Bi lateral Reconsruction with LD

[Rainbow444]

Thank you Morweena your post made me laugh.
Also v reassuring regarding movement, hopefully things won't be as bad as I'm dreading.
Not looking forward to being stuck in hospital when it's nice weather outside. Can't wait for it all to be over, and the recovery too, feels like a sentence if I'm honest. Don't like to wish my life away bit I wish it was Christmas!

[Morwenna]

I'm just starting to consider what, if any, reconstruction I will go for, but I do have some experience of both DIEP and TRAM surgeries as I was a Physiotherapist on a plastics unit!

Both are what they call "free flaps" taken from the abdomen, but the main difference is that TRAM is an older technique and involves taking a portion of abdominal muscle, whereas the diep takes just fat and skin tissue with a perforating blood vessel. Not all surgeons are comfortable with diep as it is a newer technique, I guess, and some like to stick with a procedure that works well and they are comfortable with. I believe both take a similar time in surgery and are very fiddly!

The main difference from the rehab point of view is that the TRAM takes a bit longer, as it involves the abdominal musculature. I used to see ladies for their six week check, and they were normally very pleased with themselves by then, although there were extremes of "I cycled 50km last weekend!" to "Exercises? What exercises? "You mean I can move my arm now???" 😉

I just wanted to point out that the "no arms above head" rule is referring to shoulder range of more than 90 degrees, so you CAN put your hand to your head, say, bending your neck will help. You just have to make sure your elbow is not raised above your shoulder. Practise this at home before your surgery, eg trying to see what clothes you can get into while avoiding that movement?

I never worked with lat dorsi reconstructions, or implant patients.

And I never imagined for one second that I would ever end up as the patient rather than the therapist!!!

[Cheryl17]

Oh Rainbow444 what a b****r. Keep your chin up at least you will be recovering during the nice weather. So nice gentle walks planned for June. Are you planning on going on a summer holiday? Just re reading your post, like mine the cancer appears to have been caught early, mine was diagnosed as DCIS following my first routine mammogram, not even a lump. With having 3 children under 6 do you have plenty of help at home. I was in hospital for 1 week, My hubby was off with me for the 2nd week and parents in law for the 3rd week I was then ok on my own, you may need help for a further week or so because of the children. Keep me posted. Xxxxxxx

[Rainbow444]

Yes thank you Cheryl17 all the little details are really helpful.
Had another meeting at hospital yesterday only to find out that there has been a massive mess up with my op date... It's an audit day so no ops that day, should never have been given that date. Anyway so now my op will be Friday May 17 th. Honestly what a hideous business this all is. Has now set me all in a turmoil all over again about sorting child care.
So yes, any more experiences & little tips are really welcome & helpful. All such a lot to think about.

[Cheryl17]

Hi Carabel, yes the bra size sounds about right but also invest in a pack of bra extensions.Debenhams sellthem for £4.50 for apack of three proved invaluable. With regards to the clothing. Jogging bottoms are ok, but I only used button through tops as myconsultant insisted on no arm over head movements! So i wore button through nighties or Pjs with button tops/camosol tops For the first 24 hours they will inspect the blood flow to your front scars and back scars every 15 mins, so again something easy to remove. Good luck PM or post if you need any more info only pleased toshare my experiences. Xxxxxx

[Carabel]

Rainbow444 i am also having bilateral mastectomies with ld lap reconsruction although my surgeon will only do them one side at a time. First op also is on 23rd April. I am not having impants with the flap and dont have much fat to transfer so hope i get a decent size. I am not big busted just now (32D) so hopefully wont be too much smaller :-). Lots of luck with your op and I will check on here to find out you are doing.
Cheryl17 your post is very helpful in giving an idea of what to expect. Ive been told to get sports bras one back size up and one cup size down so 34C - does that sound about right to you? Also been told to bring baggy t-shirts and leggings/jogging pants into hospital so i can get dressed but wondering how i would get t-shirt over head!
Xx

[Cheryl17]

Hi Rainbow444. So sorryyou are here and having to make this decision.My experiences are for 1 breast Not two, but thought i would share my experience as i know i wanted to have all the info to hand when i had to make the decision.
I had an immediate LD backflap with implant 12 weeks ago on my right side. I am right handed. I was unsure as to what type of recon But went with what my consultant recommended. I am so pleased I did, result amazing my new breast now feels like me and the shape is amazing. I am 52 years of age and a 38c and all of this came about from a routine mammogram, no lump. I returned to the gym at 6 weeks just walking on the treadmill and cycling and now back to cross trainer as well. I have two dogs and walk over 1 hour each day.
My operation took 9 hours and I was in hospital for 7 days. I had 4drains, all removed before I left the hospital one 1 urinary catheter in for I day. The first few days are tough, open front gowns onlyup you cannot lift yourarms more than 90 degrees for 6 weeks not even to put on a tshirt so plenty of open tops are needed. Support bras day and night for 12 weeks. Front fastening bras get you independant quicker. Extension packs are brilliant as you are swollen and I was using all three to start with. The back scar surprisingly is not soreunder a bra. Hair washing and drying is difficult, I cheated and had my hair cut short the week before the op so I could manage it myself and not rely on poor hubby to blow dry etc., I was drying my hair with a hair dryer myself around week 3. I showered the day after my op and every day after that, you can't use deodrant until after 6 weeks, I bought some Tisserand deodrant no alliminum and my consultant was happy for me to use that after 4 weeks.
I am pleased with my decsion and given the choice again would do the same option. Feel free to PM me or pOst again if you need any more info. Good luck with all of this.

[Rainbow444]

Thank you all everso much for your replies.
It is really helpful that you are so honest and open.
My surgeon hasnt discussed DIEP with me....
I'm struggling so much to find the time to focus on all of this as I've got 3 children under 6 & its the Easter Half Term!
...diagnosed Feb 28th, i have DCIS, no symptoms, only went to Doc with a 'feeling'..she very nearly didn't refer me, still can't really believe all this is happening, i feel well and normal physically ( other than biopsy sites and healing scars from sentinel node removal of course)
I don't want to go have a great big op and feel ****!!!!
ARRRRGGGHHH!
Think its probably going to be LD op for me, but I am scared.
Scared of losing my lovely boobies and the feelings they have,
Upset beyond consoling that i wont get to breast feed a 4th child
Dreading the op & recovery, being in hospital away from my children ( only ever been away from them for 1 night)
Thinking it will be horrible post op not to shower and feel clean & fresh...when are you able to???
What do you wear post op, after hospital gown?
What bra???? How uncomfy would a bra be with wounds on your back as well???
This is going to sound so vain but i blow dry my hair straight every 3 days normally. As i wont be able to do this myself, for how long though??? Would i be able to get a mobile hairdresser to come & do it for me...I would feel shocking otherwise with my frizzy barnet!!!
Sorry to rant but i do feel overwhelmed.
wanted to contact the one to one but just not had time today. lovely hubs will look afterkids tomorrow so i can get some head space for all this!

[dib]

Hi,I had LD flap in 2011,recovered well,still have a little discomfort now and again but a m very happy with result.My daughter had tram flap a year later,her recovery was much tougher and longer,she too has a little discomfort but she is also happy with result although her size is quite a lot smaller than she was originally.Major decision and not an easy one but personally,given the same decision again I would go for LD.Good luck
Di.x

[samos]

It's such a big decision isn't it!
I had an immediate bilateral DIEP recon last June - see the 'Diep date 27th June' thread as its full of info you may find useful. It is a huge op, and one that I would whole heartedly recommend - providing you are going into it fit and healthy.
I was a size 10/12 32DD before the op, and staggeringly I'm a 32DD even E now! My ps had said she wished she 'had more to work with' as I didn't have much of a tummy, and that she hoped to get a B or small C cup. I still have no idea where these boobs came from!
Recovery starts slow, but grows day on day - I managed a weekend in London a little over two weeks after my op. But the first few days are gruelling - especially getting in and out of bed, but I found it so much easier once I got home.
Obviously you do need to listen to your surgeon - may I ask why you were wanting a TRAM as opposed to a DIEP?
My op went really, and I've had no issues - I've just had stage 2 - nipples, and that's gone well too.
Hope this helps a bit.
Sue x

[Guest user]

hello,

I Had a dbl mxt followed by bilat-recon last may 2012, it was my 1st big op,(9hrs or so) and it scared the life out of me the thought of losing my breast, the one which host my tumour, but also losing the other too, i found out after i was diagnosed that i was a brca carrier (gene) so i had the grim task of choosing (what choice?) both to come off!

My biggest fear was waking to nothing, i didnt want to face that, though some people are happy too, i was 30 so needed to have some sort of breast to live with!

I had to have the ld flap on the cancer side it was my best chance of overall out come being successful, the other side was what i call a scoop & fill! lol i did have implants, both sides, i found the op/ hospital team, amazing, the recovery & early days emotional, i miss my old breasts always! i miss my nipples weirdly? i didnt feel great about everything at 1st if im honest, but the surgery side of it shocked me, it wasnt easy to get over but i was suprised by how good they healed & how quick!
The LD Flap side is the worst, the back gives me more grief than anything, i just feel like everythings thight, but it will ease im told! the scaring is going down loads, they dont bother me so much now as they 1st did, the other side gives me no issues, they both feel weird, im only just starting to get used to them really, it takes time. The plus side is they dont move much! so when your lying down they wont roll under your arm pits! lol

The LD Side feels funny under the arm area, i have no feeling there but had my limphs removed too, so thats poss why, the muscle they bring through from the back is still swallon, so you are aware of it when your arms by your side its a funny feeling having it there when there was nothing before but again it gets less of an issue.

Im due to have a nipple recon soon, i have opted for a tatoo instead of faffing with rebuilding new ones, ive been through enough! & hope it brings things in line a bit, at the mo i have one side with the outta nipple area left on the new recon breast, very life like if your looking into a mirror! the LD side has nothing, so the tatoo will bring some balance living without a nipple at all is strange - its just a mound/breast shape.

I definately made the right decision whatever i may think of my new pair! when im dressed (even in a bra) its like nothing has happened, no one would ever guess, and i think thats enough for me to hold onto & build a future with, if that makes sense?, im faking it i guess, but still have some curves, & for me i find that helpful, im not sure ill ever feel sexy again, but im working on it!!

Best of luck with whatever you decide ,
hope this has helped!
sam x

[Janet_BCC]

Dear Rainbow444

While you wait for other forum members to come forward you might also consider using our one to one support service. You would be put in touch with a trained volunteer who has had a similar experience. I have attached a link for more information:

http://www.breastcancercare.org.uk/breast-cancer-services/someone-talk/one-one-support

Very best wishes

Janet

BCC Moderator

[Rainbow444]

Please help!
On April 23rd having bilateral mastectomy with immediate recon.Don't want implants.
Had decided to go for Tram.
Further discussion today with surgeon & he is recommending LD (but ultimately my decision)
He says Tram is so much more to go through especially as its bilateral, and LD will give me as good end result ( if not slightly bigger ie nearer my size now) as Tram.That LD less trauma,less risk, less chance failure, quicker recovery etc
Really need to hear others experiences of bilateral reconstruction PLEASE.