I’m facing a mastectomy and am trying to decide whether or not to have an immediate LD flap recon (as suggested by consultant). I am really having trouble making up my mind. The thought of mastectomy is horrible (already had a lumpectomy and ANC but margins not clear). An immediate recon will spare me some of the loss of my right breast, but am worried about success or otherwise of surgery, and possible side effects and complications.
I am 46, normally quite an active person (walking, running, aerobics, etc). My partner says it is my decision but he, like me, thinks I will find it hard to live with one breast off.
I am new to the forums but have read some postings about this topic already, so thank you to all of you who have already shared your experiences with us.
Hi GardenGirl you are in the same situation as me.
I’m going for the reconstruction with the LD flap. The thought didn’t really enter my mind not too!
All surgery carries a risk of complications, but they are usually all treatable. I think the long term psychological benefits out weigh any short term risks for me.
But then again, some people find that not having a breast doesn’t bother them at all, and they just learn to live with it.
There’s no right or wrong answer, it whatever you feel comfortable with.
Hi
i had reconstructive surgery at the same time as mastectomy, you do need to think about that to expect when you have had it done.Yes i would say that it is better to wake up with a breast there then not, but you do wake with a different look and it was not one that i expected!I had the other one augmented so the size and shape match but up to now they dont! im told that it is still early,but this does worry me as i went into it wanting to come out with a perfect match.Talk to your surgen and see what they are going to do and what to expect…Unfortually for me i was so so scared to ask questions that i didnt want to hear the answers to.I think maybe if i had found this site i might av found the answers to the Q i was to scared to ask. good luck x
Don’t expect perfection. How many natural boobs are the exactly the same anyway?
My breast care nurse showed me lots of pics, so I am fully aware of how good reconstructions turn out, but she also showed me some where they didn’t work out so well. I asked lots of questions!!
But even the not so good ones were acceptable. Perhaps there was a bit un-eveness, but with their bras on, you wouldn’t be able to tell.
But I would allow time for your new boobs to settle. It can take many months. If you are still very unhappy with the results you could always ask for some revisional surgery in the longer term.
You are not going to come out of an operation like this looking like a supermodel. But you may feel a bit more like yourself.
You need to be aware that your new ‘breast’ will not be a breast, just something that looks like one. You will have some numbness - I’m not sure how much with an immediate recon, but with a mx the whole chest area is numb initially, now after 2.5 yrs only the scar line is numb, plus strangely some of my upper arm. I’ve also heard that the LD flap can give funny feelings in the chest, as the muscle still thinks it is in the back, so be prepared.
I was not allowed an immediate recon, and am now on the waiting list for an LD flap. I looked into it a lot before I made the decision. If you can get hold of a book called ‘Breast Reconstruction:Your Choice’ that has a lot of information in it. Or you can google for images of reconstructions.
Make sure your surgeon has lots of experience - I understand that it is much better to have a plastic surgeon than a breast surgeon to do the recon bit of the operation.
Don’t forget that whatever you choose it is all a compromise - it is just a question of deciding which compromise is best for you. ie no recon = flat chest & prosthesis, LD recon = loss of back muscle (tho’ I’m told you have to be a serious athlete to notice - I run & swim and have been told it won’t cause me problems), tummy recon = huge tummy scar/possible loss of muscle, implants = not such a good cosmetic result.
So arm yourself with information so you know as much as possible before you make a decision.
Note that all photos I have seen, immediate recons look better than delayed ones (because of the loss of skin in a delayed one - so the new breast is a bit of a patchwork). But often satisfaction is higher with a delayed one, as you are comparing it with a flat mx chest rather than the real thing.
Thank you so much for all your comments. Am seeing consultant today and am armed with a load of questions/comments! (including stuff I have read on the forums). I really want to ask him about side effects/issue with the back post op, etc. Have seen photos of a number of recons, all of which seem ok.
Hi
Just to reassure you I had a double mx in April this year with immediate reconstruction. I elected for the double mx as I wanted both boobs to look even and symmetrical. I also wanted to avoid mammograms and not have to worry about a tumour popping up in the healthy breast. On my diseased breast I had the LD flap procedure and tear drop implant. On the good side I had the tear drop implant. I am delighted with the result and had no problems whatsoever with the operation, recovery and overall appearance. The staff at the hospital were very attentive post-op checking my wound on the back every hour, making sure the drains were doing their job and feeding me a cocktail of antibiotics to avoid any infections. I was in hospital for 10 days following this strict routine. I do have scars on my breasts but they are so faint and smooth that make- up easily conceals them. What amazed me is that apart from a stitch or two to hold the drains in place I did not have one stitch in the reconstructed breasts. It was all either internal stitching or fused skin - amazing.
Because of the good results with the reconstruction I do not feel as if I have had a mx and have suffered no psychological problems with the loss of my breasts. In my opinion they look like breasts and feel like breasts. The only difference is that my new breasts are composed of muscle and fat from my back and implants as opposed to milk ducts and lobules. I do appreciate that bc is not all about appearance and boobs but a good reconstruction goes a long way to help in fighting this awful disease.
When you see the plastic surgeon be sure to talk about all the options for reconstruction. In order to get the best cosmetic result, it really does depend on your breast size, the amount of fat available and your general health
Can you tell me what it feels like in your good side? I used to be an A cup a long time ago before three children, but ended up as a small AA cup, which I’ve never been happy with. I would like to go back to being an A cup. So far I have agreed with my PS that he will do an LD flap on the mx side, but with no implant. That should match my AA side. Then in about six months I can decide whether to leave it at that, or have implants in both sides (I really want to have lipofil but he wasn’t keen on that idea. So Im wondering what an implant feels like - both to me (to the touch and as somthing hanging on my chest) and to my husband.
Hi
Both my breasts now feel the same as even though I had the LD flap on the cancerous side I still elected to have tear drop implants fitted on both sides. At first the implants felt very alien and quite heavy in the chest. However now six months on they just feel part of my body. They are firmer than a normal breast but don’t droop when I take my bra off. My bust does look a lot neater under clothing. I am now a 36B/C cup - prior to surgery I was a 36DD which to be honest was too big. I asked to go smaller and neater. The good thing with the tear drop implant is that they can add saline or remove it to adjust your bust to the size you want. As you have smaller breasts I think you would probably get away with just having the LD flap and no implant. I think without my implant I would be an A cup. The LD flap in itself is firm and stable. The implant is merely there to give a bigger bust size. By the way there was a lady in hospital when I had my op who had the LD flap with no implant as she required rads and her new boob looked as good.
By the way are you a runner. I was running about 20 miles a week prior to surgery. I am just getting back into running but have still managed a good long walk every day. The more physically fit you are the easier you will find it to cope with the op.
Vicky
Thankyou vicky - all reassuring stuff. Pleased to say I had a good meeting with the cons and feel much better than I did previously. He was really patient with all my interrogation! I also feel that he will do the best possible job that he can.
Had quite a bit of discussion regarding using the Lat D muscle, as I was worried about the loss of its use. However I am not so concerned now. Vicky and Roadrunner - it is so encouraging to hear you talking about your running and other activities, and how you are progressing, as I do not want to feel I can’t run or swim any more. I am managing to get some good walks in now after the lumpectomy and ANC, which is great, and will be looking forward to running once I have sufficiently recovered from surgery. (Had a hysterectomy a couple of years ago and was really pleased at how I recovered and resumed activies - just took some patience and careful progression).
LD flop has left me disaboled and this is NOT are, repeat NOT rare.
Please ask questions and do not just believe your surgeon and it is not he/she who is undergoing this -it is you and whilst it is in fact reversible, your back and muscle will never be the same.
I am in constant discomfort and have gone from being fully active to being unable to even carry a handbag of the affected side.
PM me if you want to know more and especially if you are in the south west - I’d hate to think you might risk the same surgeon.
This op is oversold and under delivered except by Plastic Surgeons who do it well and who do it properly by dividing the nerve and the tendon etc.
Read, read and research and do not think all the postive people are the only ones - the disasters tend to go home and hang their heads and hide because surgeons say “MOVE ON, WE CANNOT FIX YOU” which is what I was told and it is cr*p.
Hmmm, think what I have to say will make you think twice also. I had the LD flap recon at same time as mx., with no implant necessary.
Before I’d even been discharged, the back wound split open, and I was sent home with one drain still intact even after 12 days in hospital, and an open back wound of 8cms (that was soooo scary and deep).
For the next eight months my life was taken over by having to sit in and wait for daily visits from the district nurses - never knew when they were coming - so obviously couldn’t work. Was originally self-employed as a registered childminder - so that went straight out of the window - being unable to lift the kiddies.
During this eight months I had numerous infections, 6 chemos - which obviously hindered the back healing, full node clearance and 5 weeks of rads.
My back aches constantly and have been on tramadol for most days since last November.
Apart from all that and looking like a walking autopsy … the new ‘boob’ is great!!!
Good luck, you’ll probably be fine - but you did ask!!!
Thank you for all the information Vicky. That has been very helpful.
Dahlia - I am aware of your problems, I have read your posts. My surgeon is a PS, I asked him about the problems I had read you can get, and he told me about the extra step he does in the operation where he divides the nerve/tendon/whatever, and this stops those problems. He was obviously aware that some surgeons do not do this, and clearly felt that they were sub standard although he was very careful what he said. The surgeon I will have is very highly rated.
Sorry for delay in replying, but thank you for sharing your experiences and giving your advice. I really appreciate it. I have been up and down about this whole thing for weeks now…swinging between positive and negative. I think I have researched it enough, but it doesn’t make the choice any easier.
I am near Inverness, so not same surgeon as you, Dahlia. Mine is said to be a reconstructive surgeon and has done lots of these ops. He says he tries to divide the tendon where possible. My other concern is that I had ANC which might affect the op, but he seems to think it won’t be an issue.
He’s right - you having had ANC before won’t affect this op.
I had ANC after mx., and recon., and they said that it was really difficult because the back muscle was now in the way, so it won’t affect you with the ops being the other way round. xJacqx
Hi Garden Girl, I have had a LD flap op and I am very pleased with the results. This was done in 1989!..and twenty years on…it still looks good. I have been very pleased with the result and the scars are pale and cannot ben seen when wearing a bra. My other breast is not so firm however as the years have passed by and my reconstructed one looks better than the other one now! I hope whatever you decide to do is the rught decision for you. But just thought I would let you know I am still here with my LD flap 20 years on and do not regret it. Love Val (Scottishlass) X
Thank you for advice re the ANC. Best wishes to you
Hi Val,
Thank you for your message, and great that you are doing well with it 20 years on…well done you! (I’m sure my remaining boob will heading south before too long…!)
Reconstructiove surgeons are usually plastic surgeons. Bog standard breast surgeons do not generally have the skills to even find the nerve, never mind divide it, or the tendon. My surgeon had done over 200 LD flaps but it did not stop him from completely failing in mine - as was pointed out to me by the next 4 surgeons who I sought opinions from, just to make sure I wasn’t being too harsh.
So sorry you have had such a bad experience. It seems unbelievable that someone with that much experience could still mess things up. I feel very sorry for you (sorry - I meant to say that before and didn’t).
Sorry to be a bearer of the down side, my advice is to make sure your surgeon is also a plastic surgeon as they tend to cut the nerve from the start. I wanted to warn you that there are pitfalls with ld flap. I had mine done with implant 2 years ago, was told only problems were possible infection, rejection of implant and some weakness in affected side to the back and the arm. I had an infection in the back drain which has caused mild lymphodoema, and I had a small seroma (fluid sac) on my back for about a year, this fills up from time to time still when I overdo things if you can call normal life overdoing it. I have some weakness in back and arm on affected side and look like a skinned chicken on that side too from the back. I have nerve damage (fairly rare I am told) and this is very painful and is not getting any better this past year, am on painkillers for this.
Also the back muscle detached from the chest wall muscle and it is hanging on at one small area, this causes the weight of the recon breast to pull down quite sore at times. I had the tendon divided at my first op but have now a large lumpy sore area under my arm. I face another 2 and a 1/2 hour surgery (different surgeon who is a plastics man) my original surgeon was a very experienced surgeon but not plastics trained) in less than 2 weeks time to cut the tendon and resite at top of the recon, cut the nerve as it never learned to stop working and pulls the recon all the time, (this is why the muscles detached) by mid afternoon it is quite painful. Also he will reattach the muscles together again and replace the implant as well. All in all not what I had been told when making my decisions 2 years ago. The good thing is that he is going to reconstruct a nipple for me so there is an up side to this ha ha!! Also I was exhausted for many months and have pain in my mid to lower back which they also think will not go away. An area of numbness above the scar on my back and when the fluid builds up in my mid lower back I get what they tell me is formication which is not sore just very irritating, intense itching and I have been known to scratch till I take the skin off. Sorry this is not what you had hoped to hear but if I had known just some of the above I would not have had this done. I am a 32dd so not a huge girly. Whatever you decide I wish you the very very best outcome and I remain so glad to have survived this monster despite the continued pain I am in and am likely to be in for life. This op will at least take it down a level or 2 tho. Take care
