hesitation to me) strange, given that this is his field of practice, and I would think that photos would be used widely in going over procedures/possible results. (I could certainly be wrong, since this is my first time dealing with PS for any reason.)
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