LD flap reconstruction

Am due to have mastectomy and LD flap reconstruction, but I can’t find any info on what the ‘ridge’ under the arm might feel like/look like. My mind is not yet made up, and I think I might be OK without any reconstruction as I’m anxious about creating more scars and strange puckering on my back; a weird sensation on my back and a ridge under my arm. I could wear my usual fitted t-shirts with a prothesis, but maybe not with a reconstruction due to the underarm lump. Does anyone have any views?

Hi Annie,
I had delayed bilateral LD reconstruction with expander implants 5 years ago.
I didn’t have a puckering on my back and the scar (which extends the whole width of my back, due to having bilateral recon,) is now extremely faint and covered by my bra strap anyway.
I have had no weird sensations in my back and no ridge or lump under my arm either.
However, I was unfortunate and unlucky (so my PS tells me) and had lots of problems with infection / rejection of the implants, which necessitated several further surgeries over the following 3 years and culminated in my having bilateral TRAM (on the left side) and DIEP (on the right side) in July this year, as my body obviously objected to the implants - and I am delighted with the results.
Annie, I sincerley do not want to alarm you with my story but simply want to answer your query with honesty.
I am aware of lots of ladies who have fabulous results from LD.
I hope this helps in your decision making Annie and wish you lots of luck.
Please don’t hesitate to contact me here or by private message if you prefer, if there’s anything else you’d like to ask.
Take care x

Hi Annie

I had a delayed LD flap reconstruction in April this year. I
didn’t have a puckering on my back and the scar healed really quickly,is faint and covered by my bra strap.
I did have a few weird sensations for a couple of weeks after surgery, but apparently that is down to your brain geting used to your shoulder muscle now being your boob. I was lucky and had no complications and would do it all again tomorrow if I had too.

For me its been a great confidence booster and I am really pleased with the result.

Hope that helps a little

Jax

Hi Annie,

I just had LD flap recon 3 weeks ago and have to say I am doing fine with it (I know it’s early days yet).

I have a bit of a swollen ridge under my armpit, but that is mainly due to scar tissue from the previous lymph node clearance. The consultant warned this might be a bit tricky so I was prepared, but it is really not as bad as I thought it would be. Still a bit swollen, but should improve.

I am seeing him tomorrow for a follow-up and will get the dressings removed, so will find out more then.

I don’t seem to have any puckering on my back, but might be able to let you know more later? Ask to see photos of ops your surgeon has done. I saw some before I decided to have mine done, and it helped for me to see what sort of result I could expect.

My recon ‘boob’ does sometimes move a bit strangely because of the muscle used (mainly when I use my pec I think) but am getting used to that.

Good luck, and I hope you are able to reach the right decision for you soon. Love,

Hi, I am thinking about having reconstruction having had a mastectomy in 2006, but am worried as I am a very active person, riding/gardening etc and do not want to loose any movement as I am fine now, has anyone else had it done and carried on riding? Also worried what my back will look like!Thanks

Hi there,

just want to add my experience if it helps. I had an mx and immediate LD reconstruction in June this year. A part gel part saline expander implant was used which was then inflated at two weekly intervals after a recovery period. I have no ridge under my arm and have complete movement of the arm in all directions. I haven’t yet returned to doing all the exercise that I was doing pre ops but I only had my last chemo 10 days ago so still looking for some energy! Having said that I am using a power plate at home and doing a little pilates. I would say that riding wouldn’t be a problem for me if I wanted to do it though perhaps I would still find the jarring movements a bit uncomfortable as yet but my arm movements wouldn’t be the cause of too many problems I don’t think, my upper body strength is definitley returning.

However I have no scars on my back. My surgeon did an unusual operation (he is one of only a few who do it) where he manages to hook the muscle from the back through the cut under the arm and part way sround the breast. Quite a clever feat which he was careful to warn me that he couldn’t guarantee being able to do. If you look at me recon from back and front no scars are visible and the nipple was also retained. A very clever man. I’m in the Guildford area y the way.

I do, however, have to have another op in December as the implant has gone rather hard. Called contracture and is due to scar tissue sort of grabbing at the edges of the implant. He will create more space and put in a new gel implant which will better suit my shape. I hadn’t understood that this was a possiility but hey ho it has to be done as it’s rather uncomfortable.

I hope this helps. I’m very happy to answer any questions.

Lee x

Dear Annie22 and others

I had an LD flap last Christmas (13 months after righthand mastectomy).

It will probably be sufficient endorsement of its success to say that I am going into hospital on the 23rd November to have the same op on the healthy lefthand side to achieve better symmetry.

The op last Christmas was a real success as far as I was concerned, and the result is outstanding. I have every intention that the next op will be as good.

Bubs xx

Hi Bubs,

I am very impressed by the fact that you find your recon outstanding and would love to know a little more as mine isn’t there yet but I live in hope!

Did your good result come from one op or did you have more? Is the result quite soft and was it always like that (mine’s very hard)? How long after the op(s) would you say the result was as good as it is now.

Sorry about the interrogation, I am trying to work out what is a realistic expectation from my upcoming adjustment op.

Thanks
Lee x

Hi Lee and everyone

My recon is firm, but certainly not hard. In fact when I am in the showers after yoga and see all shapes, ages and sizes of breast, I would describe it as quite enviable!

The result was excellent from day one. And of course since the operation some 11 months ago, the scarring has reduced considerably. It was this result which spurred me into having the lefthand (healthy) breast reconstructed by LD flap (currently it has had the breast tissue removed and replaced with an implant, which is not very good without the skin, fat and muscle from the back beneath it) to match and this is scheduled for later this month. I’ve decided to ditch the remaining nipple and start from scratch as that at least will guarantee matching nipples.

I think it is fair to say that we are all so very different, as are our respective plastic surgeons, so what works for one will not work for another.

Hope this helps.

Bubs XX

Thank you for all your advice; I’m glad I asked. It is all reassuring (even the honest ones with bad experiences) as it all helps to set the expectations - so I’ve confirmed the reconstruction at the Royal Marsden.

Has anyone else since having Ld recon suffered from cramp like pains in their chest. Under the implant?

I have been getting these for the last couple of weeks, yet had my recon in May this year. They are evry painful and make me breathless when they happen.

Would really appreciate knwoing if this is normal or something i should see Gp about.

Thank you

Thanks for the info Bubs, very interesting to hear the details, I’m sure I will be as happy as you by the end of it all as I have a great surgeon who is able to do his own plastic surgery work…one of the new breed. The fact that you are able and confident to share communal showers is amazing! I’m not aiming that high!

Annie well done for making your decision. Good luck with it all.

Mounties, it is quite common to have almost stitch like muscle cramping…I certainly have that. Apparently that’s the repositioned back muscle still behaving like one until it learns its new job. Anything more or if you’re still worried it’s always est to get it checked.

Lee x

Thanks for all your advice. I had my mastectomy, LD flap recons, SNB all at once on 30th Nov. Am now back at home, have had a shower and even washed my own hair! I could sleep on my side for the first time last night. The only problem is the ‘hot water bottle’ which is under my skin on my back and sloshing about a bit. It is very uncomfortable but will absorb back into my body after a while. So, apart from that, I am not using any painkillers now and it feels like the worst is over. I am amazed at the speed of recovery, but equally, still sleeping and resting a great deal. So, I hope this is reassuring to anyone else making a decision about reconstruction.

Hi all

Really interested to read all your comments as I have an appointment to see surgeons in two weeks to discuss a possible bilateral MX as risk reducing surgery. It would involve an immediate LD flap reconstruction with implants.

I was diagnosed six months ago, aged 38, and there is a fair amount of family history so I really want to do anything I can to keep me here for my gorgeous baby boy!

Annie, glad to hear you sounding so upbeat and thank you for sharing your story.

I wondered what the recovery, ie time off work, period is like after an operation like this. Having just started back at work after six months off, I don’t want to be going off for another six!! Am I right in thinking that the norm is one to two weeks in hospital, then up to three months off?

Thanks, grateful for any advice …

Shenagh x

Hi

I will shortly (January) be posting a permanent posting on LD reconstrucTIVE surgery. There are risks to be aware of and pain to be aware of, ongoing pain, muscle pulling, flap twitching - all of there are very real for women and patients should be asking far more questions than they do at present.

This NOT an op for an active person or for someone who lift things in their job, who csrries plates, boxes, suitcases, for press ups, canoeing, rowing, skiing, even swimming can be at risk, climbing and much more.

It is a suboptimsl option which is why few plastic surgeons do it and offer better options.

There are IGAP and SGAP otpions which are less mutilating and give great results without pain or move of muscles or without, twitching, pulling or the need for damned awful implants that never feel real or warm or part of you and creak like a wired bra.

Please say you have a good plastic surgeon and not some gung ho breast surgeon offering something he has no skills or care to deliver.

Say you’re not under Adam Hart but perhaps Eva Weiler-M.

Don’t flunck it - you only get one chance in the end.

Don’t waste your back muscle and flesh; you have a youngster to look after.

Oh dear, I am due to have this reconstruction done in Feb next year and I’m worried. My surgeon told me he is not happy with using the stomach one and has found the best results using the back muscle. Is it really very debilitating, he says I would be able to play tennis by the summer ( not that I do anyway… can’t stand the game). Any info would be a great help. I live in France now and have my treatment in Bordeaux… they have been wonderful in fact they saved my life as I had the lump before I left the UK and the breast clinic there said that it was nothing to worry about… 6cm x 4 cm lump, and no biopsy done because Radiology Consultant said that it was not necessary even though the examining surgeon wanted to do one… my sister had ovarian cancer and died as did my maternal grandmother and all my aunts and father died of cancer too.
Hurrah for the NHS !!! Found that it was ILOb/BC and it had spread to 5 lymoh nodes 18 months later. Doc and hospital have apologised and said they would learn from my case; but Rad Consultant says she would make the same decision again given the same circumstances… Don’t go to G Hospital Breast Clinic… she’s still there.
Anyway, anything you can tell me about the op would be very useful as I still have not finally made-up my mind.
Thanks for listening and good luck everyone… Naiad xx

naiad,
I for one am happy with my LD recon.As long as you have a good experienced surgeon you will be fine.
Dot
xx

Briefly my history: diagnosed 2005 (at the age of 30) with BC, had WLE, node clearance, chemo and rads, have lymphoedema and was recenty diagnosed with BRCA1.

I had LD flap reconstruction with implants (nipple & skin sparing) 3rd nov 2009 (after many months of research) and I am happy with the results already. Every day they feel more and more like proper boobs (I still getting used to them). One breast is slightly higher than the other one and they are still quite hard.

With regards to my back, I was surprised when I saw the scar for the first time purely because of the length. Its healing well. I’ve had fluid drained from my back three times so far and I anticipate that I well need a few more.I have had no problems with movement since the op but so far I have been careful with lifting etc.

Despite the negatives this was the most suitable reconstruction for me and I’m glad I chose it. My operation was carried out by an experienced breast and plastic surgeon who I would wholeheartedly recommend to others (Mr Heiw, Swansea).

This operation has given my a good comestic result and has given me more importantly some piece of mind.

On another note I am surprised that LD reconstruction is being singled out for a permanent posting, which appears to concentrate on its negatives. As with all reconstructions it has its negatives and positives and for some (like me) it is arguably the best option. In my opinion (and this is only my opinion) I feel that should such a posting be made permanent that a comparable one be made for the other reconstructive options available. I know that some people have had bad experiences or results with LD as I am sure people have with other options and people need to know these to make informed decisions.

I’m sure that I will have some strong responses to this posting, so be it. This is just my opinion, my comments to this thread.

Hope the above helps someone.

Adele

Adele, all

The reason I am doing an article on LD reconstructive surgery is that the pitfalls are downplayed by surgeons and not well documented anywhere, as far as I have read.

It is NOT the optimal reconstructive surgery but I accept that for some women it is the ONLY option, for now anyway. In a few years time things may well be different.

Perhaps BCC will welcome articles by women (not necessarily patients because some women have these procedures during preventive surgery and not always as a result of breast disease) on other reconstructive options.

Note that I say reconstructiVE surgery, per the threads, as there is no such thing as breast reconstruction whatever we might read/hope.

My article will articulate the “pitfalls” but it will be objective. It will be vetted by BAPRAS and at least two senior and eminent plastic surgeons who have also had to undertake several revisions; there are plenty of them required, sadly. I’m not discouraging anyone. I am merely ensuring that they go into this with questions, eyes wide open and fully informed because I can tell you that many surgeons do NOT provide sufficient information and many patients are not aware of their own ignorance. Like all postings on BCC, no one is obliged to read it.

I hope this clarifies for anyone who is interested.

Best wishes

I had an LD flap last Christmas, and was so absolutely thrilled with the result that I had a further one two weeks ago on the other breast to achieve symmetry.

I am more than happy with the information provided to me by the plastic surgeon(including warnings about what could go wrong) and the explanations given in respect of options available (the only other feasible option being a DIEP in my case).

So I really do think it is a matter of personal choice, but such choice only to be made once you are in receipt of accurate information, and may be consulting with ladies who have undergone the procedure, seeing photos etc.

It just so happens the LD option worked for me, not once but twice!