Reeconstruction with latissimus flap

JRLucy50 · October 2018

I had DCIS 6 years ago in my left breast, treated by lumpectomy and radiation. Now DCIS has shown up in my right breast. Since I had a number of problems after radiation, (including a really bad-looking breast) I decided to opt for bilateral mastectomy with reconstruction. Both surgeons think this is a good idea, so I'm going to have this done soon.

Plastic surgery will be done using expanders on both breasts and additionally a latissimus flap on the left breast due to the damage done by the former radiation. The plastic surgeon said in addition to the anesthesia I would have an epidural.

I'm wondering if anyone has had a similar situation. or at least what someone might have experienced with the latissimus flap procedure. Was it very painful afterwards? How long for recovery? If you had an epidural was this done during surgery, or afterwards? Any answers would be appreciated. I want this done but I'm extremely apprehensive.

Hopfull2 · October 2018

hi. I had the last flap done one year ago 6/2017. It was done only on my right side the cancer side. Left side I had prophylactic Mastectomy so didn't need lat flap on that side. My recovery was not bad. I was off of work for 8weeks but recovered well sooner. In the hospital for about 3 nights. So I had the last flap and implant was placed. I had expanders prior to the lat flap surgery. I have no problems with my back yes it's numb and I have a scar but no issues using that arm

CHUCK7 · October 2018

Hello JRLucy,

I am sorry that you have to go through any additional unpleasantness and I’m sure since you have had problems in the past that you have researched all of your options to feel good again. I was lucky to have my cancers, yes a different cancer was found in each breast, detected early through a mammogram, but I was unlucky in that I did not have options as to how much surgery, what kind of surgery or how many surgeries I would end up needing, and still need. After bilateral mastectomies with immediate expanders placement, then bilateral removal of expanders to implants, then (R) implant rejection to its removal, then (R) implantation again, then (R) implant rejection again, requiring bilateral implant size reduction and another (R) implant placed with a (R) Latissimus Dosi procedure. In between all procedures, there were countless reopenings and closings of the (R) due to infections, which then caused an ongoing Gastro problem. Because my family and I had been through so much, I did ask my PS, that if we just took out the implants, would we be able to address other options, in oder to avoid having to do the Latissimus Doris procedure and he said no. I’m telling you all this because the L.D. procedure is a big surgery. You will have surgery on your front, that will require you to search for a comfortable recovery position and you will also be having surgery on your back, that will require you to search for a comfortable recovery position as well and that is impossible. It is even worse if your Dr.is stingy with pain meds. You will want to have a bit of time to recover in the hospital, but get out of there as fast as you can to avoid infection. Also I do not understand why you would need an epidural if you are under general anasthesia? Are you possibly a candidate for having a modified flap procedure or fat grafting? I hope whatever you decide you have an easy and fast recovery. I’m here if you need. xoCHUCK7

Lula73 · October 2018

Be sure to check out the lat flap thread in the breast reconstruction category. Have you considered a muscle sparing reconstruction option that more often than not does not require implantslike DIEP instead of the lat flap?

Wink22 · October 2018

Hi JRLucy50,

I had BMX with bilateral latissimus dorsi flap reconstruction over a month ago. It was a big op, with 7 days in hospital afterwards. I’m feeling really good now though, driving, walking the dog, started yoga again. My tip would be make sure that your PS is very experienced with LD recon. I sought out an excellent PS who does an anterior approach type of surgery, so I have no incisions on my back. I have no numbness in the back either. For me, my expectations have been exceeded. Take your time and make sure that all of your questions are answered. I’ve not heard of epidural anaesthetic being used with GA for this

CBK · October 2018

JR Lucy

You can see in my notes I had a lat flap in April 2017. After expanders were placed over a year before, I never quite had the right result on my right side. BS actually blamed herself for taking too much skin!. I ended up opening a pore- sided hole and PS and I decided LD flap would be performed a week later. Even though I am very small in stature, my breasts were always a large C and I was not willing to be smaller than my original size. I needed additional coverage and blood flow on that side.

I'm assuming your PS is using epidural in breast area known sometimes as a "nerve blocker"? It gives you added comfort coming out of surgery for approximately 72 hours? If so, I had the same thing.

Now my surgery was with no other procedure besides placing a silicone implant on that side. It was about 3 hours in totality. The recovery was UNREMARKABLE. I literally took one dose of torodel and a few Tylenol after that. My surgery was performed on an outpatient basis. I have one incision that is about 4 to 5 inches and it's located more towards my side body.

There is a lot to consider, any flap surgery is considered major. I found this to be very easeful both post-op and recovery. Please feel free to ask any more questions.

Wink- can you explain briefly on your PS anterior approach?? Thanks

JRLucy50 · October 2018

Thank you so much for taking the time to give me this information. As you know from experience, the whole thing is frightening to contemplate.

When the plastic surgeon told me I would have an epidural to help with pain in the chest and back, I didn't ask any questions about that. Everything else seemed more important at the time! If everything goes well, I will spend one night in the hospital. Wish it could be outpatient surgery, but for some reason they wanted me to say overnight.

It is good to hear from someone who had the latissimus flap and epidural. When did they do your epidural? Was it done while you were still in surgery, or sometime after? I've never had an epidural, so the idea of it makes me nervous.

JRLucy50 · October 2018

Thank you so much for your kind words and encouragement. I am so sorry you had so many problems with all this. I hate cancer.

My doctor said that the epidural would be used for managing pain after the surgery, so I wouldn't need as much pain med. It is for the back and chest area, I assume like what women have while giving birth, but for a different area. I've never heard of this being done, and I've never had an epidural, so I'm nervous about this in addition to everything else.

Again, thank you so much for the information.

CBK · October 2018

JR Lucy-

You are staying overnite because you are having a BMX with a lat flap on one side. I stayed over-nite after my BMX when they placed tissue expanders.

But I had a problem with thin skin and circulation on my right side. So I just had lat flap with silicone implant placed on that side AFTER BMX. You can look at my below profile to understand better.

Outpatient surgery and they placed the "nerve block" during surgery. I was not paralyzed, I was fully functional. It just helps with muscle spasms that can sometimes occur after this type of surgery, I believe. I will ask my PS tomorrow if this is what some call an "epidural" and come back to you, but I believe it is..

Reeconstruction with latissimus flap

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