Advice

phurst · 02-20-2010, 12:54 PM

My wife had a bi-laterl and 15 lymph nodes removed.Because of the amount of radiation & being very lean she can only have Latissimus Dorsi Trans flap(I hope i spelled this correctly).Any advice pro or con.

whatz · 02-20-2010, 02:22 PM

A doctor friend of mine advised against the procedure unless it was done by a plastic surgeon that was doing this procedure on a regular basis and had plenty of success stories under his/her belt. The simpler route surgically was the implant (hence I opted for that one since it was possible for me). Make sure your doctor has plenty of experience.

caya · 02-20-2010, 02:30 PM

As I understand it, it is not a good idea to have implants after radiation - the failure rate is high.

Def. go with a plastic sugeon with many successes with the lat. dorsi. - And see if they need to add an implant as well. They often do have to add a small implant, which may make it difficult because of your wife's radiation.

all the best
caya

phurst · 02-20-2010, 04:39 PM

I forgot to add that they will have to use a muscle from her back.The plastic surgeon at Duke said she did not have enough fat so he would have to use the muscle.

Laurel · 02-20-2010, 04:53 PM

It is standard with a latissimus dorsi flap to use the latissimus dorsi muscle[IMG]file:///C:/Users/AnnaMae/AppData/Local/Temp/moz-screenshot.png[/IMG]. It is released and brought around to the chest area. Usually an implant is needed to form the breast. Here is an excellent link that provides easy to understand information with photos, etc.

http://www.breastreconstruction.ca/living_latflap.htm

I echo the others advice to find an experienced plastic surgeon to consult.

All the best.

Cannon · 02-20-2010, 07:17 PM

Caya, can you expand (oops - hee hee) on this?

I was advised not to have reconstruction at time of surgery, so there would be no interference with radiation, but that I could always do reconstruction later (which I have not, but consider).

Did you mean that the radiation fails, or that the implants fail? please let me know. Thanks

caya · 02-20-2010, 08:23 PM

Cannon - it's the implants that fail, not the radiation. I have a friend who had an implant after radiation and it was one big mess. She finally had to have the implant taken out and uses a prosthesis now.

I am not an expert, but this is what the plastic surgeon(s) I saw told me when I went for consultations. I did not have radiation, so they told me I was a good candidate for implants, and the lat. dorsi (with an implant).

I have decided not to do any reconstruction, at least for now. I just don't want to look for trouble, another big surgery, possible pain etc. I never say never, but at this time, over 3 years out, it's a no for me.

all the best
caya

Ruth · 02-20-2010, 08:29 PM

I presented with the same problems...too lean at the time and lots of radiation however I was able to have successful implants so it can be done sometimes. My PS told me that he feels my success was partly due to my never smoking and my skin was still elastic and very healthy even with all the radiation. It does have a high fail rate when the expanders are filled too fast it seems. It is an easier surgery (outpatient) and heal time is quicker. If it failed then I would have considered the flap. It's been almost 5 years and my foob is still doing ok.
Good luck!
Ruth

harrie · 02-21-2010, 12:18 AM

I had the DIEP flap reconstruction (muscle sparing) which is relatively similar to the TRAM flap, plus had small implants put in. I am also small and lean and had radiation to both breasts about 6 yrs prior to my mastectomy/reconst. I had an excellent plastic surgeon who did a magnificent job. Am very happy with the results. The radiation made it more difficult, but with a very good plastic surgeon, was very successful.

Cannon · 02-21-2010, 07:47 AM

Caya, thanks for clarifying. I am also 3 years out from surgery and not ready to do anything about reconstruction. Due to my multiple Crohn's surgery, they cannot use abdominal muscle. I think I would go implants, but the filling part sounds awful, and the replacing them the rest of my life sounds appalling.
Rebecca aka

Becky · 02-21-2010, 07:57 AM

Rebecca

Even though you have had abdominal surgery (so tram is out of the question), Diep is not. Just an fyi since if you do consider reconstruction in the future, you should keep all possibilities in mind and then go through the pros and cons of each - then choose.

http://www.breastreconstruction.org/index.htm

This is a good site that explains all methods and even gives questions to ask a doctor when having a consulting visit.

Cannon · 02-21-2010, 08:19 AM

Becky,

Thanks, I guess that is true in general, but I was told that nothing could be taken from my abdomen because scar tissue interrupts the blood supply. This was a Park Avenue NYC plastic surgeon, and I'm confident that if he thought he could, we would have said so. Things may have changed, I consulted before my mast., which (yay) was a while ago.

Rebecca aka Cannon

Westcoastgirl · 02-21-2010, 05:38 PM

I was very disappointed to find out I needed radiation as I wanted reconstruction and am also too lean to find enough tissue to create two mounds, at least that is what I tell myself....to tell the truth I do not want my body cut anymore than I have already. My plastic surgeon is older and experienced. He talked to my surgeon before the double mastectomy so he would leave as much skin as possible for reconstruction, in the hope that I could go directly to implant without expanders. I questioned my ps extensively about implants after radiation and he agreed that the procedure holds more risk for contracture but that he personally has had success with implants after radiation. It is the easiest of the procedures and I will give it a shot when I am ready to venture there. He told me I had enough skin for a B cup but I figure if I go smaller, A cup, I will be even more successful, at least that is my hope. I think finding an experienced ps is the best way to ensure that you will have a good result no matter which procedure you choose.

LoriE · 02-21-2010, 07:16 PM

I had a lat flap recon 3 years ago. The recon looks pretty good. Much better than I envisioned! The surgery did leave two things I don't like, though - the scars on my back are not pretty and the scar tissue is quite uncomfortable on the sides. I have not been able to wear a bra. That has been a big disappointment. I am having surgery in a few weeks to replace one implant with a different size (things heal and change) and remove some of the scar tissue that is causing the irritation. Then I'm starting physical therapy to try to break down the scar tissue.
If I could have a "do-over" I would have sought another opinion. I had one side fail and ended up with an expander. I had been told an expander wouldn't work for me. Ends up, it did.
Whatever your decision, I wish you the best.

Margerie · 02-21-2010, 08:02 PM

breastrecontruction.org has a great lat flap section that explains the procedure very well

http://breastreconstruction.org/Type...orsi_flap.html

I know one survivor that had the procedure done by my reconstructive surgeon and she is very happy with her result.

In my humble opinion, these kind of surgeries require a microsurgeon/reconstructive surgeon as opposed to a doc who is just trained in plastic surgery.

Jaimieh · 02-22-2010, 08:26 AM

I was told lat. flap was my only option after implants failed but I got a second opinion at the Center for Restorative Breast http://www.breastcenter.com/ and they were able to use my upper hip area and get enough fat. I am beyond pleased with how things turned out. I had been expander prior to this and I had more issues/pain with the expanders than I have had with this surgery. I do have a scar acrossed my back (below my panty line) that is a think line and it is pink now. I just had this procedure on January 26, 2010 (so it's still new). My new breast feel wonderful and I am a good C which the surgeons who I spoke with up her told me that I might be able to get 2 small A's.

Good luck and if you have any questions I would be happy to help you.