Dr. Stefan Hofer - Lat Dorsi reconstruction post-mastectomy

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hicksc
hicksc Member Posts: 17
edited June 2014 in Canadians Affected by Breast Cancer

I'm in Toronto and just wondered if anyone has had Dr. Hofer do their reconstruction and how it turned out?  I wanted to do the DIEP but don't have enough abdominal fat to do it (which I can't believe!) so he has suggested a Latissiumus Dorsal (sp?) reconstruction with the possibility of also using a small implant because I don't have that much back fat either (which I really can't believe! - how much do they need anyway, I'm very small chested).

I'm a runner and do a lot of upper body strength training as well - I want to make sure that doesn't get compromised.  I'm concerned about the stories I'm reading about the tightness that people feel.

Also, I should note that I had my mastectomy in Nov. 07 so am 1 1/2 years out from that and wondering about anyone else who has had this surgery post-mastectomy.  I have numbness from the mast - wondering what else to expect other than the possibility of the tightness and overall, what are the outcomes like for Dr. Hofer's patients having this surgery?

Anyone have any feedback?

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  • hrf
    hrf Member Posts: 3,225
    edited April 2009

    I'm also curious. I have an appointment for a consult with him next March 2010 -- he's booking a year ahead just for a consult.

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  • samy2009
    samy2009 Member Posts: 1
    edited July 2009

    any news, Did you meet Dr. hoffer?

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  • jennyc
    jennyc Member Posts: 4
    edited July 2009

    I had a double mastectomy and immediate reconstruction six years ago. I also was unable to use my abd. and ended up doing the latiismus dorsi flap,without inplants. I have had a lot of problems with tightness, burning, tenderness, stabbing pain, numbness, ever since. My shoulder,esp. my right constantly aches, hard to move, they both get tired quickly. I do not believe there has been a long term study done to see what happens for us women down the road to our shoulders/backs/ etc. I have been looking and have only found bits and peices but sounds like there is a issue. I believe you can not move large muscle without something happening to what they were connected to/what part they played.I was told the only problem would be if I was a down hill skier, its that last push, other wise thats all I would notice. Wrong!!!   If I knew now what I know ,I would do different, I thought there was a ?like gummy bear inplant ,not sure, but I would investigate that first, before I started moving mucles around. The problem is for me is I wanted breasts , I do have to say my breast turned out well, I do have a hard time finding bras that fir correctly, as I am fuller under my armpits ,and if I get a bra that helps pull that over I am in severe pain, crazy . All I can say if you are not in a hurry, check all your options out, I wish I had. Let me know if I can help in any way. jennyc

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  • analu
    analu Member Posts: 4
    edited July 2009

    I had an appoitment two months ago with him,  I am having bilateral mastectomy in September but i refuse having reconstruction for now, he suggested also the flaps since I CAN not get implants due to radiated skin tissue, neither can have skin from my stomach.I think it is better to recover myself from the mastectomy and I will see later..I will keep reading other peoples comments that my help me also in my future decision.

    Thanks ladies and God help us.

    .

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  • graciemom
    graciemom Member Posts: 4
    edited September 2009

    Dr. Hofer took over my care after Dr. Neligan left.  He is an exceptional surgeon, and I would trust his judgement.  I had an IGAP due to insufficient stomach fat.  I had a lot of problems post surgery, but it finally all resolved.  I have a really good result, no pain anymore, and although my reconstructed breast does not look much like my real one, it looks pretty good with my clothes on.  I had same day reconstruction because it was my second bout with breast cancer in the same breast, and the radiation had happened 12 years previously.  the second surgery was a mastectomy, and I wanted it all done at the same time.  Mastectomy is more an emotional recovery than a physical one, so I went for the reconstruction at the same time to get it over with. 

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  • graciemom
    graciemom Member Posts: 4
    edited September 2009

    If you truly want a second opinion I would check out Dr. Levine in New York city.  He is a colleague of Dr. Allen, the first surgeon who developed the use of flaps for breast reconstruction.  I saw him before I had my surgery done in Toronto, because I was having difficulty getting an appointment to see the surgeon, in time to have a same day reconstruction.  It will cost you an airfare to New York and a consultation fee ( about $350 US) but well worth it if you are unsure. 

    However, I have great confidence in Dr. Hofer.  He is an excellent surgeon, and the University Health Network did a large search before they selected him.  He is totally dedicated to the best result for you. 

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  • phoenixsmom
    phoenixsmom Member Posts: 58
    edited September 2009

    I will be having Dr. Evans at University hospital in London do my diep surgery in 2 months.  Won't they give you some more time to get a little more fat before your surgery?

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  • graciemom
    graciemom Member Posts: 4
    edited September 2009

    You'll probably find that once he sees you, and if you agree, your surgery will occur fairly shortly after. 

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  • Lizzyshort81
    Lizzyshort81 Member Posts: 1
    edited September 2009

    Dr. Hofer's outcomes are good.  He is pretty good at what he does.  I had my surgery by Dr. Jugenburg and I was very happy with him, but he no longer works at Toronto General.  He is at Humber River, I think.

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  • Dee123
    Dee123 Member Posts: 26
    edited October 2009

    Hi there

    I had Dr. Stefan Hoffer. My mastectomy was done by a general surgeon from PMH  and Dr Hofer performed the reconstruction with implants. I am very pleased with the results. I found him to have great bed side manner and really tried to give me the results I was looking for. I also did the nipple reconstruction and again was very pleased.

     My range of motion is great. I did my recommended stretches daily!!!  I can wakeboard/waterski, run, yoga, etc. There still is  some tightness but you get used to it. also............It took a while... but I can sleep on my tummy again too!

    That was my experience.

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  • lovemyself
    lovemyself Member Posts: 29
    edited October 2009

    Hi Dee, it is nice to hear that you like the result. What kind of nipple reconstruction you did? I am going to see my surgeon in two weeks to discuss about it. He usually does skin grafting for areola and CV skate nipple.

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  • Dee123
    Dee123 Member Posts: 26
    edited October 2009

    Hi I had a skate flap (I think that is what its called)

    He used my own tissue to recreate a nipple.

    I am going to tattoo for the areola as I dont want to scar another area of my body.

     These truly are very tough decisions... I just want to laugh when some of my friends stress of what color to paint their bedroom. When I have to worry about the color of my nipples???? :)

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  • lovemyself
    lovemyself Member Posts: 29
    edited October 2009

    Hi Dee,

    I am sorry if I side tracked the original message. I just want to thank Dee for her response. Yes, it is weired to keep thinking about nipple and areola colour. I went to my previous mastectomy bra lady some days ago. When I mentioned about nipple reconstruction, she looked at me as if she had never heard of this. She asked me why I would want it as my new girls look so great. I answered, "complete picture???" It is weired. 

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  • graciemom
    graciemom Member Posts: 4
    edited February 2010

    It is definitely the final completion of a long process.  The nipple creation and tatoo makes such a difference.  Your reconstruction actually looks like a breast when it is finished.  Otherwise, to me at least it just looks like a lump of fat. 

    You might be interested in knowing that we are organizing a Breast Reconstruction Awareness event on April 29th 2010, at TGH, which will be an educational presentation by Dr. Hofer, and Dr. Zhong followed by cocktails and a Q & A and a chat with those of us who have had the procedures done. 

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  • Mantra
    Mantra Member Posts: 968
    edited February 2010

    Hey Gracie, Is this by invitation only? Wonder if I'll be invited. My surgery is scheduled for April 16 with Dr. Zhong(replacement of my left breast tissue expander - original doctor put it in an incorrect postion . . long story!). I am also most likely having a prophylactic mastectomy with Dr. Easson followed by one step alloderm with Dr. Zhong. Going to be a long day . . . glad I'll be alseep during most of it.

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  • nosurrender
    nosurrender Member Posts: 2,019
    edited February 2010

    Hi,

    I am very athletic. I am a swimmer and use my upper body quiet a bit. I had a LD in November and I can no longer swim and cannot do a quarter of what I used to do.

    If you are a tennis player, swimmer, upper-body-user- be advised that things will not be the same.

    I am having another surgery to try to correct what is wrong, but it is doubtful I will ever be where I was before. 

    My implants failed and I don't have enough belly fat for the DIEP. I had rippling with the implants. I still have it with the LD. I don't have back fat so it is just the muscle covered by my previously radiated skin, rippling just as bad as before.

    Do your research. Ask this doc if he completely severs the thoracadorsal nerves so you don't have nerve regeneration and movement, contracting and muscle tightness.

    Please note: I know of MANY WOMEN who have had great success with LDs. I am just not one of them and had to let you know.

    hugs,

    g

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  • jasonborn68
    jasonborn68 Member Posts: 5
    edited March 2010
    I can't help you with a specific recommendation. Would suggest stretching your search to include physical therapists tho. I've had better luck with most of my various injuries with the PT than the physiatrist. The PT I saw after surgery did a lot of hands on work helping to loosen muscles as well as teaching me stretching, strengthening, etc. I'd suggest asking your surgeon for a recommendation. Good luck - it's wonderful that you're pursuing this. I'm always amazed at how few women are told about the options available.
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  • nkotarski
    nkotarski Member Posts: 1
    edited March 2010

    'jennyc' and 'nosurrender'--Thank you for your honest appraisals of Life after LAT reconstruction.  I am so sorry that your active lifestyles have been compromised.  I am sure that your surgeons meant well and wanted to help you regain self-esteem and health after mastectomy, but unless our doctors are athletes, they don't understand the importance of the mind/body connection, and that we NEED to be able to USE our bodes to help us get well!!  I will be going to a R breast skin-sparing mastectomy on Thursday, and initially was going for the LAT flap, but the more I read about it, and the more exercise I do, the less interested in it I am!  I don't like the idea of implants, and all the possible surgeries and replacements down the line, but at least I hope to have full use of the  muscles in my right back and shoulder and my abdomen!  My abdomen is not very strong, and my right shoulder and neck have often had 'issues' over the years--I don't see where having a muscle removed from my latissimus dorsi would be doing it any more good.  I like to swim!  I want to be able to continue!  I also run, so I've been trying to research running with implants--silicone versus saline.  What a terrible decision to be in a position of making.  I hope that you will both have continued healing and improvement, with time.

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  • Dee123
    Dee123 Member Posts: 26
    edited April 2010

    Hi  nkotarksi,

    I had my breast reconstruction done by Dr Hofer about a year ago. I chose to do expanders which were then replace with cohesive gel implants. I have 445 cc in each breast which was placed under the  muscle.  I am very happy with the outcome.

    I can still swim, wakeboard, jog, bike ride etc.Only have some difficulty with pushups and plank position in yoga.  . Jogging is  fine... they dont move...no need to wear a bra (ha ha). 

    Sorry I cant comment on the Latissimus Dorso Flap reconstruction but there is a website that may help you www.breastrestoration.ca

     Good luck with your research and decision making. I know how difficult it is.

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  • hardtail59
    hardtail59 Member Posts: 4
    edited January 2012

    I had my surgery on Oct 3/11 and let me tell you ...it was the best thing i have ever done!!

    I walked around like a monster for 8 yrs with a radical mastectomy I was horribly disfigured!!

    I saw Dr Hofer, and I was in within a month or 2 and I saw him before the surgery, he smelled good and was ready to change my life. I woke up with a feeling I had gone to the gym and did a bit to much on the weights, no real pain at all, and the BEAUTIFUL BREAST was there, he truly knows how to make a beautiful Breast!! He is a wonderful guy and funny, and I just love him!! He has restored my hope in DR's and his team, aka Katrina and Dr O'Neil are just wonderful too!

    I have to finish the other side in Mar so this summer is going to be amazing, my Harley no rubber boob and a tank top...THANK YOU DR HOFER... You're amazing!!

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