LAT with implants vs DIEP/SIEA? I have to decide this am :(

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akmlawgirl19
akmlawgirl19 Member Posts: 2
edited November 2018 in Breast Reconstruction

I am 42, just a little overweight, weighing 158 and 5'5", just diagnosed with invasive infiltrating ductal carcinoma. ER/PR+, HER2-. BRCA -, but my mom has had BC 3x, and angiosarcoma 4x. My dad had prostate cancer, his twin brother had it, and his mother had BC. So I want a DMX with reconstruction rather than spend another 20 years worrying like I have since age 21, when my mom finally told us. I really wanted DIEP but now am scared about the possible impact to my core strength and stomach muscles. But also worried about implant issues and the tunneling with the LAT. Help?

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  • OCDAmy
    OCDAmy Member Posts: 873
    edited November 2018

    DIEP does not cut the muscle so you'll be fine with core strength. I had DIEP in July and am very pleased with results.

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  • Moderators
    Moderators Member Posts: 25,912
    edited November 2018

    Hello, akmlawgirl , and welcome to Breastcancer.org. We're sorry you have to be here for this reason, but we're really glad you found us!

    For more information on reconstruction techniques, what to expect, risk, pictures, etc., see the main Breastcancer.org site's extensive section on Breast Reconstruction.

    We hope this helps you make the best decision along with your medical team and opinions from others here.

    Best wishes,

    From the Mods

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  • akmlawgirl19
    akmlawgirl19 Member Posts: 2
    edited November 2018

    Thank you both. I have extensively looked through journal articles and this forum, and just cannot decide between the two as the risks with both are there, but hard to compare. I have the fluff to do the DIEP and would go from a DD to a small C. I could be a D with the LAT but would need implants. I am a bit freaked by the thought of implants and having a foreign body in my body, plus knowing I'd need at least three more surgeries--nipple creation, swapping the TE for implant, then in 10 or 15 years, implant replacement. The LAT recovery is still about 4 weeks, DIEP they say 6-8, but no third surgery, and no multiple followups for expansion. So to me recoveries are really equal other than one being a bit more painful. I guess I'm hoping for recovery stories, and I will jsut look further in the forum. Tahnk you!

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  • anotherNYCGirl
    anotherNYCGirl Member Posts: 1,033
    edited November 2018

    akm, - I had a lat because I did not have enough fat for diep on two sides. I think the recovery is longer for the diep, but the results seem to be more satisfying to those who had it. The lat changes your upper torso forever. There is much compromise to arm and back strength, at least in my case. In addition there is the concern of implant/foreign body, etc.

    I wish you an easy procedure which ever you choose!!

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  • Lula73
    Lula73 Member Posts: 1,824
    edited November 2018

    No worries over core strength with DIEP unless you’re seeing a PS who converts to TRAM flap. Big question to ask:what’s your conversion rate to TRAM? Answer needs to be 0. Lat Flap DOES use muscle from your back - muscle you need to stay upright as you age, muscle you need to properly swim, muscle you need to keep your arms in a raised pisituin for any length of tine, muscle that will now contract on your FRONT when you’re trying to do any of use things. Muscle that will leave a bulge under your arm/on your side that’s can’t be removed as it’s where they flipped the muscle over to bring it to the front. Scars on your back you can’t hide in a swimsuit. And lat flap almost always uses implants. Trust me, the extra 2-4 weeks of recovery is 100% worth it. And it’s not like you’re a complete invalid during recovery from DIEP so those extra couple weeks aren’t a big deal physically either. Wish I could show you my DIEPbefore and afters... there’d be no question.

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  • buttonsmachine
    buttonsmachine Member Posts: 930
    edited November 2018

    They almost had to do a lat flap on me - not to make a new breast, but to patch up the chest wall resection. I was SO glad that didn't happen.

    I'm hoping to do DIEP or SGAP breast recon one day.

    Check out this thread on pain if you haven't already. Best wishes to you!

    https://community.breastcancer.org/forum/136/topics/788542?page=6#post_5299304

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  • Runrcrb
    Runrcrb Member Posts: 577
    edited November 2018

    akmlawgirl - Lula is right - you want those muscles they repurpose in the lat flap. I too am an advocate for DIEP. I know you haven't had a mastectomy but I had a mastectomy 15 months prior to DIEP and my recovery from diep was easier. Yes, the abdominal incision is long and hurts; your skin is tight since they have to pull it tight to close up the area that was removed to go to your breast. But, I can still swim, do sit ups, push ups, etc. Not sure I could do those things if I'd moved muscles around. Regarding nipples, have you talked to your surgeon about nipple sparing? Largely dependent on where your cancer is and if he/she can get clear margins but I'm glad I had nipple sparing - goes a long way to making my breast look "normal."

    Don't let your diagnosis or any surgeon make you rush a decision that will last a life time. Talk to more than one plastic surgeon and work your personal network to find women you can talk to face to face who've had the surgery you are considering.

    Good luck in the decision making and then the surgeries.



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  • CBK
    CBK Member Posts: 611
    edited November 2018

    Honestly I don't advocate one or another on type of surgery one should have for reconstruction, it is a personal issue and many factors come into play in the decision.

    I did have a lat flap as a surgery to salvage one side that never healed properly post BMX. I would not have chose to do it with BMX nor would I have chose to do DIEP at the same time as BMX. And yes, if you are a large cup patient, of course with lat flap you will need an implant, no doubt.

    My range of motion post lat flap was better on my flap side. No idea what accusations are about fat under the arm, back scars (my scar is between my underarm and back) and that I can't hold position of my arms over my head for a long period of time.... I am a long time yoga instructor and student ; I do plenty of movements arm over the head, with a YIN YOGA practice even!

    Best to you!!

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