Lat flap vs. diep flap

tjohnson1971

I met with plastic surgeon this week.

First off she says she will not do immediate reconstruction for lat flap or diep because of risk of complications. So I will have to wait 3 mos after double mastectomy. The only immediate recon is implants. I am not in total favor of implants only and wanted some of my own flesh for a more real feeling.

So she gave me two options to decide. Latissimus dorsi flap will be less recovery, and get me true to size (c) but I need implant to make up the difference.

Diep flap will yield a smaller cup size, maybe a B, more recovery but added tummy shrinkage.

I am torn. I wonder what the benefit is for Lat flap with the muscle? Do we move the muscle? I wonder why an implant can’t be added to the diep flap for added fill?

Do any of you have recommendations or suggestions?

CBK

Lat flap is cutting the entire lattismus Dorsi muscle or a portion and tunneling it to needed breast for added circulation and tissue to support a bigger implant that would not be able to be placed with current breast tissue environment. Often it is used when tissue expander has failed for one reason or another, although some choose to do lat-flap with with immediate reconstruction. I've always heard of it being done in conjunction with implant reconstruction. Many people have complained of severe complications on these boards with this type of surgery. I haven't had that experience I found it to be a super easeful surgery but i only had it as a salvage surgery on one side.

If you don't want an implant diep is your answer.

jbdayton

Small implants can be placed under the DIEP flap. I know several women who chose this option. I am not sure if they can be placed immediately or in a second surgery when you typically get some fat grafting for symmetry. I would think the later,, in the initial surgery they are concerned with getting good blood flow through the reconnected vessels for a healthy flap.

Mavericksmom

I'm 65 and had DIEP reconstruction in January. I am having issues with it only because I had radiation the first time I had breast cancer.

I would recommend it. I only had one side, they refused to take off my healthy breast.

Note that you are cut hip to hip, have your belly button moved up and surgery at the breast, so basically your whole front body is a surgery site, That said, it wasn't all that painful and had I not had complications I would have been back to work in 8 weeks or less.

I don't know if it is me because I'm overweight and I.never had a good image of myself, or if it happens to everyone, but my first view of my body freaked me out. I was swollen, looked hideous and I burst into tears because I never thought I could look worse than I did before surgery. That look was VERY temporary. The swelling went down and I look more like me.

It takes time to get used to new body, flat stomach, but everything considered I am glad I was talked into having the DIEP reconstruction and I would do it all over again!

I would advise going to a plastic surgeon who has donethis surgery often, at a cancer hospital if possible. I live in a suburb but went to the city to be treated.

Best wishes for a positive surgery experience!

“You never know how strong you are until being strong is the only choice you have!"

SuQu31

tjohnson, I had immediate reconstruction with lat flap and tissue expanders. Waiting to schedule the permanent implant exchange and nipple reconstruction now (they will be done at the same time). My PS recommended the lap flap procedure for various reasons, including that I did not have enough tummy for the DIEP flap surgery. I have not had any complications from the lat flap so far. You will see in my signature that I required re-excision for a close margin- to the extent I've had any difficulties, taking that extra tissue and skin was the cause. Of course, I wanted to be rid of all cancer, so no regrets. I did not find these boards until after my surgery, but I did notice that many people have been dissatisfied with lat flap surgery. I'm not sure if the surgery has improved with time, but I see that many people who have had it recently have had fewer complications. I don't know the reason for this, and I won't hazard a guess. I wish you the best as you go through this process, and please let us know what you decide.

tjohnson1971

Thank you ladies for answers.

jbdayton- I asked the PS if it’s possible and she hasn’t replied back yet. But I would think it possible after things settle down. I hope so. Although her attitude was sort of one or the other so we’ll see I may get a second opinion but I have 3 months after mastectomy, so some time to do that.

Lula73

tjohnson71 - i was offered lat flap but I did DIEP because sacrificing my back muscles was just not an option in my book. I need them too much. Plus I’d still need implants. I didn’t need the extra fat I was carrying on my tummy though, so DIEP it was!😀 The best advice I can give you no matter which surgery you choose is to do your research (the good, the bad, and the ugly), consult with more than 1 PS that does both of these procedures, insist on seeing before and after photos of that PS’s work with ladies at your starting point having the exact same surgery and if you would not be happy with the results you see in those photos for yourself - happy without having to qualify it with a statement like, ‘I’d be happy with that considering i had mx and it could be worse’ - cross that PS off your list and move on to the next one, no pics = moving on to the next PS. You need to be 100% sold on the type of recon as well as the PS that will be doing it. Once you do a lat flap, you can never reverse it and put that muscle in your back again.

tjohnson1971

thank you. This makes sense. I decided yesterday that I didn't have a good feeling about this PS so need to look for another. Some of her replies are so rigid and I know there can be more options and perhaps flexibility. When I asked her for permission to contact one or two patients she said no one was willing to volunteer- and I found this odd since she has been doing this procedure for 20+ years!

Ldrumm65

Mavericksmom - What complications did you have with the DIEP reconstruction? I want to have DIEP done and I, too, had radiation the first time I had breast cancer eight years ago. Thanks!