Breast Reconstruction and Lymphoedema

kerrie389

Hi Ladies,

Wondering if anyone can share their experience in this matter.

I'm off to see the PS next week to start the ball rolling with my reconstruction process. I think i will be having a skin sparing mastectomy on my good side and a DIEP reconstruction.

My concerns are:

Will this surgery make my lymphoedema worse.

Will the scar across my abdomen prevent me from doing the self massage and moving fluid down to my inguinal nodes.

I have just completed the lymphoedema therapist course. I have no experience at all but i now have all of this new information and i'm wondering if i am doing the right thing by having the surgery.

Would really appreciate any feedback .

Kerrie 

NatsFan

I had DIEP and have no issues moving the fluid across the scar.  My LE therapist gave me some exercises to do to help loosen the scar tissue and that has helped as well.  Not sure if the DIEP worsened my LE or not as I wasn't dx until long after the surgery.  But I can tell you I love my DIEP recon and am so glad I did it.

Good luck!

Anonymous

Kerrie, I have truncal LE and just had surgery to remove my implants. My surgeon has completed LE training and definitely modified my surgery to minimize the impact on the path to the inguinal nodes. She didn't extend the incision across that area because she didn't want to create scar tissue that might hinder lymphatic flow. She even placed the drains in the front of my chest under the breast area vs. under my arm since that's where most of my LE exists. I have developed some post surgery swelling in the breast area where she worked, as well as in my original LE area. The LE therapist working with the surgeon has recommended I wear compression for four months to help prevent my LE from becoming worse. It does seem to be helping to reduce it everywhere, and I am hoping I will eventually be at my pre-surgery level of swelling. The surgeon thinks it may even improve since the implants were such a problem. My surgeon does mainly flap surgeries, and I wonder what she would say about DIEP and existing LE. Kerrie, as someone with LE, these are good questions to be asking prior to surgery. My surgeon was Dr. Marga Massey, and she may be a good resource re the impact of DIEP on LE.
I will add that while I had my implants, which had a lot of scarring, I was seeing a myofascial therapist to help reduce that. My LE definitely improved as the scarring was minimized. My myofascial therapist has been sensitive to my LE areas and definitely has a gentle touch, but in general, those trained in LE might worry that this kind of therapy could be too aggressive to the lymphatic system. My surgeon said that since I have had positive results from this that she wouldn't tell me not to do it, but did recommend waiting at least eight weeks before letting the therapist work in the surgery area. It would seem that the myofascial therapy hit on some of the intercostal nodes, which may be why it had a positive effect, but the concern would be about potential damage to the delicate lymphatics close to the surface of the skin. In my experience, if the scar therapy is gentle and causes minimal inflammation, it hasn't resulted in a flare.

NatsFan, I would be very interested to hear what exercises your LE therapist recommended to help loosen the scar tissue. Glad to hear you are happy with your DIEP recon!

kerrie389

Thank you very much NatsFan and Tina.

I will definately be discussing theses issues with my PS. Tina i have never heard of  myofascial therapy. Something more for me to research!

Tina you were very fortunate to have a surgeon trained in LO therepy. It just amazes me how the doctors have absolutely no idea about it.

I did the course mainly for my own education about my health and am so glad i did.

After i have recovered from the surgery i will definately be looking at working in this field to help other people.

NatsFan i will be interested as well to hear about the exercises you were given to reduce the scar tissue. 

NatsFan

What my LE therapist gave me to loosen the scar tissue was a square sheet of blue rubbery stuff - like something you'd put under a plate to keep it from sliding.  It's extremely friction-y (if that's a word) and I use it to aggressively stretch the scar tissue in a diagonal pattern across the scar.  It's easy to do but hard to describe, but basically it's as if I draw a series of X's across the ab scar with the blue sheet, stretching very aggressively pulling one way to draw one stroke of an X a few times, then doing the other stroke of the X a few time.  Then I move over a few inches, and do another X.  She said I should really stretch it to the point just short of where hurts.  I also did that a bit for my port scar and that loosened nicely.  I should do the ab scar more often that I do it - I think you've both inspired me to get back into doing it more regularly. 

My ab scar is well over 2 years old, however, so she probably OKd me being a bit more aggressive about the stretching since it's completely healed by now.  I'm not sure how aggressive one should be on a newer scar.  And of course you don't want to stretch it to the point of injuring the skin or causing inflammation which could cause a flare.