Latissimus Dorsi Flap Surgery tips-advice

LokiJewels
LokiJewels Member Posts: 13

I'm having LDF surgery Oct 4th on only one side.  The radiated breast needs fresh muscle & skin. Anything you would like to share about this before/during/after process would be a great help.  I'm no stranger to surgeries (since my diagnosis 05/09 I've had six) but for some reason the thought of back incision is really bothering me.  I think having two small boys to take care of too is overwhelming.  On another note I'm so happy stumbled on this site! What a wealth of information on here!  Wish I would have found it earlier. Have a great day.

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Comments

  • mittmott
    mittmott Member Posts: 409
    edited September 2010

    I had the same thing.. Lat flap on one side only due to prior radiation... The other side is just an implant.  Some will tell you the surgery is no big deal.  I found it to be a hard recovery... Much tighter and more pain then just my implant side...That said, I think the results are much better on the lat flap side..  It looks more like a natural breast.   Others didn't find the surgery / recovery hard.   I do have to tell you that I don't feel the scar and cut along the back have really affected me.  It is tight, and you will have the tight bra feeling for quite a while, but it doesn't stop me from doing.  Unfortunately, I have severe nerve damage in my arm due to an axillary node dissection with a touch of lymphadema, so that is what gives me trouble...  Good luck with the surgery and a speedy pain free healing.

  • GG27
    GG27 Member Posts: 2,128
    edited September 2010

    I am one of those that had a pretty easy time of my lat flaps.  I had both sides & like you was worried about the pain especially on my back.  It was (for me) a much less painful operation than my BMX.  I didn't find the pain to be bad at all, the back incisions are just that, incisions, not grafts which would be very painful.  I've had a bit of tightness after my fills, but I took it slow & will have my exchange next month, eight months after TE's were placed.  

    You will have to take it easy, not easy to do with 2 little boys around, but you will want to try really hard so you can heal well & not have a hard time with your fills.  Good luck, you can PM if you have any specific questions.  Hopefully others will pop in to reassure you too!

    Cheers, Dee

  • LokiJewels
    LokiJewels Member Posts: 13
    edited September 2010

    Thank U for your comments. Feel so alone sometimes on this long journey.  This information helps me.  I also have an implant in the other side and the TE and implant will both be exchanged in 3 months.  This is my third reconstruction surgery (first two failed-both were implants) so I'm keeping positive on the third time :-)  

  • mittmott
    mittmott Member Posts: 409
    edited September 2010

    Good luck and have an easy recovery.

  • Annabella58
    Annabella58 Member Posts: 2,466
    edited September 2010

    Hi there,feel free to PM me, I had a uni lat flap after 1st go round with a lumpectomy and rads.

    Lat flap is a tough surgery to recover from,but of couse, it is doable. You will need help for the those two little guys, dear.  If friends offer to cook, give them shifts and freeze it.  You want as much help and ease as you can get.  Tell the boys what they can handle, (mom's back is sore and we need to pick out new videos works) and see if you can swing a babysitter for the afternoons so you can grab a nap.

    You may need some physical therapy after and I highly reccomend it.  It really helps with the mobility getting back.  I did not find my strength compromised at all from it and the boob is gorgeous.

    I admit, the back scar had me scared, but it fades with time to a very thin white line, under your armpit down about 5" on your side.  Wearing backless stuff, low cut things, is just fine.  The only thing that this would show with is a string bikini.  All PSs are different, but do ask yours to show you his "brag book."  It should make you feel better about all this.

    Good luck, PM me for any life easing tips, (I have lots) and know all will be well and you'll come out cancer free, and with a lovely hooter. 

    Annie

  • momofcuig
    momofcuig Member Posts: 85
    edited September 2010

    Hi...

    I had a uni lateral latissimus dorsi flap on May 26th. I have had 3 of my 4 chemo cycle's. I just happened to see this thread and wanted to comment.

    Unfortunately I have not had a good experience since my surgery. For whatever reasons....my graft site (my back) has never healed properly since my surgery.

    I have been hospitalised once with a wound infection and then a second time right after my first chemo cycle. I had developed a temp and had ALOT of drainage from my wound but even though they cultured the wound the second time...I did not actually have a infection.

    Anyway, there is no medical reason why my back is taking so long to heal. And 2 breast surgeons and a plastic surgeon have tried different things to help it heal to no avail.

    I too have young children. So my doctor had warned me after surgery to take it easy...no heavy lifting, stretching, reaching, only light housekeeping. I couldn't even lift my baby in or out of his crib. I didn't drive for 6 weeks. I am also a nurse so believe me...I knew what could go wrong if I didn't follow doc's orders. So I did follow order's!

    On a positive note......while I was in hospital having my mastectomy I met a woman who was having the exact same surgery as me and same surgeon. We both had Lat dorsi flap using our own tissue, not implants. She is 33 and has 3 young kids, I am 40 and have 5 young kids. We have kept in contact with each other and she is doing really, really well. No problems with her mastectomy site or her back. She has even completed a triathlon since!! The only difference between us is that she had chemo prior to surgery.

    I do not mean to alarm you with my story but want you to know that things can go wrong. Please feel free to private message me if you wish. Best of luck and ask plenty of questions.

  • tamgam
    tamgam Member Posts: 255
    edited September 2010

    Kimberly- I had the LD flap surgery done in march.  I had both sides done and no other tx.  I have to say that my back incisions healed wonderfully.  I had lots of numbness which is very awkward.  But after healing for a few months and slowly getting my energy back I feel great.  I do not notice any strength issues and my range of motion is quite close to normal.  I have 3 young children (not toddlers) and I will agree you will need lots of help the first few weeks.  But I want you to know I feel very close to my old self 6 motnhs later.  My PS never really suggested exercises so I did light stretches and not much else.  As soon as I felt more energy I started walking for exercise again.  It can be a pretty "easy" recovery if you are fortunate so keep good thoughts!  Lots of luck and hugs to you! 

  • robin2
    robin2 Member Posts: 7
    edited September 2010

    Kimberley- I am 12weeks post lat dorsi reconstruction/Mastectomy and still have limitation of shoulder movement on this side and a feeling of tight scar tissue around my back.It is encouraging to read from others that give it another 3 months and I should  be feeling alot closer to my normal self.If you have small children it is paramount that you get help for the first 6 weeks especially if you are having surgery on your dominant side as I did(R side and I am R handed)You will not be able to lift/do housework and will find it difficult to sleep due to having a scar on you back and the swollen mastectomy site on the front(although it is a little unclear from your post if you have already had the mastectomy on this side?).

    My surgeon also advised me that as I was very thin he had to take an extended lat dorsi flap(ie the whole muscle)and this was why I had more post-op pain on my back.I recommend Diclofenac for the muscle pain its excellent. On the positive side he has done an amazing job and the reconstructed side matches the normal side well. When I came home from hopsital my 19 year old daughter wanted to see and it was heartwarming when she exclaimed' Wow Mum that is amazing!' especially as I had considerable bruising and swelling still.

    So my advice would be expect the first 6 weeks to be hard and protect yourself/get help-my sister was amazing! I am having fortnightly physiotherapy where the PT massages and breaks down the scar tissue and this is worth doing.Good luck we will all be thinking of you.

  • rockyroad1203
    rockyroad1203 Member Posts: 31
    edited September 2010

    I am struggling with the decision of having the lat done on one side or both . I am having a BMX on Oct with reconstruction (TE & Implants).  I only need to have the left done, but I am choosing to do both. I am right handed.  The left needs the lat procedure as I have had previous radiation.  I know having both lats done will result in a better cosmetic outcome.  I don't know if I want to put myself through the additional surgery/pain for that reason, but it is important to me to be symmetrical now since I have not been for the last 8 years after my previous lumpectomy and radiation.   Any more advice?  

    Missy 

  • LokiJewels
    LokiJewels Member Posts: 13
    edited September 2010

    Robin2 - I opted for the bi-lateral Mastectomy and since have had two implant reconstructions (on both sides) that did not work so now we are attempting the LDF surgery due to the radiated right breast. I'm right handed which will be my surgery side so it will be rough.  I am also thin so extra muscle will be taken in my case too. If this works in 3 months I will have the TE removed and the left implant removed and have an exchange done on both so they will somewhat look similar. Nipples and other fine tuning will be done 8 weeks later.  PT sounds GREAT!  I will have to look into that after this first upcoming surgery.  Thanks for sharing

  • robin2
    robin2 Member Posts: 7
    edited September 2010

    Kimberley- yes the PT doesnt just do the massage etc but they listen to you and encourage you which is just as important. I do not think you will disappointed with the reconstruction after your exchange-the extra tissue is needed to support the implants and adds to the more natural look of the breast.At 3/12 the bruising and swelling has all gone and I am so glad I had it done even though it was hard physically.And I can get my arm above my head now with little stiffness-even my back is nearly there.

    Let us know how it goes-all thinking of you 

  • scareds
    scareds Member Posts: 77
    edited September 2010

    Hi Kim,

    We are are all with you! This isn't an easy surgery. In fact, I had a very difficult time with it and still have many long lasting side effects from it, but it does give a beautiful result. I had 2 boys at home when I did it. They were fine. So was dad. Good luck to you! Wish you only the best!

  • LokiJewels
    LokiJewels Member Posts: 13
    edited October 2010

    Hello Ladies,  I'm back home from surgery.  In hospital for 3 days but now home with 3 drains.   So far the hardest part for me is the drains.  Can't wait to get them out tomorrow!  The breast already looks 100% better than before and I have good range of motion in that arm.  Majority of the pain is from the drain area, if it wasn't for that I probably would skip the pain meds but as it stands right now they are needed.  My Mom has been here helping with the boys so I'm taking advantage of lots and lots of naps.  I'm allowed to take showers (Doc said I could) and that alone makes you feel sooo much better  :-)   I'll update after my appointment tomorrow, keeping fingers crossed that all 3 drains are removed.

  • Annabella58
    Annabella58 Member Posts: 2,466
    edited October 2010

    Kimberly, so glad that you are done!  And it sounds like you will recover very well.

    I know the drains are awful, but try to remember what an important job they are doing for you.  Mine did stay in 3 weeks, but everyone is so different.  At the end of the first week, I had gotten it down to about 2 minutes, zip zip and done. 

    wonderful news!! So happy for you, and you will be happy with the result!

    xoxo

  • robin2
    robin2 Member Posts: 7
    edited October 2010

    Kimberly

    I am so glad you got home even with the drains in-there is nothing like your own bed and to see your family(even if you have to stop the boys jumping on you!). I came home on Day 6 with 1 drain in which they took out on Day 7 even though it was still draining 100mls.The unit I was treated by have a policy of not leaving the drains in longer due to the infection risk and they also do not drain seromas for the same reason.

    From what you have said be prepared to develop a seroma as you are thin like me.It was explained to me that the lat dorsi had been completely 'transplanted' as I had very little fatty tissue so this had left a 'vacuum' where it was before.The body likes to fill vacuums with fluid hence the seroma.I developed about 300mls of fluid within a week of the drains coming out which felt dispiriting but dont be tempted to ask them to drain it-it DOES go away and I found it also reminded me not to do too much.I am now 31/2 months post op and still have about 50mls but I am sure the body will reabsorb it.

    Take care-it will be so good when you can hug your boys again even if it is gentle!

    Robin 

  • LokiJewels
    LokiJewels Member Posts: 13
    edited October 2010

    Robin - my drains were only producing 25 ml each a day that's why she removed them...WOW 100 ml a day for you and they took the drain out?! It is sooo interesting to me how each Doc does things so different than the other even in the same town let alone in other Countries.  I'm feeling much better this week and I am actually holding a play date at my house today after school!   Seven screaming kids... hope I did not bite off more than I can chew ;-)   but two other Moms will be here with me to keep them in check.  I hope you all have a great week!  I love this time of year and so blessed to be able to spend it with my family and friends.  This board is a lifesaver!!!!!!!

  • julie75
    julie75 Member Posts: 635
    edited August 2013

    Ladies:

    I had a BMX on September 17, with TE's placed, and had to go back two weeks later to have some necrosis removed on the left side.  Well, he deflated the left side, and it looks a bit flat by the scar.  I had asked for an extra cup size, which I think will add an inch or so to my existing bust, but due to the necrosis removal, he said the skin might not stretch enough to provide the extra inch.  I think I'd need to get the Latissimus Dorsi Flap Surgery done to give me the extra inch.

    Right now, I'm not too concerned about adding an extra inch to my bust, but I don't want a flattened breast - I want something natural looking.

    Has anyone had this issue?  I'm just not sure how much skin can actually stretch after tissue removal, so any thoughts/advice would be much appreciated.

    Julie

  • julie75
    julie75 Member Posts: 635
    edited October 2010

    Ladies:

    I'm considering the LAT flap, since I had necrosis removal in my left breast, and the PS doesn't think there's enough tissue for the expansion results that I want.

    Having said that - can anyone give me a bit more information on the back scar(s)?  I've read that the middle- or lower-transverse location for the back incision is the best.  Also, how noticable is the scar?  Apparently, some women have very thin incisions.

    Thanks.

    Julie

  • LokiJewels
    LokiJewels Member Posts: 13
    edited October 2010

    Julie I just had the lat flap done about 3 weeks ago on my right side.  My PS measured my belly skin and my back skin and decided the lat flap was best for me.  She also decided to do my back incision horizontally so the scar will be in my bra line.  It is about 6 inches long and 1/8" wide right now.  I had my 6 month check up with my Oncologist yesterday and he was amazed at how wonderful the back scar looks and is doing so Kudos to my PS!  My husband said it's getting smaller and smaller everyday.  At first it was very swollen/ugly but now it's looking much better.  My PS said that it will not show unless I'm wearing something really thin like a string bikini.  The incisions for the transplanted skin on the breast looks even less wide, I'd say about as wide as heavy thread that you would sew with.  Hope this helps and PM me if you would like to talk more.

  • julie75
    julie75 Member Posts: 635
    edited August 2013

    Hi, Kimberly:

    Thanks for the quick response, and the very descriptive information.  I'm glad to hear your scars are healing well and that the back scar is shrinking. 

    I'll be seeing my PS next week and will follow up with him.

    Julie

  • Helpersis
    Helpersis Member Posts: 2
    edited December 2013

    anyone have tips on how to help someone the first couple weeks after surgery?  My sister in law will be at my house, post op (bilateral).  How will she sleep with drains front and back?  Is there a special pillow I should get  to help make her more comfortable?  She is in surgery now. 

  • lizzi
    lizzi Member Posts: 4
    edited December 2013

    Hi everyone

    My name is Liz they call me Lizzi  I will be having a mastectomy and Latissimus flap the same day which will be Dec 23 this coming monday really scared but has to be done this is the first surgery i have ever had so hope all goes well hope i am making the right decision is there anyone who recently went through this and can give me info on the procedure

    Thanks Lizzi

  • KSteve
    KSteve Member Posts: 486
    edited December 2013

    I was glad to see this thread pop up.  I'm going to have the laissimus flap and new skin on my radiated side from my back.  Will have a tissue expander again on that side, with exchange surgery about 10 weeks later if all goes well.  Will probably do different implants and do both sides at exchange.  My surgery is on January 23.  Here we go again!  Would also love to hear from those who've been through this procedure.  I'm really wondering about the scarring from where the new skin will be attached.

    Good luck to you, Lizzi.  I'm in a different position than you, having had my BMX in January 2011.  But I wish you the best in your surgery on Monday!

    Kathy

  • Moderators
    Moderators Member Posts: 25,912
    edited December 2013

    Lizzi, welcome to Breastcancer.org. As well as what you can learn from members' own experiences in previous posts, the main Breastcancer.org site has a section on Latissimus Dorsi Flap surgery that will walk you through what to expect, and also link to the area for what to expect from a mastectomy.

    Other good places to connect with members are the December 2013 surgeries thread, and the Latissimus Dorsi Breast Reconstruction thread in the Breast Reconstruction forum.

    Best wishes to you, and please post to let everyone know how it goes for you. 

    • The Mods

  • lizzi
    lizzi Member Posts: 4
    edited December 2013

    Hi Everyone  This is Lizzi i Had my surgery on Monday Dec 23rd Mastectomy and Latissimus flap All went well I am finally starting to get around slowly but surely sore some what but much better i had 3 drain bags put in at surgery time 1 in front and 2 for the back and just went last Friday to have 2 took out feels much better still have one in back  that will be took out next friday but overall doing good .

  • Horse02
    Horse02 Member Posts: 17
    edited January 2014

    Hi Lazzi, 

    I hope you are recovering well. I am about 8 weeks out of lat flap and left side mastsectomy. My first ever sugery as well.  Started PT to help with scar tissues. My range of motion is good although I have constant tightness in my under arm area. The emotional healing, however, is another story. Did you have implant as well? 

    Horrse02

  • lizzi
    lizzi Member Posts: 4
    edited February 2014

    Hi Horrse02

    Doing well since my Surgery Dec 23 2013 6 weeks out now Yes i did have a implant put in this is on my right side still swollen some and alot of tightness as well under the arm from the lattis flap  breast is still tight and firm as well not bad but its there hope thats normal this was my very first major surgery as well still working on getting my arm lifing higher its half way but still sore probably due to the swelling. I see the oncologist this tuesday they told me i will be taking the pill for 5 years as for chemo im not sure yet still waiting for results they did a oncodx test to see if chemo would benifit me as well its been 4 weeks  waiting for results man thats to long the wait is killing me but hopefully she will know something on it tuesday when i go in my emotions yeah gets the best of me some days to but you know got to get through it all and we will what kind of implant did you have

  • sandra4611
    sandra4611 Member Posts: 2,913
    edited February 2014

    I'm new to this thread. My situation is different...the LD surgery will be used to repair damage from an infection. Actually I'm not positive I'm going to agree to it. I see the PS Thursday and want to have a list of questions for him, so your expertise is welcome. I had a "one and done" BMX with immediate permanent implants 5 months ago in August. The day afterward I started running a fever and one of the new "foobs" started showing signs of infection. The third antibiotic did the trick - I was on it for a month. I had surgery #2 to remove all the damaged skin, tissue, and muscle under my arm and on the side of the "foob." There was no longer enough skin to cover the implant, so it was replaced with a tissue expander. In December I had surgery #3 to exchange both the TE and the original implant on the other side for new implants. I received a different kind of implant (anatomical shape instead of rounds) which because of their taller shape, covered some of the "divots" in my chest from the BMX.

    Now we're looking at surgery #4 sometime in the next month or so. Because parts of three muscles were removed, the muscle attachments from the top and side of the foob to my shoulder area are the problem. They are VERY short and cause limited range of motion and discomfort. If I reach out and slightly up, the whole foob becomes distorted from the pressures/pulling on the pec muscle. Under my arm is just skin over bone with a bunch of healed incisions, so the PS wants to do fat grafting there and on the remaining chest divots. The original BMX incision lines are "wavy" from the way the muscles pull. I also still have the "mudflaps" left over from the original BMX, which everybody has until they get them fixed.

    I've been to physical therapy and the muscles are stretched as far as they will go. The PS thinks doing the Lat Dorsi procedure will give him the tissue, fat, and muscle to do the repairs. I'm a nervous wreck. I am allergic (seriously - I've coded 4 times) to narcotics so the only thing I can take after any surgery is Tylenol. I've managed through the past surgeries, but wonder if I'll be able to handle the back wound plus the arm/underarm surgery.

    I'm 65. What do you think?

  • lizzi
    lizzi Member Posts: 4
    edited February 2014

    Hi Sandra 

    I honestly think you will be fine with the lattis flap surgery and as far as the back you should be fine  course we are all different but with me i was so scared that i would have problems with my back and to be honest my back has not bothered me i really had no pain with it sleeping the first couple weeks was hard  but after was fine just the muscle tightness which is still there after 6 weeks  im still swollen under the arm i am trying now to get my strength back by lifting arm as high as i can really what bothers me is the tightness in the chest with the muscle being there and the implant just feels uncomfortable but overtime im sure will be fine . but to answer your question  really dont worry about it i believe you will be fine  . have a great day and keep me posted

  • rozem
    rozem Member Posts: 1,375
    edited February 2014

    Sandra - if you are having range of motion issues and tightness I think the lat will make it worse for you. Its a big surgery, and some of us do having lasting complications from it.  PM me if you want more info

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