Latissimus Dorsi Breast Reconstruction

Linda54

Fearless

I had a lumpectomy with rads 23 yrs prior to my 2nd DX in the same breast.  My PS would not place a TE without some new skin and muscle. He told me the chance of it not working was too great so he recommended the LD flap.  I did not want to take the chance of multiple surgeries or infection so I had the flap done.  I have done great and the breast did fine. It is still soft so no CC has formed. 

I pray your surgery goes as planned and you have a quick recovery. Please let me know if I can help you with any questions you may have.

keep us posted

Fearless_One

Thank you, Linda...my other surgery was only a year and a half ago, so not sure if it matters how long you wait after having had the rads?    I asked PS about the lat flap, but he seemed to not give me a definitive answer, wants to see internally how bad the damage is.  

Should I tell him I want the lat flap from the start, rather than taking a "wait and see" approach?  Like you, I don't want to have to go through additional surgeries due to CC.

Linda54

Fearless

You should talk to your doctor about this and then decide.  Tell him of your concerns about failure and CC. 

I see that you just had hyster/ooph.  I am having a rectocele repair and also while my doc is in there he will take the uterus and overies (my uterus has fallen about halfway). Might as well get it all done in one surgery.  How was your recovery, pain and whatever else you can tell me?? any advice would be great.  I am already in menopause (57 yrs old) so it will not throw me into instant hot flashes. 

Linda

Fearless_One

Linda, I had Davinci Robotic Hyster/ooph.   I was back to work full time in 2 weeks and have 4 little scars the size of nickels.    You are going to be just fine  :-)

justagirl

Fearless One,

Rest assured,  this time I made sure I got the painkillers I needed, and I have to say I really needed them.  The LD flap really liked to hurt the most.  The first few days, even simple things like brushing my teeth or eating would send shooting pains along my back.  Showering was impossible without getting painkillers before. I would hope your surgeon would do the lat flat as my PS said radiation really destroyed the tissue and from the start you want the best chance you have to have a successful surgery, even if it's more involved in the beginning.

Linda,

The pain is easing up, it's now been three weeks.  I do take a muscle relaxer and pain pill at bedtime but don't take anything anymore when I wake up at night.  Finding a comfortable sleeping position is still a challenge.

All in all, things are going great.  All I need now are a couple of nipples and I'm good to go.  This is also the year anniversary of finding the lump, which was March 16th.  A year I wish I never had and wish no one else did either.

Fearless_One

Justagirl, I would say that since you are only at three weeks and not even needing painkillers during the day, that seems pretty good.   I am not surprised at all that the first few days would be painful..   I am glad you are doing okay, sounds like you are over the worst hurdle. 

I will see PS on Thurs and discuss more about the Lat flap.  He did want to wait and see how the implant did without one, but perhaps I need to emphasize to him more that I really don't want to "experiment", even if it means more involved surgery from the start.

westieluv

Well, I made it to the other side.  Bilateral Lat Flaps are done.  Surgery went well.  It all looks a little strange with bulges underneath my armpits.  They couldn't put any fluid in the TEs yet. My skin was too tight and PS was concerned that skin integrity could be a problem if I don't give it a rest.  He had initially said he would do fills quickly, but I think we'll be going slower.  Should get to go home tomorrow.  It's a 5 hour drive to get me back home.  Can't say enough about Northwestern Hospital.  Dr. Kim and the residents have taken good care of me. Goodbye Chicago!  I'll update again when I get settled in at home.

justagirl

Fearless One,

I totally am in sync with you - no waiting to see if the initial surgery is enough!  Each situation is different but all I know is from the beginning my PS said she would do the lat flap because radiated tissue could not be relied upon to support an implant.  If your PS doesn't do the lat flap at first and you need it later, it's another surgery and has the superficial tissue now been compromised?  Or your nipples if your initial intent is to save them?

I admit I am sore as hell with the lat flap scar but am glad my tata's are safe and secure.  All I need now are nipples as my PS and BS presented to me just before my surgery that trying to reattach my nipples for the thirdsurgery was asking for trouble as there surely would be decreased circulation to them and then infection.  Once you have infection, my PS then removes the implant!  No, no, I just didn't want to go there.  Especially since my PS can make me nipples!

Suggestion: write a list of your concerns and take it with you to refer to when you see your PS Thursday.  Good luck Fearless One!

Fearless_One

Thank you, Justagirl....and are you happy with the appearance?  I hear lat flaps - while highly inconvenient/painful really make them look natural....

Linda54

westieluv

so glad you are on the other side....sounds like you have a very good PS.

Fills are better to go slow.  Take care

Fearless

do you have access to the picture forum? I have picture posted of my lat flaps.  My lat flap surgery was very uncomfortable but not painful like some women experience.

Fearless_One

Linda, no - I never was on the picture forum - I need to PM TimTam?  Is that the correct name?

justagirl

Fearless One,

As far as how my lat flap reconstruction looks, well, it's just been three weeks but I think it looks just like my other breast reconstruction, which is just a silicone implant of 225cc, whereas the breast with the lat flap only has an implant of 195cc.  To me, they both look the same - very good - and fine, even without the nipples.  There is some bulk under my arm from swinging the muscle around, but even that has decreased significantly.  My PS said the lat dorsi muscle would atrophy in the next few months due to non-use and therefore the bulk under that arm should virtually disappear.

Anything is better for me than the constant worry of a reoccurring BC due to LCIS and getting two new breasts out of a DM is just a bonus!

My 17yo son saw me in a sport bra yesterday and said my breasts looked huge! (Hmmm, the implants were 100cc smaller than I was).

Linda54

Fearless

You need to PM Timtam....you know she lives in Japan but was somewhere else when the earthquake hit.  She is fine but I do not know if she had damage to her home. 

westieluv

I'm home from the hospital.  Feeling pretty good in comparison to the BMX I had in December.  Everything feels very tight.  Now I know what the ironbra feeling is all about.  I am working consciously to make my rib cage expand when I breath to stretch out the muscles.  Pain is primarly in the back. I'm very nauseated and fighting major constipation.   I took some natural herbal laxative pills last night and I noticed that my intestines were actually making noise about 4am.  It may take another day for all of that area to wake up and start moving again. I plan to take a walk today if it's nice enough outside to accomplish it.

It's early, but I am happy with how things are looking so far.  My DH says it is a remarkable improvement.

For those considering this procedure who live close enough to Chicago, I would recommend this practice.  I got excellent care at Northwestern.  My surgery was at Prentice building and then they moved me to Feinberg for post operative care.  It's all connected.  It's a night and day difference between this hospital and surgical practice and my prior care.  In comparison, my BMX care and post op treatment at Indiana University was ghetto slum.  There needs to be a way to effectively gather information about surgical practices, plastic surgeons and the hospitals where they work for a person to make an informed decision on where to go.  We need epinion for doctors and hospitals.

I'm going to wait until next week, but then I am going to start my picture journey.  Hoping for sunny days and warmer weather soon.  Have a great day!

Linda54

Beth

So glad you are home.  Take it easy and do not do too much.

The ironbra...oh yes...still have it going on. I decided not to wear a bra yesterday (out doing errands) but felt like I had one on that was too small.  Try to keep your shoulders back and chest out as much as you can. I can see where this would help.  I wish someone had told me this. I spent a lot of time sitting at the computer while recovering and my posture was not the greatest which I know now was not good. Cannot be positive that is what contributed to my tightness but it could have.

Fearless_One

There is just one thing I am unclear about (but will ask my PS Thursday) - does the use of an alloderm sling (which he will use) possibly negate the need for lat flap?

IllinoisNancy

Hi Ladies,

I'm getting my lat flap on April 6th.  The doctors didn't really give me a choice since I had a lumpectomy and radiation in 2007 along with the fact that my new bc showed up on the skin. It is right next to where the lumpectomy was.  I wish I would of had a Bilateral Mast the first time.  I think our breasts are trying to kill us and it doesn't matter what you eat, drink or take for meds.  I did everything by the book and I still got it back.  Also, please don't trust the Oncotypedx since I scored a 9 and cancer returned in four years.  Good luck ladies and I hope we all do well.

Take care,

Nancy

Fearless_One

Nancy, I am sorry that happened to you again, but glad you caught it.   I too, wish I had MX initially.   So you could see it under the skin?   Or you felt it?

Interesting so many docs want to do lat right away when you had lumpectomy/rads, but mine doesn't necessarily - I hope I am in good hands!  

Fearless_One

I was concerned about harvesting the lat flap since I am fairly thin, but he says "most women" have enough for this.  ?    I guess since it takes muscle as well as fat, you can be thin and have it done.   But still, I don't seem to have much back there!   

Linda54

Fearless

Lat Flap usually not enough fat to make boobs. That is why implants are also used.  I have always been thin (104 at time of surgery)...I did lose weight in the weeks leading up to my surgery.  I had no back fat.

westieluv

I've got a spot on the left side that is darkening up.  Not on the flap but damaged skin from the BMX that is adjacent to the suture line on the flap fold.  I shot off some pictures to my PS with an SOS email asking for help.  I am upset that it is a necrotic spot or infection taking hold.  I was praying for no complications this time.  I'll let you all know what he says about the photos.

Linda54

You are in my prayers Westieluv

Fearless_One

Linda, wow, you are very small (thin) so if you can do it, hopefully I will be okay.   I know it wouldn't be enough to make foobs, but I was concerned that he wouldn't even be able to take the flap.   I am meeting with him again today.

Westie, please keep us posted ......

westieluv

Nurse called me back to say that they think this is infection in that area of skin.  Put me on a broader spectrum antibiotic along with the Keflex and I outlined the spot with ink pen so we can watch to see if it is spreading. If so, then I'm off to Chicago again for them to look at it.  Waiting on my husband to get home from the pharmacy with the new drug to start taking it.

westieluv

I'm just wondering how long it takes for the muscle tunneled under your arm to start going down in size.  I feel like a linebacker and I can't.....I mean physically unable to do it....move my shoulders up and back to a normal position.  I am humped forward.

The ironbra feeling is ok and more minimal in the mornings, but as the day goes, the tighter I get and the more hunched forward.

Did anyone's PS allow them to take Flexeril or something to help that back muscle relax?

asr51

Westieluv, my bulge under my right arm has never gone down. I had my BMX in June. I believe it's a combination of the muscle and fat that was originally on my back.  Because of it, almost every bra I've tried is uncomfortable.  In a couple of weeks, I'm having, I hope, my last surgery.  The PS is going to do liposuction on the bulge and then use some of the fat for fat grafting.

When I had my BMX, my PS did give me pain medicine and valium.

westieluv

Thanks asr51!  The PS said something about doing liposuction to that area if it doesn't go down, but I was not prepared for how big of a bulge it is.  It's very early for me as I just had the surgery last week.  Maybe with time it will go down some, but I will be asking for some kind of revision if it doesn't greatly improve because it looks like I have foobs under my armpits.

Fearless_One

Westieluv, I wish you the best - I hope it's just because you have only recently finished.....hopefully it will go down in time.....

Anonymous

Hi westiluv,

I, too have the bulge under my arm.  It looks more pronounced because I only have a lat flap on one side.  PS said the same thing to me:  Lipo in the horizon.  Probably not in the near future, though.

The past few weeks I had been nursing a spot on the flap incision!!  It has finally closed up.  Thank goodness.  I have had it with the surgeries and I'd like to wait - if I can help it.

Take care.

Brenda 

kal_1865

westieluv when i first had my surgery i not-so-fondly nicknamed the bulges under my arm "the pontoons" cause they certainly would have kept me a float if i found myself in water...it did take a while but i would say that within 3 months the bulges were gone.  i have found that i'm not comfortable in regular bras, i'm still wearing front close, racer back jogging bras, then again i really have not gone clothes shopping yet.