Breast Reconstruction with Latissimus Dorsi Flap
My name is Sherry and i'm 58 yrs old. This is my 2nd bout with breast cancer. I had it in 2002 and I had a lumpectomy, chemo and radiation. It came back in December 2021 in the same breast. This time my surgeon said that I would need a mastectomy. I have also seen my plastic surgery. On February 16, 2022, they will be removing the breast with immediate reconstruction using the latissimus dorsi flap method with a tissue expander and then eventually a implant. I have researched this procedure and have read some horror stories about major back problems and other issues. I'm also not sure if I want to deal with the potential problems of a breast implant. I'm thinking of just getting the mastectomy for now to give me more time to consider my reconstruction options later. My question is for any ladies that have had the latissimus dorsi flap procedure if you can tell me a little about your experience. I was considering getting the tram flap but my doctor said that I didn't have enough stomach fat. The tumor I have is located right below the nipple so I won't be able to save the skin.
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I am going for consultations this month for flap reconstruction too. I am also highly considering having no reconstruction. Would love to hear others experiences & recovery from any recent flap procedures.
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Sherry -
I don't know how thin you are, but you might consider getting a second opinion on the TRAM/DIEP flap. The first plastic surgeon I met with told me flat-out I didn't have enough tissue. Two other surgeons - both of whom had much more experience with the procedure - said I was a good candidate, but they would have to take both sides of the abdomen. It is called a "stacked" procedure. The PS also reduced my other side to match. I am now about one cup smaller, but both sides look great.
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I too am considering having latissimus flap surgery. It’s been 2 1/2 years since my lumpectomy but I still have a seroma. I had a second surgery by a breast surgeon who was not a plastic surgeon. That surgery did not eliminate the seroma. I now need to have the radiated tissue removed so it will heal.
If anyone has had this surgery, please let me know how difficult and/or painful it was to undergo. How long did it take for you to recover enough to do most of your daily routine?
Thank you!
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Hi @jumboshrimp and welcome to Breastcancer.org. You're sure to find great support here, even though this thread has been quiet for a while. Hopefully your post will revive it so that others can weigh in with their experiences with LAT Flap Reconstruction.
In the meantime, you might find it helpful to read our page on Latissimus Dorsi Flap Reconstruction, which explains what to expect with the surgery and recovery and more.
We hope this helps. Let us know if there's anything we can help with as you navigate our Community — we're all here for you!
—The Mods
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@jumboshrimp I am also considering a latissimus flap reconstruction. I had a bi-lateral mastectomy in February and was a candidate for direct implants, which failed due to the frailty of my skin. I currently have tissue expanders, completely flat, and my incisions will not stay closed due to the tension..
I don’t have enough excess tissue on my belly for the DIEP flap, and using tissue from my back appears to be the best option.
I would love to connect with others that have made this decision to understand the pro/con and outcomes.
thanks Mods for sharing the link!2 -
In case your doctors have not mentioned it- Just putting other potential microvascular reconstruction ouotions out there;
Tdap (sometimes called TAP) flap (thoracodorsal artery perforator flap) - not sure if this will give you enough volume.
sGAP flap (which I have.)
The above require microvascular surgeons. Depending on who is available in your area - you may need to travel to find someone who is very skilled and doing them in high volume.
Another potential source of info:
Your local chapter of FORCE
www.facingourrisk.org
(Even though I was not dealing with hereditary bc. The local FORCE members in my area stepped in and helped me.)
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Hi @chasing.dragonflies !
The MOST important thing about any type of reconstruction is having a plastic surgeon who has done many of them and has had good outcomes with happy patients. Be sure that is the case with your ps.
I had my 2nd mastectomy with immediate Lat Flap in December of 2022. My 1st dx was 19 years prior and I had a delayed Tram Flap (the older version of the Diep). So, I have one breast with each type of reconstruction. My case is a little different in that my Lat Flap does NOT have an implant. Instead the volume was created with fat grafting where they took fat from other parts of my body (liposuction), cleansed it and built a breast. In order to do it this way, I had 2 surgeries after the original one. This is a newer method and worked well for me, but not too many p.s. are doing it, I think. It also results in a likely smaller breast than some people may want.
So, my results may not be the same as someone who has a Lat Flap with implant. So far, I am happy with the Lat Flap. In my last surgery, I did have a 'ridge' cut down a bit that was the muscle that pulled around. For most people this flattens when the muscle atrophies. It didn't seem to happen that way for me. I will say it feels 'tighter' than my Tram Flap side, but that may lessen more with time. The 'feel' of it feels quite natural like my Tram Flap side. My Tram Flap side is still a slight bit bigger, but that is due to my decision to do it without an implant and I am okay with it.
My experience with the surgery itself (which was at the same time as a mastectomy) was that I was in the hospital for 2 days. I could have gone home the next day if I had wanted to. I just felt I needed the extra day. Do be aware that the incision for the lat flap is a very long one across your back though they do try and make it along your bra line. My experience with scars is that they all eventually fade pretty much. My breast surgeon had referred me to PT just based on her experience with others who have had the Lat Flap. I think this is a good idea to be sure to get everything moving again, especially in your case, if you would be doing a bilateral. PT went well for me and I felt pretty much recovered in about 4 weeks.
Everyone's experience with reconstruction is a bit different and there are risks with all of them.
Good luck with your decision.
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