Anyone with LE have LD flap recon?

Amoc1973

I'm wondering if anyone with existent LE had reconstruction with Lat Dorsi flap & what your experience was. I had ALND w 17 nodes removed. I'm currently finishing chemo & still have to do rads....another worry that my LE can worsen. It's mild at the moment. Any info would be great!!!! (PS I've looked into diep flap. But I'm more keen on LD. I like my stomach the way it is & for some reason I'm more ok w scar on my back)

Binney4

bumping so those of you who have done recon can weigh in here

Happy weekend, everyone!
Binney

carol57

My recon was a diep, so I have no personal experience to draw on.  But I can say that I've heard conflicting opinions from two very well qualified reconstructive surgeons. Dr. Marga Massey, who also is a certified LE therapist, believes that an LD flap recon is an invitation to LE.  On the other hand, Dr. Alex Munnoch, who is a well respected microsurgeon whose practice in England offers the full range of recon options, told me once that he believes that an LD recon might well improve existing LE, if its root cause was node removal or another surgical treatment that caused scar tissue in the area. His thought is that the LD recon surgery can include some removing scar tissue that might be causing or making the LE worse.

I wish there was clarity on this, but I suspect there is not, and after hearing both of these very qualified recon surgeons who also have a lot of LE expertise take opposite views--well, I hope you do hear some answers to the exact question you asked, which is to learn the experience of those with LE who had an LD recon.  I think that's the best way to judge the range of possibilities, and I hope more than a few women with that experience will find their way here for you.

Amoc1973

Thanks carol57. I also have spoke to 2 diff plastic surgeons with opp opinions. It would be great to hear actual experiences. The whole idea of recon is overwhelming. I have may last taxol in a week.....still have rads to get thru. Really can't imagine putting myself thru more

carol57

amoc, did you try posting your question in the recon forum?  Perhaps some who had LD recon also have LE, but it's mild or well controlled, and they don't visit our LE forum.

kira66715

When I was on the Johns Hopkins site, they said that LD and TRAM were outdated and they didn't offer them any more.

Now these are the same people who claim no LE in any of their SNB patients.

I'm no expert on reconstruction, and the people who perform it are going to be biased toward the method they perform.

Carol is far more expert than me.

It's so hard when experts differ.

Ok, I searched pubmed, and found an article about one patient in Korea whose LE got better after a LD flap. It's only one patient:

http://www.ncbi.nlm.nih.gov/pubmed/22783516

Arch Plast Surg. 2012 Mar;39(2):154-7. doi: 10.5999/aps.2012.39.2.154. Epub 2012 Mar 14.

Improvement of upper extremity lymphedema after delayed breast reconstruction with an extended latissimus dorsi myocutaneous flap.

Lee KT, Lim SY, Pyun JK, Mun GH, Oh KS, Bang SI.

Source

Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

Lymphedema is a common complication after mastectomy in breast cancer patients. Many treatment options are available, but no treatment results in a complete cure. We report a case of lymphedema that occurred after modified radical mastectomy in a breast cancer patient who showed objective improvement after delayed breast reconstruction with an latissimus dorsi myocutaneous flap. A 41-year-old female patient with left breast cancer had undergone modified radical mastectomy with axillary lymph node dissection and postoperative radiotherapy 12 years previously. Four years after surgery, lymphedema developed and increased in aggravation despite conservative treatment. Eight years after the first operation, the patient underwent delayed breast reconstruction using the extended latissimus dorsi myocutaneous flap method. After reconstruction, the patient's lymphedema symptoms showed dramatic improvement by subjective measures including tissue softness and feeling of lightness, and by objective measures of about 7 mL per a week, resulting in near normal ranges of volume. At a postoperative follow-up after 3 years, no recurrence was observed. Delayed breast reconstruction with extended latissimus dorsi myocutaneous flaps may be helpful to patients with lymphedema after mastectomy. This may be a good option for patients who are worried about the possibility of the occurrence or aggravation of secondary lymphedema.

Here's one from MD Anderson, without the details of what reconstruction and they talked about immediate reconstruction, not clear at all how they defined LE:

http://www.ncbi.nlm.nih.gov/pubmed/22878475

Plast Reconstr Surg. 2012 Dec;130(6):1169-78. doi: 10.1097/PRS.0b013e31826d0faa.

Reduced incidence of breast cancer-related lymphedema following mastectomy and breast reconstruction versus mastectomy alone.

Card A, Crosby MA, Liu J, Lindstrom WA, Lucci A, Chang DW.

Source

Department of Plastic Surgery and the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402, USA.

Abstract

BACKGROUND:

As breast cancer survivorship has increased, so has an awareness of the morbidities associated with its treatment. The incidence of breast cancer-related lymphedema has been reported to be 8 to 30 percent in all breast cancer survivors. To determine whether breast cancer reconstruction has an impact on the incidence of breast cancer-related lymphedema, the authors compared its incidence in patients who underwent mastectomy with reconstruction versus mastectomy alone.

METHODS:

All patients who underwent mastectomy, with or without immediate breast reconstruction, between 2001 and 2006, were identified through a search of prospective institutional databases. To reduce variation caused by known predictive factors, the individuals were cross-matched for age, axillary intervention, and postoperative axillary irradiation. The incidence of lymphedema was based on the presence of arm edema that lasted more than 6 months and was documented clinically.

RESULTS:

Of the 574 cross-matched patients included in the study, 78 (6.8 percent) developed lymphedema (21 with reconstructed breasts and 57 with unreconstructed breasts). Patients who did not undergo reconstruction were significantly more likely to develop breast cancer-related lymphedema (9.9 percent versus 3.7 percent; p < 0.001). Postoperative axillary radiation therapy (p < 0.001), one or more positive lymph nodes (p = 0.010), and body mass index of 25 or greater (p = 0.021) were also associated with an increased incidence of lymphedema. Reconstruction patients developed lymphedema significantly later than nonreconstruction patients (p < 0.001).

CONCLUSION:

Patients who undergo breast reconstruction have a lower incidence and a delay in onset of breast cancer-related lymphedema compared with patients who undergo mastectomy alone.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

What this means, is that the evidence is just opinion--this is new to pubmed, and I like it: Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

Binney4

Amoc, I know this decision isn't one you need to make right away, since the rads will be up next, but if you're worried about putting yourself through more surgery you might want to consider either going without recon or at least putting it off indefinitely until you're ready to deal with it. One of the women here at bc.org has a wonderful website for those of us who haven't done recon (or whose recon failed). It's called BreastFree, and it has a wealth of resources that you can consider at your leisure. Stories of women who have not opted for recon; up-to-date information on breast forms, bras, camis, swimwear and lingerie; pics of women who use prosthetics and those who don't (reassuring!)--just gives you a feel for what that option is like. It's here:
http://breastfree.org/

Please do keep us posted. Gentle hugs,
Binney