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Topic: Latissimus Dorsi Breast Reconstruction

Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.

Posted on: Apr 11, 2010 07:46PM

Faythnme wrote:

Has anyone here had a breast reconstruction using the Latissimus Dorsi?  If so can you please share your experience and suggestions?  I am due to have a delayed reconstruction beginning of May.  I'd appreciate all responses.  Thank you.

CC Dx 3/24/2009, DCIS, 6cm+, Stage 0, Grade 3, 0/4 nodes, ER-
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Apr 11, 2010 07:55PM terrij152 wrote:

Fay, I had my BMX with lat flaps and TE's in June 2009.  I came out of the hospital after 2 days and had 6 drains in.  My PS removed 2 drains each week and the last two came out 3 weeks after the initial surgery.  My fills started a month after my drains were out due to scheduling issues.  I had a fill every three weeks and I can honestly say I had no pain at all with them.  I did have some tightness, but never pain.  I did a lot of stretching that I had done with post mastectomy patients, since I work as the director of rehab.  My exchange was in January and I am doing great!  The exchange was a piece of cake and I was back to work in 2 weeks. 

Feel free to PM me if I can answer any other questions.  Good luck to you!

Life is a journey...Enjoy the ride!!! Dx 3/16/2009, IDC, Right, 2cm, Stage IIA, Grade 2, 0/14 nodes, ER+/PR+, HER2- Surgery 4/20/2009 Lumpectomy: Right; Lymph node removal: Right, Sentinel, Underarm/Axillary Surgery 6/17/2009 Mastectomy: Left, Right; Reconstruction (left): Latissimus dorsi flap, Tissue expander placement; Reconstruction (right): Latissimus dorsi flap, Tissue expander placement Hormonal Therapy 7/21/2009 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 1/7/2010 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction Dx 4/2/2015, IDC, Left, 2cm, Stage IV, ER+, HER2- Hormonal Therapy 4/19/2015 Femara (letrozole) Radiation Therapy 6/7/2015 External: Bone
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Apr 12, 2010 08:18AM FACECRAFTER wrote:

Fay,  If you PM Linda54, she had an LD and she willing to talk with anyone on this board.  JUDY

Ring the bells that still can ring. Forget your perfect offering. There's a crack in everything. That's how the light gets in. JUDY Dx 8/18/2008, IDC, 2cm, Stage IIB, Grade 3, 5/21 nodes, ER+/PR-, HER2-
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Apr 12, 2010 09:20AM - edited Apr 12, 2010 09:28AM by Linda54

Faythnme

I love your name....(Faith in me)

I got your PM and will respond when I am not rushed.....

You need to PM Timtam and ask for permission to enter the picture forum.  She is the protector of our pictures.  She will send you a PM with the info you need to see the pictures.

In the mean time you can click on the search button (upper right hand corner) and then type in Lat Dorsi, or LD flap and also my name (Linda54) and click on search then scroll on down below that and you will have every post I have made on the subject.  Then you can PM me with any questions that you have.

I hate Cancer... Dx 3/7/2008, DCIS, Stage 0, Grade 1, 0/0 nodes, ER+/PR+, HER2-
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Apr 12, 2010 11:04AM GG27 wrote:

I had delayed bi lat, LD  flaps with TE's on Feb 3rd.  I struggled with the decision up to the day of surgery, but now that it's done, I am so pleased.  I haven't had many issues with pain or discomfort.  My PS & I made the decision to go slowly with fills because I had quite a bit of damage from radiation, but I've had three fills so far & they are virtually painfree. 

You can PM me as well with any questions you have.  

Dx 10/2008, IDC, Both breasts, 3cm, Stage IIB, Grade 2, 3/9 nodes, mets, ER+/PR+, HER2- Surgery 1/8/2009 Lymph node removal; Mastectomy: Left, Right Chemotherapy 2/1/2009 Other Radiation Therapy 7/5/2009 Whole-breast: Breast, Lymph nodes Hormonal Therapy 9/6/2009 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Dx 5/14/2014, IDC, Stage IV, mets, ER+/PR+, HER2- Hormonal Therapy 5/19/2014 Arimidex (anastrozole) Radiation Therapy External: Bone Hormonal Therapy Femara (letrozole) Targeted Therapy Ibrance (palbociclib)
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Apr 12, 2010 11:31AM joiedevivre wrote:

mfrog: Do you have any issues with loss of strength  in the upper arms and back muscle. How does the scar look? Any depressions in scar area in the back? So, you would do the same thing again with lat flap?

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Apr 12, 2010 12:52PM GG27 wrote:

I'm still working on the strength in my arms, I had all my lymph nodes removed so I've been fighting this since my BMX in Jan '09, but I worked on weight training before recon to get my strength up.  I am quite active in the garden with lots of shoveling, raking etc, haven't noticed any problems in those areas, but I know I have lost alot of upper body strength, but I don't think it's all because of the lat dorsi flaps.   But all Drs are sure that I can reclaim that strength, it just takes some work!

No problem with my back, I have two little bumps at the bottoms of the scars, but PS says they should go away, but if not, he will deal with them when we do the exchange surgery.  My scars are thin red lines at this point.  PS asked if I wanted them to be hidden under a bra, I told him to do it which ever way would give the best end result on the front, said my days of backless evening gowns were gone! Surprised

Dx 10/2008, IDC, Both breasts, 3cm, Stage IIB, Grade 2, 3/9 nodes, mets, ER+/PR+, HER2- Surgery 1/8/2009 Lymph node removal; Mastectomy: Left, Right Chemotherapy 2/1/2009 Other Radiation Therapy 7/5/2009 Whole-breast: Breast, Lymph nodes Hormonal Therapy 9/6/2009 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Dx 5/14/2014, IDC, Stage IV, mets, ER+/PR+, HER2- Hormonal Therapy 5/19/2014 Arimidex (anastrozole) Radiation Therapy External: Bone Hormonal Therapy Femara (letrozole) Targeted Therapy Ibrance (palbociclib)
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Apr 12, 2010 01:12PM tamgam wrote:

I am17 days out from my lat dorsi with TE.  I had my first fill today and it was nothing.  LOVE my PS- he numbed me first and I was not even uncomfortable.  He also drained an iv bg's worth of fliud that had bulit up after drain removal.  I feel really good today.

I have to say, the surgery left me exhausted for 2 full weeks.  The worst part for me was definitely the drains.  I came home with 6 and lost three after the first week.  The rest came out week 2 becaus emy BS does not leave them in any longer. They are not painful but theyare a pain in the A@#. I just started getting some energy and feeling human.  I normally have tons of nrg and it was hard to be stationary. 

After 2 weeks of recovery I really think the waiting and worrying were the hardest part for me.  I did it all at once and have only been DX since jan.25.

Wish you the best of luck.  Feel free to PM also if you want to know any more.  Having someone to talk 2 makes the load lighter.

HUGS♥

Tracie

Dx 1/25/2010, DCIS, 1cm, Stage I, Grade 2, 0/2 nodes, ER+/PR+
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Apr 12, 2010 06:50PM Linda54 wrote:

Fay

The end of this month will be 2 yrs since my bi-lateral MX with immediate LD flaps.  I had 4 drains and within 2 wks they were all gone.  Those are the pits!!!

I have nothing negative to say about my experience with the LD recon.  Everything went well for me.  Because of all the surgeries (4) it was hard for me to get back into routine strength training but in the last couple of months I have been getting it all together again and my weight lifting is going well.  Lifting more than I did before my DX.  I am doing everything that I did before the surgery. I am very active..running, biking, gardening.

I am a hairstylist and was off work for 4 weeks.

The only complaint I have is the tight bra feeling.  I don't know if it has anything to do with the LD recon or if it is the implants. I went to a PT and did not get relief.  If I have to live with it I guess I can. At least it is not pain.

I will be glad to answer any questions you may have.

When is your surgery and will you be having a bilateral?

I have lots of pictures posted on the forum.  Also some pictures of my back.  My back scars are verticle and are fading well. 

((((((take care))))))

I hate Cancer... Dx 3/7/2008, DCIS, Stage 0, Grade 1, 0/0 nodes, ER+/PR+, HER2-
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Apr 13, 2010 08:40AM waldo wrote:

Linda, where are the pcitures posted.  I feel all swollen under my armpits. it is such a weird and indescribable sensation that I can't describe to my husband or others that haven't experienced it but i know you all understand it.  I feel the inside sensation does not match the outward appearance.

Dx 1/28/2010, IDC, 1cm, Stage I, Grade 1, 0/2 nodes, ER+/PR+, HER2-
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Apr 13, 2010 09:32AM Linda54 wrote:

waldo

you will need to send Timtam a private message asking permission to enter the picture forum.  It is separate from this discussion site.  Timtam protects our pictures. That is why you need to have been posting here for a while so she will know you are legit.  We are so thankful to Timtam.  She will respond with a private message to you with the password to get in.  Lots of great pictures to help those seeking help with visuals.

Do you have expanders in or already have implants?  I know with the expanders I felt like I had all this swelling under my arms but it was jus the expanders.  All of that went away with the exchange to implants.

I hate Cancer... Dx 3/7/2008, DCIS, Stage 0, Grade 1, 0/0 nodes, ER+/PR+, HER2-
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Apr 13, 2010 11:13AM waldo wrote:

I have expanders and BMX and recon surgery was 3/29.  2 weeks +1 day post op- today I feel really tired.

Dx 1/28/2010, IDC, 1cm, Stage I, Grade 1, 0/2 nodes, ER+/PR+, HER2-
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Apr 13, 2010 08:01PM Linda54 wrote:

For all the Lat dorsi flap recon girls..below is a video I found on the picture site and I thought I would share it with you.

warning: this is video of live surgery

www.or-live.com/jeffersonhospital/1858/event/rnh.cfm

I hate Cancer... Dx 3/7/2008, DCIS, Stage 0, Grade 1, 0/0 nodes, ER+/PR+, HER2-
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Apr 14, 2010 03:02AM Melinda41 wrote:

linda: thanks for that video, it was long so I had to pause and come back to it a few times but it was very informative. It was interesting how little of the skin they take and how much of the muscle they take.
melinda-musing.blogspot.com/ Dx 9/22/2009, IDC, 3cm, Stage IIIC, Grade 2, 9/19 nodes, ER-/PR-, HER2+
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Apr 20, 2010 03:20PM SusanZ1961 wrote:

Has anyone out there had LD Flap surgery with out using TE's.  I am having LD Flap on left side with immediate implant and exchange TE for implant on right side. 

Dx 7/11/2008, IDC, 6cm+, Stage IIB, Grade 2, 0/2 nodes, ER+/PR+, HER2-
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Apr 21, 2010 06:19AM buddy1 wrote:

The video was amazing.  Thanks so much for sharing that

Dx 11/12/2008, IDC, 2cm, Stage IIB, Grade 3, 2/22 nodes, ER+/PR+, HER2-
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Apr 21, 2010 08:54AM clwetzel wrote:

I have had 3 failed implants due to infection and accumulation of fluid which keeps building up and breaking the skin.  I am interested in the LD flap and would like to know if anyone has had a similar situation....The issue with the skin is on the side with radiation treatment 8 years ago. 

clwetzel
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Apr 21, 2010 09:36AM Linda54 wrote:

I had rads 23 years prior to my 2nd DX in that same breast.  My PS would not talk about trying to place an implant in without support of new muscle and a flap of new skin.  He said to high a risk that the rad skin would not hold up.  I have the LD flap and no problems.  Approaching my 2nd anniv....I have read where some ladies have had success with just the implant but it sounds like it was not to be for you.  I did not want to experience what you have been through so I went with the LD flap from the get go.

I hate Cancer... Dx 3/7/2008, DCIS, Stage 0, Grade 1, 0/0 nodes, ER+/PR+, HER2-
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Apr 21, 2010 10:16AM clwetzel wrote:

Linda,

      Thank-you for your response.  Did you have any problems with fluid accumulation?  Did you have implants placed under the flap?  I do have to admit that it has been very frustrating.  Sometimes I feel like it is hopeless but I do not want to wear a prosthesis all of the time.  For me it would just be very inconvenient because I am so active...

clwetzel
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Apr 21, 2010 12:00PM - edited Apr 21, 2010 12:03PM by Linda54

clwetzel

I did not have any problems with  fluid or anything else...the only complaint you will hear from me is the tight bra feeling.  I pray that in time it will go away. 

I first had tissue expanders for almost 6 months then those were replaced with silicone implants.

It is not hopeless.  You need to get all the info you can about the different types of recon.  There is a book titled "The Breast Reconstruction Guidebook" by Kathy Steligo. It has been highly recommended by women on this site.... Wish I had know about it before my surgery. I have lots of pictures posted on the picture forum.  If you have not been there already, you need to send Timtam a private message asking for permission to enter the site. 

the best to you

Linda

I hate Cancer... Dx 3/7/2008, DCIS, Stage 0, Grade 1, 0/0 nodes, ER+/PR+, HER2-
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Apr 21, 2010 12:34PM 2Xsenough wrote:

Hi Ladies--Some of you know this, but I had the type of lat flap where the PS doesn't take any skin from the back so he is able to harvest the muscle thru the MX incision. It's rarely done but the upshot is no back scars. I only wanted to be a B cup so he didn't need to put new skin in place. He said because of my radiation from 15 years ago, a B cup was all I could go anyway without grafting in some new skin. He also said that having the new unradiated muscle in place was the key to healing, and I've healed beautifully. My only problem was because I built up so much fluid I had that rad side drain in place for 7 weeks.

 Good luck to you ladies about tobegin the process.

Bobbi

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Apr 21, 2010 01:39PM Linda54 wrote:

Bobbi

How I wish the doctors would give us all our options.  If my doctor had told me that if I wanted to stay the size I was and not have skin harvested then I would have chosen that instead of having my back scared up and football shaped skin flaps across my chest just to have bigger boobs. It is not worth it.  You were so lucky to have a doctor that gave you that option.

I hate Cancer... Dx 3/7/2008, DCIS, Stage 0, Grade 1, 0/0 nodes, ER+/PR+, HER2-
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Apr 21, 2010 01:59PM Texas357 wrote:

Linda, the surgery in the video didn't have the larger football-shaped "skin paddles" but rather a skin graft so small that it appears the whole thing would be camoflauged by the nipple and tattoo. I don't know if that's always an option or not for those of us who have radiated skin. It was the size of the graft that had me saying no to the LD Flap surgery from the beginning.

DX 9/08, ILC, Stage 3A, ER+/PR+, HER2-, 7/13 pos nodes. Mastectomy & six months chemo & 32 rads.Prophy mx 8/09. Implant only on proph side; LD flap on rad side. 13 surgeries since diagnosis.
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Apr 21, 2010 02:24PM Linda54 wrote:

Texas357

This fragile radiated skin limits our options when it comes to implants.  I tend to dream when I see something like the apple core MX with the small round skin flap.....you know, to look so natural without all the scaring.

I hate Cancer... Dx 3/7/2008, DCIS, Stage 0, Grade 1, 0/0 nodes, ER+/PR+, HER2-
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Apr 21, 2010 04:34PM 2Xsenough wrote:

Ah, Linda. Amen to the dream. But I am what I am and basically happy with the recon. Of course, with radiated skin I probably didn't have any other options.I honestly think our docs only tell us about the kind of surgery that they have the best luck with. You know, sort of like we hairdressers sticking with tried and true techniques. At least I did. I hated doing redos on anything.

Texas--Have you had recon? Sorry, I can't remember what I read in the past.

Bobbi

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Apr 21, 2010 09:01PM kiffc wrote:

I had my surgery 06/2008. When I first heard I should have a mastectomy, I was thinking of the old school "radical" kind. I had no idea of the options available. I agree that PSs choose the procedures they're most comfortable with. I interviewed two that my primary surgeon referred me to -- one preferred the pseudo tummy tuck procedure and the other, who I chose, the lati dorsi. The first was a man and the second a woman. The first one was well known but I felt his office leaned more toward true cosmetic surgery -- it didn't feel right for me as a cancer patient. The other doctor had worked with burn victims during her early years which drew her into PS -- ultimately and primarily with breast cancer patients. She also was a Harvard Med grad. What she did for me in our first consultation is bring out her own photo album of before and after pictures. She showed me a variety of situations with and without radiation. She also explained how she had several patients over the years that she's had to correct their pseudo tummy tuck procedure performed by other PSs. Her photos provided a realistic look at what layed ahead of me.

On the upside, almost two years later, it is truly amazing how breast conserving this surgery is. I didn't have radiation so didn't have to deal with any of the skin issues mentioned above by those who've had rad. I hated the drains following the surgery. It's annoying but you get through it.

Cosmetically, I'm very pleased with the end result. Now for the cons...I still have numbness. I also experience some weird sensations at times due to the way the nerves run. For example, when I was tatooed I could feel it in my right shoulder. I also have lost strength. My last surgery was 08/2009 (I had 3 total -- the latter was extra due to some fixing of my healthy breast) to shore things up. I also had at least 2 rounds of tatooing so I wasn't released until this past January. Between surgeries and tatooing, I couldn't sweat while my incisions healed and to not mess up the tatooing so I basically did not exercise during a 1-1/2 year period. Others may say "yes, you can still exercise" but for me I just can't roller coaster with exercising. Exercise for a month or two then lay off for a month or two and so forth.

Now that I'm done, I do want to try some strength training like another member posted above. It just drives me crazy when I'm stirring a pot or trying to use a screw driver -- I'm right handed and I now feel like I'm using my left hand strength wise. As far as my back, ironically the side that the procedure is done on looks better because it removed some excess fat. My scar goes at least half way across my back horizontally maby a little more. Almost two years later, the scar has whitened. You can see it but not a big deal.

The net-net, I think it was well worth it in the big scheme but you just have realize and accept everything just won't feel the same after. One final note -- I experienced a lot of fatigue and I'm an A type personality. This was really hard for me psychologically. My PS explained that I had gone through major surgery and the body works hard to repair. She recommended I increase my protein intake which I did and I do think it helped in my recovery.

Good luck and God bless!

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Apr 23, 2010 08:35AM - edited Apr 23, 2010 08:36AM by JustTurnedForty

Very interesting video.  I hoped to see them tunnel the lat muscle from the back to the front. I always wondered how that managed that one!  I had skin & nipple sparing BM with the lat flap recon, so no skin was taken from my back.  It has been almost 3 years and the scars on my back are barely noticeable, and even gone in some areas!  I do notice an indent where the muscle was taken though.  I also have the tight bra feeling.  For some of us it seems to never go away.  However, you do get used to it and don't notice it as much as time goes on. 

 If anyone would like to see my pictures, feel free to PM me.  Good luck to everyone who has to go through this!

Janine, who is now 43 Dx 1/15/2007, DCIS, Stage 0, 0/3 nodes, ER+/PR+
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Apr 25, 2010 07:44PM Faythnme wrote:

Hope for the best and staying positive! 

 Well my delayed LD recon is due to happen 5/4 and I am afraid the doctor is going to reschedule me because I am just getting over something that started on Thursday 4/22.  I've been in the house since Thursday trying to get over it.  What do you think the chances are?  It as difficult enough as it was to get an surgery date as it was and in June she will be in Alaska doing recon up there.  She's a very good PS.  Wish me luck that I don't need to reschedule. :)

CC Dx 3/24/2009, DCIS, 6cm+, Stage 0, Grade 3, 0/4 nodes, ER-
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Apr 26, 2010 05:38AM Stanzie wrote:

I had the lat. dorsi done on March 5th - bilat. It was lke the one video where you have the back scars but they go in through the nipple area. I don't think I have lost much strenght at all and overall I am very pleased. I am hoping my PS is not keeping something from me as far as why my new breasts are different sizes. Hopefully it is as he said swelling and not that he put in two different implants. I had the surgery where they put in the permanant implant. I think from viewing other pictures this type of reconstruction does give quite natural results and isn't quite as much to go through as the tummy reconstruction.

Faythnme, I hope you don't have to reschedule - there is still some time so hopefully you can just get it done. Waiting is so very hard. 

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Apr 26, 2010 07:53AM Texas357 wrote:

Bobbi, yes I had my exchange surgery in November and again in December. I decided to try implants first. If that doesn't work out, I'll go back for the LD Flap.

When I had the initial exchange, the implants were slightly too big and three weeks later the incision opened on the radiated side. So I went back in for smaller implants. But my PS didn't tighten the pocket on the prophy side so that's noticeably bigger than the radiated side. I plan to have that revised next fall (after swim season since I don't want to miss out on getting some good upper body exercise this summer).

DX 9/08, ILC, Stage 3A, ER+/PR+, HER2-, 7/13 pos nodes. Mastectomy & six months chemo & 32 rads.Prophy mx 8/09. Implant only on proph side; LD flap on rad side. 13 surgeries since diagnosis.
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Apr 26, 2010 12:01PM clwetzel wrote:

Terri,

       After you had the drains removed did you accumulate any other fluid that you had to have removed?

clwetzel

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