Latissimus Dorsi Breast Reconstruction

Sorry for answering this late - for some reason this thread was not in my threads to follow anymore...

minxie - sorry I can't be of any help.  I am waiting myself to get the appointment with a pain management dr. I can't work out as it makes my serratus muscles hurt (all the lower rib cage). I can only do a minimal of yoga postures (forget about any yoga posture requiring support on the arms). I never had, on the other hand, any ROM issues, and was able a few hours after the surgery to lift my arms above my head and have full range of motion on both arms.

I am stuck to percocet that only barely takes the edge off the pain - advil, motrin, ibuprofen are as efficient as a glass of water. If YOU find something that works better, please advise me too.

And now, to answer to the other questions - and please take this as said from my own experience and from researching extensively online.

- If you have skin-sparing mastectomy, and are not looking forward to doing rads, you DO NOT NEED LD FLAP. You can do the simplest way, either TE+exchange (taking a longer time), or one-step with Alloderm  (more painful for a while).

- If you have rads, the best is to wait until AFTER the rads to decide what flap you want. Otherwise the muscle/skin of the flap will get affected by the rads.

- VERY IMPORTANT: the more athletic (as in doing sports that develop the LD a lot, like gymnastics, swimming, etc) you were before the LD Flap the more problems you will have. Because the LD is very developed and has a very important part in holding your torso upright. The other muscles will have too much trouble compensating and you will have a very high risk of permanent back pain. Also you will be more unable to do various things (getting up by pushing yourself up with your arms, turn around in bed, etc) than women who were not athletic before, because your body would be way too used to a very developed LD to be able to compensate.

- Also in the same case as above, the bulge under your arm will be very substantial, and the LD will not atrophy properly, even if the thoracodorsal nerve will be cut - the chances of it regenerating will be very high. Also, the bulge might be so big that it will make your arm sit in a wrong angle in your shoulder socket and cause shoulder impingement. You might even have to go to the extreme point where you will need to have another surgery to completely remove the LD muscle flap to get rid of all the bad SE's with the shoulder (I have found a couple of cases).

So, please, choose this type of reconstruction only in extreme cases - if you did rads and your chest skin is compromised and you do not qualify for DIEP. Better take a few months and fatten up for DIEP than do LD flap. There a simple logic - there is NO muscle in our body that does not have a very good reason of being there. NO matter how much the PS is telling you that  you won't miss that muscle, trust me, you will

alex56 - I had blmx with lat dorsi and te's on June 1.  I love the result.  It was the only option for me, but I would do it again.  In the last couple of months, I've had a little back pain but as long as it's not mets, it's not anything that would make me say it's not worth it.  Everyone's result is different - not trying to tell anyone to do it, but just sharing my results hoping it makes you a little less anxious.  Good luck!

Tender ~

What about a free flap?

Teresa- I had LD flap surgery with TEs and then exchange.....I had my PS do revision work on the "dog ear" that was prominent on one side of the scar.... It's 4 - 5 months since that surgery and you can barely see the scar line...really glad I had that last part worked on.....

Hi all, just putting in a different perspective...while it is certainly true that lots of things can go wrong with Lat Flaps, it is not a done deal that any of the dire things will happen.  There are quite a few sisters on here who have lost no strength at all, are not in any pain, have no "iron bra" and the breast looks great.  I'm one of them.

Was I lucky?  Apparently so, but I'm not the only one.

Was my PS extraordinary?  Unequivocably YES.  Dr. James Passaretti of Darien, CT.

I have regained full strength (never lost it); my other muscles did compensate for the lost lat muscle, I have full range of motion, some or most sensation back and no bulge under my arm at all.  I was told no push ups, but I could do them if I wanted to.  It just distorts the breast in  a way that seems not a good idea, so I don't do them.  But would my arm hold me up?  Sure!

If done well (make sure your surgeon is extremely well versed in lat flap) it can be a very good operation and well worth it.

PM me if I can help you further, but for sure, do your homework on it.  Linda54 is on here, she had one as well, is very strong, looks fantastic.  Altho she has some issues with the "iron bra" syndrome.  (She also lifts weights, which is going to aggravate that).  I suspect she finds it worth it.    They are some women on here with lat flaps who kayak, swim, etc.  It can work out.

Good luck to you!!

Yes!  Thank you for sharing your successful lat surgery experience.  I too haven't had any problems.  Well, my "nipple" area seems to be a little too far to the left, but I think it will be corrected when I go for my revision.  As far as push ups, yes, I too tried and was able to do them.  Do I need to do a push up in my everyday life, probably not.  But I can do one.  I think my body will compensate for the missing muscle.  I wasn't an athlete before surgery, but I did workout with weights.  I still can.  Sometimes things feel weird, but sometimes I think it's the numbness that makes it feel that way.

 I feel so blessed that I did ok with this surgery.  It was the best choice for me. 

I had a great experience too with surgery and results. I wasn't given any restrictions as far as working out and have benefitted from the discussion not to do pushups, etc. I've been trying to do those but on my knees to relieve some of the force. I can live without pushups but tell me more about weights. Why no weights? I wouldn't want to give that up. I'm not a bodybuilder or anything but like to keep my arms in shape. Thoughts?

thanks anniealso! 

As someone who had a lot of extra skin after massive weight loss, then surgery to remove it, I would probably take the scar over the skin.  I still have some extra where my bra strap is, by the under arm area.  But it was there prior to BC and compared to what it was years ago, I was ok with it.  Not everyone agreed with me at the time for wanting PS to remove extra skin.  Well, it bothered me so I did it.   It just depends on what makes you feel better, or worse.  I think it's a personal decision and will be different for everyone. 

Yeah for you!!!   So happy  for you. 

Teresa

Faythnme...wahooooo...congrats on the nipps.  At least she will redo the one in her office.

OMG - Does the back scar ever stop itching!!  I remember when I was growing up my grandmother had one of those back-scratcher things.  What  I would give for that now.!!!

Thanks... it does look a lot better now so I'll chalk it up to healing - on way to oatmeal bath now.

I so enjoy a back scratch after healing from this surgery.  It is a little strange when the sensations go from being there, to not, to being there again.  I just tell my DH, "keep scratching, cause I only feel about half of it!" LOL

I saw my plastic surgeon last week and asked him about any exercise restrictions.  He said no restrictions unless my body physically can't do it.  Interesting how different docs say different things.  I'm still doing push ups on my knees because it just doesn't feel right on my toes.