need help options on reconstruction please

[kristen50]

Hi everybody. I have officially been dx with a second cancer of padget's. I am having a mastectomy next week and am still confused over options. I have two options available to me......Lat dorsi (which seem to my doctor to be the more favorable one). The other option is to have expander and implant only which he is willing to try but warned of failure because of previous radiation to that breast 9 years ago.
I desperately would like some feedback to see if anyone on this board has gone with expander on previously radiated breast and the outcome of that. And also would really like feedback on the lat dorsi. I am concerned about my even higher risk of lymphademia (prev aux node disection) and also what the outcome of that surgery is like....ie...will I be able to still lift weight at the gym and workout. I am very active physically and worry that this would really affect my lifestyle. I don't care about scaring but do wonder what the back looks like after and how it compensates for the missing muscle.
Please any input would really be greatly appreciated.
Thanks,
Kristen

[BonnieR]

I have no suggestions but thought I would send a hug while you await replies from the more savvy!
Keep the faith

[jaykay]

My left breast was radiated 12.5 years ago (lumpectomy, node negative via snb). Recurred in right breast about 2.5 months ago. Had bilateral mastectomy with snb, nipple sparing, tissue expanders in both.

The skin on the radiated breast has definitely taken longer to "heal", especially around the nipple. Plastic surgeon was not surprised and is not worried about final implant surgery (down the road, after chemo). She only warned me that the nipple may not make it, everything else would be okay.

I'm not sure what you mean about "what the back looks like".

I did not have aux dissection but was back to exercising upper body in 6 weeks. Expanders are not comfortable (an understatement!) but that was my only option. I don't know anything about lat dorsi.

Hope this helps

Janis

[norkdo]

http://www.breastreconstructioncanada.ca/where-are-you-in-your-care.php

Hi. This is the very best interactive website for your question. It says who is best for which kind of operation. It says who isn't. I am just healing from an emergency operation last week to remove an infected implant. It will be six months before I can try again.

Ask for no drains!!! Infection can get in through the hole in your sutures where the drain is. (I had three drains Sept 17 when my implant and expander went in.) I told him last week "no drains" cos my first mastectomy a year and a half ago had no infection and was drainfree afterwards. The surgeon just went in with a needle to remove seroma (blood and lymph fluid) every three weeks in clinic appointments.

[Pray]

As Nora said the drains are a complete drag. I did not have a Lat. flap. I had a free tram flap. First I tried expander than implants. I had way to many errors on both and just had the free tram 2 months ago. After 3 yrs my chest finally feels free! I can move freely. Taking a deep breath and expanding my chest is amazing!

As for exercise, it was way to painful to exercise with the expander. I had that in for close to a year it was very tough on me. Everyone is different and it is never the same case for anyone. Then again mine wasn't put in the right place the first time.

I was told the look of any flap all depends on the persons body type. I know a woman who had what your having. She is average wieght and in the beginning it was just swollen and after a month you couldn't tell the diff. Your body trys to make up the diff. overtime.

I'm sure you will get more posts. I don't think there is a procedure that someone here has not had.

Gods blessings to you. You will make the best choice for you.

Peace my sister. I will keep you in my prayers.

[snolan]

I had the lat flap. I had to have my expander taken out due to infection but had origonally planned on keeping it in during radiation. I too am very physically active I do cross fit and mountian bike. It has affected my strength but not to the point where I can't do my activities. Pull ups are the only thing I can no longer do without assistance, but at 43 years old so what. I do recommend physical therapy if you do the lat flap to help reduce the effects of scaring and to make sure you are strengthening your rotator cuff muscles and mid back muscles before you go back to the gym. The scar is not bad you can't tell the muscle is gone but I can feel my ribs more, I don't have a lot of body fat in that area. I have had to have another surgery to open the pocket that the implant is in due to how the skin scared from radiation, so radiation did effect how the skin expands. I can see the difference between sides how the skin healed differently from the radiation, its not as smooth, when I lift my arm there is a ridge at the edge of the implant. The lat flap surgery is a little harder to recover from I felt then the mastectomy due to having 2 incision sites, and of course the drains are a drag. Overall I am very pleased with the results, I still get tight in my left shoulder, its been 1 year since my surgery but I just keep working at that.
Suzanne

[kristen50]

Thank you everybody for your response. I feel like I just can't get a clear picture of this and my surgery is set for next wedneday. I am meeting with the plastic doc tomorrow and have a list of questions but their is nothing like talking to women who understand!

@Suzanne....I do not have much body fat and I also do cross fit along with heavy lifting/running/cycling. I don't care about the scare but just can't figure how they actually get muscle off the lat when it seems like its all ribs!! I am also concerned about the lympademia because of the previous aux disection.
Also I have noticed that some say NO DRAINS! I had drains in my first surgery, I don't think this plastic doc will let me go with no drains now if I do the lat flap is this the new trend?
Kristen

[snolan]

I had one drain in the back but ended up needing one in the front, but I had fluid issues with my mast so I was predisposed to it. It took 5 weeks and then the drain fell out and we waited to see what happened and the area cleared up within a week. I didn't have big lats either but they only take a part of it out the tendon still stays intact they just shave a little part off. The lat and the skin with its blood suppl just adds a new layer to the breast so it doesn't have to be thick. The flap is not that big, depending on your size, it ends up in a long diamond shape that the dr puts in the middle so the rest of your breast is your origional skin. The lympademia issue is a hard one, I don't have it but there is a lot of swelling under the arm pit area as that is where they pass the muscle through. But any surgery to that area can cause it to flair up. Seeing how my skin that had the radiation healed I am glad I got the flap, I don't think I would have been happy with the results if I hadn't.

[Pray]

If you have had a drain before I wouldn't worry so much about it. It is totally doable. It just needs attention. I had to keep 1 in a little longer than the others and it wasn't any worse. Try to go in with a positive attitude. There are no two surguries that are exactly alike. I think you will do fine. Peace