Lat flap recovery - specific to back pain
All,
I've been fairly active the last few weeks, and today realized I've "sorta" turned the corner. Removing my back issue (which I will get to in a minute), I would feel pretty good right now. My incisions are healed, by breast achiness is mostly gone, the tightness is getting better each day, and my energy is somewhat coming back.
BUT, the big issue is my back. I had lat flap done on the left side, and the pain is not getting one bit better. In fact, it's either getting worse or I'm getting less patient with it. Here's what it feels like......
It's in my mid/lower back on the left side. It feels like a muscle that should be flat and outstretched has contracted and tightened up to a "baseball" and that everything attached to it is being pulled into the contraction. It doesn't spasm, it doesn't contract and un-contract, etc. It just feels like it's tightened up to the baseball and won't activate, won't stretch, won't release.
I am currently not doing any exercises or PT, and it will probably be December 3rd before I start (due to Thanksgiving and then chemo on the 27th). I really, really hope that I'm not causing a greater/longer recovery by not having anything targeted to it now. I know that it is trying to heal from the "damage" and am concerned that it's learning something chronically painful that is going to be very difficult to "untrain" in a few weeks. The longer it's knotted up, the harder I'm afraid it will be to release.
Not sure anyone will have any insight, but would very much welcome it if you do.
Jennie
Comments
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Gosh, Jennie, I'm trying to visualize what you're feeling so I can think of something. You're right about the muscle"memory it will be harder to stretch out the more it gets used to its current position.Normally you'd be opening up your upper body, chest, mid back by laying on your back either on the Big exercise ball or the foam roller, but that would be difficult at your stage of healing. Maybe you can lay with your upper back on a mound of pillows, try to extend your arms out in a T shape, if you can't, bend your arms.Lay there to try to stretch your front torso , might take some of the extreme pulling or knot out of your back. Or put the pillows under the area that hurts, to kind of arch that area, and lay like that for awhile.I had a left sided lat flap, didn't experience this problem, must be stitched together very tightly. Can you get to P.T. sooner? I think ,sooner the better. Wish I was there to help!
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Hi CaliKelly - I know, right?
I've done so much research and just can't find anything that references what I'm going through. I can find information that says the vast majority of the time, this surgery is non-eventful (yeah - tell that to anyone whose been through it!). I can find information on back weakness. I can find information on chest challenges with the flap. But nothing that speaks to what I'm going through.
When I sit on the sofa, I can find a position that is completely pain free. When I sleep, I find that it feels like there is a golf ball in my back I'm laying on. I thought it was the drains, but they are out and it's still there. It's not unbearable, and I can maneuver around it, but it's there. I can find a position sitting that is relatively pain free as well.
So it's when I'm up, when I'm mobile. And it's annoying!
Also, in my "normal" life, I am extremely active. I work outdoors walking all day, I go to the gym several times a week, I garden regularly. My SO and I are planning to retire full time on a boat in about 5-7 years. The thought of not being able to do those things terrifies me. That is probably adding a bit to my anxiety related to this. I have to remember that, even if this is not "normal", it's still early and most complications (if that's what this is) are fixable (at least mostly).
In terms of PT, they don't want to see me until 4-6 weeks post op. Wednesday will be four weeks. I see my PS on Tuesday, and am going to speak to her again about this. Two weeks ago, she told me what I'm feeling is normal. I'm sure it's not. Hopefully that doesn't mean it's going to be a major issue for the long term - just something to work through. Somehow.
Once I speak to her, I can make the PT appointment. The challenge getting in is that this week is Thanksgiving, and then I start chemo on the 27th. I think it's possible to get in on Wednesday this week, and then Monday the 26th. MAYBE the 28th as well if I'm feeling OK after my first chemo.
If that doesn't work, I'm at December 3rd. Maybe I'll call Monday and tentatively set something up for Wednesday if they are open and can fit me in.....
I do want to say thank you for walking with me through this journey. I think once on the other side, it's easy to not be as engaged and to give advice, but not be as vested. I have been helped tremendously by your posts, your support, and your encouragement. Thank you.
Jennie
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Hi, Jennie, you know, it is possible that the lowest part of your scar on your back could be pulling tightly on the rest of your back. I remember that the lowest end of my back scar would burn and feel really tight. I had my hubby massage (organic) vitamin e cream into the whole scar a.m. and p.m. That seemed to kind of release some tension. And my scar became very smooth and more stretch -able. Another thing, on the day after chemo, I actually felt pretty good , I guess from the steroids and anti nausea meds in the infusion, so I think a p.t. session could be ok. I'm a very active person also, and really chafed at the forced inactivity! But as you go along, you'll find ways to get some of your activities in.I think your anxiety is that you won't be able to resume your active lifestyle. YOU WILL BE ABLE TO! OK? You have challenges to get through first, one step at time. I can do everything I did before. Took some work and determination, I'm pretty sure you're up for that💖 Massage that scar, maybe it'll release some back tension.
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Jennie
Wait a minute here are you sure you don't have a seroma? Is the actual area swollen at incision site?
I had lat flap and super common with this surgery to get seroma at donor site. It will cause tightness in that area. I don't think I felt pain, but it's a confining feeling. Mine were relatively small.
Wishing you some relief soon.
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Hi CBK -
I don't think it is a seroma - it's not swollen at all. Having said that, I think it's possible it was swollen inside and causing the "baseball" feeling. Over the last two days **I THINK** it's getting better. I'm afraid to be too optimistic too soon, but internally, I'm hopeful. Still want to start PT, as I am doing no exercising on my arms at all for ROM.
As I type this, it's a dull, achy, throb in my back but I'm not going to call it real pain. I've also been off all drugs during the day for a while.
I'm not yet driving, but I can see a light at the end of the tunnel. It's very weak, but it's there.
My mother left today, so I'm all alone now. We'll see what that brings.
Jennie
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Jennie -it would be swollen if it were a seroma.
Hopefully you will get cleared for PT soon. I bet being stagnant is not helping. How does surgeon rationalize the feeling?
I’m in PT now and it’s amazing. Hopefully PS sends you somewhere that is familiar with MX and lat flaps. You will make progress fast that way.
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Hi CBK -
Not swollen at all that I can tell. So far, my PS just says "it's a normal part of the recovery". I think I need to be more clear about how it feels. She doesn't generally refer for PT, but I'm simply going to ask for a referral. I have worked with a specific PT group before and really like them. This time around, they've given me lots of phone tips and a better understanding of what's going on, and I'm not even an official patient at this time. I hope to start PT sometime in the next three weeks. It's weird timing because of Thanksgiving this week and chemo starting next week. I can't say they have exact experience/expertise with lat flap recovery and DMX, but said they can absolutely help me with massage and ROM exercises. Fingers crossed.
I know we shouldn't wish time away, but I would gladly fast forward to next spring when chemo is behind me and my exchange surgery has been done. How was your exchange surgery? Do you feel like your breasts are "you" now and not a foreign body in your chest? My expanders are so uncomfortable!
Jennie
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Hi Jennie, I'm sure that p.t will definitely help, get started asap, you should still be able to do it during chemo, my chemo was every 3 weeks, only first week after that I felt pretty crappy. I still went to the gym week 2 and 3. Modified my workout, based on how strong I felt. But, again ,I had chemo before surgery. The boobs are WAY more comfortable and normal feeling than the expander. WAY! Nice and soft. Not foreign feeling.You'll be pleasantly surprised. Mine does animate on certain exercises, but I got used to it! Best wishes , Happy Thanksgiving. You'll get there! It's a challenge, but YOU CAN DO IT😚💖
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Jennie
I’m sorry I missed your reply. I think that’s wonderful your PT people are trying to help you. Were you able to obtain referral? I just felt so taken care of once I got into PT. And really have benefitted so greatly with electro-stim, strength training and manual stretching. I have a whole routine to do on my own as well.
I actually had a rough exchange surgery. Developed a hematoma on lat flap side, so long story short, my foobs do not feel like my own yet. But they are moving in that direction and I’m not in any pain. I’m so thankful for that. Getting stronger every day with PT. And foobs getting softer as I begin to massage hematoma side! Expanders feel like rocks yes, but they will be gone in time!
Ugh chemo, yes I’ve been there. Only good thing is that generally does not affect your reconstruction. Might be nice if you can get PT referral, to have that diversion from chemo to attend to! Make sure you take extra care of yourself either way and reach out whenever you need to!
Wishing you much healing and progress!
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Hi CBK -
My PS agreed to refer for PT, but wanted to wait two more weeks. So, I'll get a referral on December 4, which is six weeks post op. I'm anxious to get started. but see the light. While I am having some ROM issues, I mostly want the PT for my back. The "knot" has FINALLY loosened up, but I'm still very tight and sore. I very much think I need some help lengthening the lat flap that is left in my back (or whatever muscle it is I'm feeling back there). I feel that if I can get it lengthened, a lot of my tightness will go away.
On another note, I discovered a seroma last night at the end of the scar on my back. It's not large, and just slightly uncomfortable, but I'm surprised to see it more than four weeks post op. To the best of my knowledge, it just popped up. It may, however, explain why I've felt a "lump" when I sit against my back or lay on it. Hoping it doesn't grow!
I'm also thinking about starting to wear sports bras now. My PS says "wear bras or don't - your choice". Her nurse thinks that it may help me with the heaviness of the expanders. My question/concern is the pressure/support on my back. Part of me feels that I don't want anything against my back. Another part of me feels that the support of the bra band may actually help. We'll see.
Funny thing about chemo - I'm counting down the days. Each day gets me one day closer to exchange surgery. I have to be 4-6 weeks post chemo for exchange surgery, even though I'll be expanded well before that. So I count the days......
I just keep hanging on to the fact that by May 1st (just picked a random date), all of my active treatment should be done and I'll have my new to me foobs, and feel SOOOO much better.
Day by day........
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Seroma is super duper common with this surgery. I was reading a study that was done on women and majority who have this surgery end up with a seroma. It’s not a big deal to drain; I had mine drained multiple times in the PS office. Of course if you are needle shy, just don’t look. But it doesn’t hurt! If it’s small and not causing problems you can let it reabsorb on its own.
I wear sports bras most of the time. But really exciting now that I see those foobs over the last couple of days dropping. I have space between them now- wohoo! Only problem is my lat-flap hematoma side is still high,so I’m lopsided again. I wonder will I ever be even. 😡.
PT is going to help you tremendously. First thing my guy did was stretch stretch stretch. When I had my exchange surgery my PS loosened the lat muscle thread. I had too much animation on that foob. So that’s always an option too, when you see where you are at.
I wish you much luck with chemo. Honestly I thought it was going to be much much worse. If I could do over, I think I would have tried intermittent fasting.
Here’s to moving forward...one day at a time!’
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Jennie, didn't the surgeon give you ROM exercises to do at home? Mine had me doing them right after surgery.Just simple stretches. You are right about needing to stretch the back muscles.Without the lat muscle, the trapezius, a muscle that goes all the way from neck, down the back along side the lat, is going to take over some of the work. Also some smaller supporting groups , rhomboid, in between the shoulder and spine, and spinal muscles further down, towards the bottom of your scar. All need to stretch out! I did stretches at home, before 6 weeks! Gentle of course, dont want to mess with the healing layers inside. Try reaching forward, and pulling back, like rowing, while seated. Round your back forward, hold it to a gentle stretch, then straighten,pushing chest out. Feels good! Also shoulder rolls, loosen trapezius up. You'll get there, frustrating when you have to wait, I know!
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Oh and sports bra, it was comfortable for me! Zip front made it even better
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Hi CaliKelly! My PT not only didn't give me any exercises, when I asked, she said I could "google" some. I'm so afraid I'll overdo it or do the wrong ones. But I have found that sitting upright, then rounding my back and twisting toward the non-affected side seems to really stretch out what's sore/tight. I'm trying to do that as much as possible.
Thanks for explaining what's going on with my back muscles. I really am looking forward to getting them lengthened and stretched out. I'm getting there, but awful slowly!
Also, the sports bra today seems to be helping with both the back and the chest. It seems to have taken some of the pressure/heaviness off of both areas. I may even try to sleep in it tonight and see how that does. The one I got is pretty tight - not too tight, but tight enough to really hold things in place and support.
I am frustrated I haven't started PT yet, but it's coming. I start chemo this week, and will get clearance for PT next week. I will start it 6 weeks post op. With a focus on ROM for my arms, and lengthening/strengthening for my back, my hope is to be feeling as normal as I'm going to get with expanders in as close to the end of the year as I can. Definitely by the end of chemo (January 29). That way, I can just look forward to the exchange and get all this behind me!
One day at a time!
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So yeah - I spoke too soon. While the sports bra seems to be helping my back, my chest is more sore than ever before. The bra is tight, and I think it's moving the TE a little, and the muscle surrounding the TE is angry. I will not sleep in it tonight and see how it feels in the morning. I know (think) if I can push through it for a few days, it should adjust and settle down. But, it really hurts right now, so I'm going to have to keep my end result in mind on this one. It seriously hurts to breathe right now....
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Maybe too tight! You just want a nice hug from the bra, not a passionate squeeze!. To just keep it from moving around too much. It's going to be a little uncomfortable til you get rid of the expander, that thing bugged the sh*t out of me. I was always bumping into it! When you can start stretching everything out you'll definitely feel worlds better, believe me! Its quite a project, this cancer stuff. Not as fun as i thought it would be😉But when its all over, and you start feeling back to yourself, its so sweet!
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CaliKelly - I LOVE this description. I tried a different bra today, and it was definitely better. Still supported the back well, and didn't make the TE as uncomfortable. It did get uncomfortable on the sides of the breast - the bra pulled them in just enough to be uncomfortable. But I don't think the bra was too tight - it's just that I haven't worn one for over four weeks, and the TE are adjusting to being pulled in a bit. Maybe I'll do a few hours a day to get adjusted and not be too uncomfortable/sore.
On an unrelated note, I read the patient information for my TE today. They are the air expanders I can expand at home. The information says not to expand if there is any pain or soreness. Yeah, right. I'm supposed to expand how then?
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Wow I didn't even know such a thing existed, Were you given guidelines by your surgeon about that?
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Nope - but when she expanded me to show me how to do it, she knew I was sore. I suspect that the patient information is a CYA from the manufacturer, but will confirm with my PT at next appointment. My pain/tenderness is in the muscles surrounding my expander, but not where I'm actually expanding - it's more to the sides than the front. Having just said that, though, I realize that I don't have feeling in the front, so maybe I'm really sore all over :-).
I know the TE never get comfortable, but does the real soreness/tenderness go away? I still feel like I've been beaten up!
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It does go away, you're still healing from the MX. The t.e. Will just be a nuisance after awhile, not painful. When mine got expanded, at the surgeon office, not at home,it felt tight for a few days. But it's awkward, doesn't feel comfortable, etc. You'll be so happy when its swapped out for the implant. It's like night and day!
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Thanks CaliKelly! Looking forward to a pain free day sometime (hopefully soon)!
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Hi Everyone! I wanted to give an update on my back. I started PT last week, and it helped immediately. This week, we added scar tissue massage and OMG. It hurts so bad while they are doing it, but it has immensely helped. Only two massage sessions, but the "knotted" feeling is GONE. It's still tight, and still needs to stretch/lengthen, but the difference is AMAZING! If I had to live with it how it is right now, I absolutely could. My expanders are still annoying, and I'm counting the days until they come out (Christmas Day is the halfway point on my two surgeries, AND I will be more than halfway through chemo. It was just a few short weeks ago I was so frustrated and concerned. But now, I feel great and I see that there is a return to "normal" in my future......
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Oh, I'm so glad! I had a feeling that exercises and massage would loosen things up! When the chemo is done and you can get your strength fully back, you will see, life can resume with all your former Super powers! Thanks for the update, I was hoping things were improving for you. Happy holidays💖
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CaliKelly - question for you since you're in the unique position of truly understanding what I'm going through and having the professional expertise and knowledge. My back is much better. I would dare say it's pain free. However, it is still tight and needs to lengthen. I'm in PT and getting scar tissue massage. I still have my tissue expanders until the end of February, so those are also uncomfortable and tight.
I've come to accept that until the TE are out, I won't be back to my physically normal self. But I'm hopeful that once I have the exchange, the back will resolve the remaining issue on it's own. But I know it might not. So here's my question.....
Let's say I get to the other side of exchange, and my back is still tight and not lengthening further from PT and scar tissue massage. First, will myofascial massage add any additional benefit at that point? How is it different from scar tissue massage?
Second, if this is as good as my back gets, should I be able to return to my normal physical activities? Ie gardening, kickboxing, lifting and carrying heavy objects? In other words, will a tight back (that is not painful, just tight) be safe for me to resume full physical activity?
I'm not sure I'm making full sense, but what I'm trying to figure out is will my tight back provide long term physical restrictions, or just remind me of a tight back as I go about my daily, active routine?
Thanks for all your support the last few months! Today is the halfway point between my mastectomy and my exchange surgery. Merry Christmas!!
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Jennie,
I'm 8 years out from the surgery. I had seromas, and the PS didn't drain them. That contributed to more scar tissue formation.
It feels like I have fishing hooks with lines that pull in certain areas - that's the only way I can explain it.
Also, in 2-3 months, my scars start contracting (especially if we have rainy weather) until I feel like I'm in a corset too tight. I have to do deep tissue massage to "soften" them, then it gets better (not perfect though). Rinse and repeat 4-5 times a year.
I wasn't able to draw a deep breath since I had the surgery. I'm actually having breathing issues because of it - my oxygen levels are always in the 96 range.
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Hi, Jennie, I'll tell you my experience. I never had massage, , only a couple of PT sessions. Basically, I went back to my weight training regimen, at reduced weights, and let the weight machines kind of stretch the back, and scar area, GENTLY. I work at stretching my upper body every day. I have gone back to ALL my former activities. There is a tighter feeling on that side, because the lat muscle is removed, and then skin stitched back together, naturally gonna be tighter. But it will loosen up ,once you're exchange heals completely, and you can start really working on it. I was impatient, didn't know why I had to wait so long ,til my Dr. explained, just cuz it looks healed outside, inside many layers of muscle, blood vessels, nerves ,etc.have to heal. But now, a little over a year after, I'm back to Super hero status😉 . The only weird thing is once in awhile, the lat muscle in front will animate when doing a back exercise. Feel and looks weird, but no obstacle to any activity. You will be able to go back to work and recreation, with a little patience and work! Keep a-stretching!
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CaliKelly -
Exactly what I needed to hear! I am doing the PT, mostly because I think the scar tissue massage is working well. I think I could do all my exercising without them, but I love what the massage is doing for me. I also have come to accept that I'm going to be limited until after my exchange surgery. Which, if all goes well, will be the last week in February. I am soooooo counting down the days. The expanders are now more uncomfortable than the back. They ache all the time, and I still can't sleep on my side. Add to that the "zingers" on the right one, and I can't wait to get this done. Having said that, I'm LOVING the way clothes look on me now, so finding the silver lining. Soooo, just need to be patient and wait out the next 8 weeks. I'm making a May 1st goal to get back to the gym in some capacity, even if it's just to lift 5 lb weights!
BTW, I know what you mean about the lat firing on back exercises. Mine does that on a specific PT exercise. The muscle "twitches" in my chest. It's bizarre, but I'm getting used to it now.
Thanks again for all of your support through this!
Jennie
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Hey Jennie and Cali-
I had that animation you are both describing and during my exchange surgery my PS loosened the lat muscle and adjusted motor nerve. This animation disappeared!!
Resistance training under guidance of my amazing PT with stretching 🙆♂️, electro stim, and his manual manipulations have made me a new person. Funny thing is some of my upper body issues were just from BMX and 16 infusions on one arm!! Omg.
I have not had any massage therapy. Every woman that has had this surgery needs PT, I am blessed to have one that is knowledgeable in this specific rehab!!
Much healing to you ladies!!
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CBK, that is so interesting. My Lat flap surgery was my 2nd reconstruction, my first was straight to implant surgery, which got all tightened up by radiation. The first surgery was uncomfortable because my implant was under my pectoral muscle. I hated it! This is so much better, especially for weight training, and other upper body exercises. 16 infusions in one arm! Yikes🤤My veins got fried, and we alternated arms! So great that you found just the right therapist, makes a big difference😊 Happy New Year!
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Calikelly
Wait you have no implant with your flap? I have implants under the pec and I’m ok.
My PT guy is brilliant. He helped me so much withscar tissue strangulation feeling in my forearm from infusions. No idea what he did, but once I told him I had 16 infusions on one arm, his jaw dropped and he went to work. And he just gave me one stretch to do holding onto a door lever. Place your back facing door, reach back with your hand and grab lever, stretch arm straight and gently pull.
Angels along our way.... blessed!
Happy 2019 to you as well, may it be filled with progress and light.
❤️ KC
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