Latissimus flap 2020

Imkopy2

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The Lat Flap procedure has been around for many years and I know there are several advancements that have been made over the last decade.

I was originally diagnosed in 2016 had BMX (chemo/rads) had reconstruction w implants (2017 & 2018 revision w scar tissue removed and new implants). Originally my PS said the skin on my rads side looked good but now he’s concerned. He would like to do a Lat Flap on my right side direct to implant in January.

I am fairly active person I do HIIT training 5-6 days a week, I also golf, kayak, paddle board, etc and wonder how this surgery can potentially affect my life. I know my PS said about 10% of my strength will be lost but would like to hear from people who have actually had this procedure. Gentle hugs to all of my warrior sisters out thee

megryan57

I had BMX with lat flap and immediate implants in 2008. I was 38 years old and a tri-athlete. I experienced post mastectomy pain syndrome for 3 1/2 years. It was brutal of course but from what I can tell, that is an unusually long reaction. My belief now is had I given my body true and proper time to heal, the pain would not have lasted so long. I never really stopped working out like a tri-athlete (with the exception of 12 weeks of PT right after surgery which I highly recommend).

After 3 1/2 years, I started a new job where I had to give up working out for about 5 months. NO exercise at all. I realized after about 2 months of no exercise that I no longer needed pain pills and in fact my pain was gone!

Since then, there are definitely a few things I can't do or stay away from because of the surgery such as push ups, and anything requiring pulling down (rock climbing) or pushing up (weights). I've slowed down but of course i AM 50 now so there's that.

If you decide on this surgery, my suggestions would be DO PT, and give your body a true rest for recovery. Be patient with your body and allow it to heal.

Best of luck with this decision!!

Imkopy2

megryan57- thank you so much! I’m 49 and completely understand. I love my PS and he def knows his stuff and has an amazing skill set. He did my revision surgery, ( he saw how jacked up I was from my first surgery) and I wonder if the surgery is truly necessary or if he wants to aesthetically make my right side as beautiful as he made my left. I’m trying to view all perspectives in helping me come to my decision.

OCDAmy

Why not consider DIEP?

CBK

Imkopy2

I had a Lat Flap on one side. Although not radiated, I had very thin skin on my right side and opened up a pore sized leak just before my exchange.

The surgery itself was the easiest I ever had. I had very little down time. In fact I didn’t even take anything more than Tylenol.

I don’t have any problem lifting weights. Push-ups are very difficult for me, but I don’t blame the lat flap for that. I blame the BMX and sub pec implants for that. I actually took up lifting after my lat flap as part of my PT.

I just went in for a tune -up with my Physical Therapist. He told my my ROM on my lat flap side is excellent . I happen to be a long-time yogi and instructor so that may be part of it. Overall I’m just weaker in the upper body in general but again I don’t blame it on the flap.

Trust in your surgeon is very important and I felt the same about mine. I do wish I sought a second opinion before I did the surgery because perhaps something less invasive could have been done.

I’m grateful I’m not painful and my flap was well done. I do have a strange spasm on that side that has seemed to have subsided. I actually had it botoxed and it made the spasm worse. I’m trying to ride it out and see if it disappears.

Please feel free to ask any more specifics ....

Imkopy2

OCDAmy- I’m not a candidate for DIEP

Imkopy2

CBK-I’m going to send you a private message if that’s ok

CBK

Absolutely! DM me anytime. I will be happy to share my experiences!

NotoriousWW883

Sorry if this topic has been covered already. I'm wanting to have my implants removed and my flap removed. My plastic surgeon says it can't be and he would be leaving the flap as is, just remove the implant under the flap muscle. One of the main reasons I want this surgery is to remove EVERYTHING including the flap, and take my body back to its normalcy without the flap. I'm looking for more information on this and feel I need a few more opinions. I find it hard to believe this tight muscle can't be removed if it's no longer serving its purpose to be a "breast" anymore. Thoughts?

CBK

https://naturalbreastreconstruction.com/2018/03/23/ask-the-doctor-can-my-latissimus-flap-reconstruction-surgery-be-reversed/

Not that I have any experience with this group or Doctor but it may be a place to start. He gives some interesting technical information on why pain could occur.

Hope you can get some relief!

ilovepugs

Hi lmkopy2,

My worry for you is that the very activities you mentioned~golf, kayaking, paddling may be compromised by this surgery.

I had lat flap reconstruction on my left side in 2015 and I had a revision to that side in 2016. The implant was migrating upwards and towards my armpit. My PS explained that this was due to three things: radiation which makes the skin less elastic, scar tissue, and the muscle pulling the implant in that direction. The implant was originally placed under the pectoral muscle, in the revision it was placed on top of the muscle.

I find the decrease in my range of motion, and the tension from the pec to the arm frustrating. I have difficulty pushing myself up from a lying position on my left. I have a long back scar which cannot be hidden by a bralette or tank top, but that’s almost irrelevant because wearing one makes my back ache, so I opt not to wear one. There's a mix of numbness and sensitivity in the region, and after work I often experience tightening and back fatigue in the area around the lat. I joined a dragon boat team to try to regain my strength and rom, but I couldn't sustain it.

You mentioned that your PS is concerned about your skin. My skin above the flap is very thin, so it appears rather purple. The contrast between the thick flap skin and the thin radiated skin is significant. I thought that the flap skin would stretch more because it has more elasticity than the radiated skin, but that's not the case. Additionally, the left breast is bulkier than my right breast (I had reconstruction on the right side too, but no flap) and is somewhat misshapen because of the lat flap. I've been dressing strategically for the past 5 years to try to hide the discrepancy, but it's challenging.

I am scheduled for another revision next month, as my left implant is migrating upwards again, but this time toward my sternum. In the past couple of years I have been experiencing an increased amount of tension from the top of the implant to my shoulder and neck. My PS recommends a smaller implant on the left, fat grafting to eliminate rippling and that purple skin appearance, and denervation of the muscle.

So, I recommend asking your PS if there is another solution to your issue, maybe more fat grafting?

I hope this helps you with your decision. It's so difficult to predict outcomes. I amhappy to share photos of my back and breast if necessary.

Imkopy2

I love Pugs, btw I love that name and your pic looks like my nieces pug. He’s such a stinker but you can’t help but love him lol!

Yeah that’s my fear too. I went to my GP (we’ve been together years) and he said he’s knows 1 person that had it done. He recommended I get a 2nd opinion which I already had scheduled. I’m going to see what he says and recommends. (If anything) I’m also on a fb page that discusses this topic. Such a tough decision. If you wouldn’t mind sharing pics I would be most appreciative.

The other fear I have is opening up a new can of worms where I have other procedures to tweak...I just want to be finished with this and move on. But if I’m going to experience issues in the next 5 years then I’d rather just get it taken care of and call it a day. Thanks again for all of your advice it is much appreciated.
hugs michelle

ilovepugs

Michelle, I totally know what you mean by just wanting to move on, and not open a can of worms. It's a real dilemma, and not a decision I'd want to be making right now, but you’re smart to do your research.

I sometimes consider whether I made the right choice with this type of reconstruction, but my options were limited, and this seemed like the best course of action. Naively, I did not talk to anyone who'd had the lat flap done prior to my surgery.

I'll send you pics via a private message....

izzy16

hi lmkopy,

How about doing a TDAP flap where they don't take the latissimus muscle, just the skin and fat? Not as many surgeons do this though and you may be better suited for a latissimus.

https://www.hopkinsmedicine.org/breast_center/treatments_services/reconstructive_breast_surgery/thoracodorsal_artery_perforator_flap.html

Similar to CBK i haven't had radiation but bc my skin is so thin on my left side and scarred down a surgeon wants to revise to latissimus but bc i have a lot of back issues i won’t do it. And like others have said w the BMX and sub pec implants upper body strength is already greatly reduced; i'm hoping to revise to Pre Pec soon but concerned about thin skin, etc

I get the idea of a latissimus bringing in healthy tissue and blood supply though.

Lmkopy perhaps you can ask your plastic to talk w one of his patients that had a latissimus? You might also consider talking w a PT or a sports med / rehab doc / physiatrist that can examine you and your activity goals and see if they agree w a latissimus. With your activities I'd be concerned about the affects but maybe w PT and denervation it could work.

best,

izzy

Imkopy2

That is an excellent idea Izzy. I am going to a consult and see what he says. I have also sent all of my questions to my PS to see what he says. It’s kind of like an interview. I am asking the same identical questions and seeing how both respond. But I did find this video which may help others out there. This surgeon does address the activities factor and his explanation is certainly interesting.https://youtu.be/JJtTJv27tl8

Paraprofessional70

I read your thread. I am considering lat flap reconstruction. My main concern is-- is there long-range pain or discimfort after having this surgery? Does it affect your spine, arm, back? Is reconstruction soft/hard? If uni-lateral, is symmetry good? Would you do it again? Do you recommend it? I wish I could see pics. This is a really tough decision. I don't want chronic pain the rest of my life.

Imkopy2

Paraprofessional70...I found a fantastic group on fb all of the ladies there have experienced surgery and are happy to share their story. I have gained an incredible wealth of knowledge. I am actually scheduled for surgery in January with the PS who I went for a 2nd opinion. I even found a gal who lives close to me that had the surgery with the PS I called for a 2nd opinion.

FB group-Latissimus Dorsi Flap

Jaybird627

Hi. I've had no issues almost 3 years post lat flap. I'm active and work full-time as a flight attendant. I did a lot of research before I went with this surgery. I have no regrets.

Good luck!

Jaybird~