LD flap problem

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1

Hi
Has anyone experienced anyhting similar to me? I had an LD flap recon in February with a small implant and have been quite swollen post-op till about 4 weeks ago when things looked a lot more normal and getting back to an acceptable shape and size.
About 2 weeks ago I noticed that the breast appeared to have changed shape and looked really strange. The curve at the top of the breast was higher up almost under my throat and where the flap was (in the middle of breast, where the implant was originally, appeared flatter!
I saw my Surgeon last week and he said the implant had moved upwards and he asked if I had had a trauma or fall recently. I had slipped on the wet kitchen floor about 4 weeks before but can’t say for definite that that was the cause but he thought it could well have been and he said he wasn’t sure what he could do about it now!

I was disappointed because my breast care nurse had assured me before I saw him that they could put it right with surgery as they’ve done it before in a few cases.
He wants to wait 2 months to see if it goes back into the space on its own but will only perform more surgery if it’s the very last resort.
I’m quite upset about how it looks now especially as it was perfect a few months ago.
Has anyone else experienced this and if so, did it go back into place on its own afterwards?
Bev x

2

Hi Bev
so sorry to hear about your implant moving but i know exactly how you feel - mine moved twice and my body actually expelled it out of the bottom of my breast the 3rd time!!!
The first time i was violently ill after surgery and it moved up under my chin. Doc said it may move back down but it didnt and i was eventually taken back for surgery and another one was put in. This one then moved round under my arm (where the ld flap comes round) and again he said to leave it for a couple of weeks. They tried “strapping” it 24hrs a day but this made no difference. I was then taken back for surgery again and the next time I wore my support bra and strapping straight after surgery 24 hrs a day. After 2 weeks my implant literally fell out of the bottom of my breast through the scar - i was petrified. I was taken back for surgery to have the breast cleaned and scar re sealed and i have been “implant less” since December. I hate not having it in cause the shape of my breast isnt right. The doc has said that he wants to wait a year for it all to settle down and then he will try again with the implant.
Its been a long road for me and there isnt any advice I can really give you because if the implant isnt going to move then there isnt a lot you can do about it. I tried massaging it down every night so you might want to try that… I will keep everything crossed for you that you wont have to go through what i did. please keep me informed.
any questions then please ask away.

regards,

deed
xxx

3

Thanks Deed. Seems like you’ve been through a horrendous time!
My Breast care nurse also told me to try massaging it downwards every night which I’ve been doing all week. Doesnt seem to be making any difference though.
The trouble is I’ve already had surgery on this breast 4 times and I think my surgeon is thinking that there’s going to be an awful lot of scar tissue and possible wound infection if he goes in again.
I had lumpectomy 2005, breast reduction 2007, mastectomy following 2nd cancer in same breast Sept 2009 and this recon in Feb this year.

So will just have to keep fingers crossed and hope by the time I see him again in 2 months, it will have moved …but I’m not very hopeful, yet I can’t bear the thought of having it removed, its so much better than the prosthesis that I had for 18 mths.
Love
Bev x

4

Bev,
sounds like your boob has been through the mill already!! I know what you mean about not wanting to have the implant removed. I was rushed into hospital one saturday morning when mine was literally coming out of the wound and was told i was going straight to theatre. This was 3 weeks before I was due to get married. A wedding that we had postponed 3 times due to cancer…i was devesated!! I still hate what ive got but ive started seeing a life coach that specialisez in cancer and she is helping me to “like” my new breast and to make it healthy ready for surgery again in December. I dont know whether there will be too much scar tissue to get an implant in there but im keeping everything crossed - and will do the same for you!!!

big hugs

deed
xx

5

Hi Bev and Deed,
Sorry you are having problems with the LD and implants - unfortunately I can totally relate to your situation.
My reconstruction journey has been eventful(!)following delayed bilateral LD with implants in 2004.

Like Deed, I suffered infections and rejections of implants, resulting in several trips to theatre to have the implants removed and later replaced, over the following 5 years.
The PS, ward nursing staff and anaesthetist were on my Christmas card list - I was seeing them so often!!!

You will understand my distress.

Cutting a long story as short as I can, my PS eventually held his hands up and said that to continue replacing impants would result in the same scenario, as my body obviously objected to them and he referred me to another PS who specialises in TRAM / DIEP reconstruction.

I underwent simultaneous bilateral TRAM (left side) / DIEP (right side) in July 2009 - no implants, all my own body tissue - and a fantastic result.

Since then, I’ve had nipple reconstruction and tattoos last year and
3 weeks ago I had lipofilling of the "breasts"to even them up, in what should be my last surgery / procedure - finally - 9 years after initial diagnosis and bilateral mx!!!

I certainly don’t want to alarm anyone considering recon, as the majority are sucessful and uncomplicated - I just wanted to share my experiences.

I accept that I have been unlucky but living “breast free” was never an option for me.
It’s taken me a long time and a lot of pain and suffering but the result now is worth it.

I really hope that your problems are resolved soon and if I can help at all, please don’t hesitate to ask - I’ve been there, done that, worn the t shirt etc and understand exactly how you’re feeling.

Very best wishes to you both x

6

Thanks both, I’m feeling really down today because it looks even more deflated! My physio is seeing me on Monday to see if she can help by massaging and manipulating the breast to move the implant but I’m not very hopeful.
I feel more encouraged by your comments because you’ve obviously perservered until you had the right result. I know there’s a risk of infections and more scar tissue with each surgery but I feel at the moment that it’s worth risking.
I just hope my surgeon will see it the same way when I see him again end of Sept!
Thanks again both for your support xxx

7

You’re very welcome Bev.

Sorry you’re having a down day - I’ve had lots of those too!

As with anything, waiting is the hardest part, particularly if like me, you’re not a very patient patient!!

Wishing you better days ahead - please don’t hesitate to contact me on here or by pm if you prefer, if there’s anything I can help you with, or if you just want to rant to someone who’s been there and understands! x

8

Thanks for the info doxey. Can i just ask you, how many times did they try putting the implant in before they decided that your body just wasnt going to accept it? this is my fear now…do i try again or do i go for different surgery?
Bev, so sorry to hear your having a rough day. I remember sitting massaging my implant for hours and willing it to move. My best friend has just had the same operation and hers has taken beautifully and looks fab, i have to admit to be slightly jealous seeing as im STILL waiting for something that resembles a matching breast. pls let us know how you get on with the physio.

thinking of you

deed
xx

9

Hi Deed,
Ask away!
This is the sorry saga -

January 2004 - removal of right implant due to infection, 6 days post op (blateral LD recon.)Wound breakdown and many problems healing.

May 2005 - right implant replaced but it gradually slipped position and became uncomfortable.

January 2006 - left implant removed and replaced as not in a good position.

March 2006 - left implant removed as infected.

October 2006 - left implant put back in.

Beginning November 2006 - left implant removed again due to infection.

End November 2006 - emergency admission and theatre for washout and draininge of wound due to wound breakdown and infection.

Nvember 2008 - left implant replaced but poor cosmetic result and discomfort.

July 2009 - sucessful bilateral TRAM / DIEP - NO IMPLANTS!!

When I look back at all this with the benefit of hindsight, I wonder if I should have pushed for referral to another surgeon earlier but I trusted my PS and his advice!

Good luck - I’ll be interested in how your journey goes - and ask away anytime x

10

Thank you Deed and Doxey!
I heard from a friend of mine last night who also had an LD flap recon last July 10 that she’s going in for her nipple tatoo today in the finale of her reconstruction! Hers looks amazing - she’s about the same size as me 36B/C and has had no trouble with hers, it’s great for her but makes me wonder “why me”?? Another friend had her nipple done last month and says she feels amazing.
I always seem to be the one with problems along the way!
I somehow feel that it’s too trivial to keep pestering the BC nurse about as it’s cosmetic and not medical but I feel so disappointed, especially as on holiday in Ibiza 2 months ago it looked so good in a bikini top.
Should I take the risks involved with more surgery and keep on to my surgeon or just persevere with what I have??
Bev xx

11

Hi Bev,

I too always felt “why me?” when things went wrong, as I too was aware of lots of women who had sucessful, problem free reconstruction and looked great, whilst my chest either looked completely uneven, or as if I had 2 mis-shapen lumps of concrete stuck on my chest, depending on which stage of my recon journey I was at.

I was also aware of women that decided “enough is enough - I’ll live breast free.”

For me, that was not an option and I can only say that psychologically, having the best recon that I could, was so important to me.

I have had friends and family tell me to “give up and stop putting yourself through this - you’re alive and well and look great - a recon doesn’t matter.”
Well of course, whilst I was glad to be alive with “no evidence of further disease,” it did matter enormously to me but we are all individual and deserve the right to choose.
I must say that my PS and BC nurse supported my quest too.

I certainly don’t feel it’s trivial Bev but only you can decide which way to go, having armed yourself with information and shared experiences.

I wish you all the best with your decision making and will always be here if you need to ask anything .
Pleae keep me posted as to what you decide x

12

Thanks Doxey. I understand totally what you say. But the good news is, my BC nurse had a meeting with my surgeon last week and has rung me yesterday to say he’ll see me on Monday!
Looks like she’s told him I’m distressed about it and also, it’s now causing me some discomfort.
Hopefully on Monday he’ll tell me I’m on his waiting list or he may even give me a date to go in!
You encouraged me in your message to have it re-done. We shouldn’t put up with second best. My surgeon is a lovely man, very understanding and gentle and I trust him completely.
Will keep you posted how things progress.
Love
Bev xx

13

Hi Bev,

You’re so right - we don’t need to put up with second best and discomfort.

Lots of luck for Monday and do please keep me posted.

So pleased for you that progress is being made and you are feeling more in control of your situation??!!

x

14

Hi Doxey
Saw the consultant again on Monday and had ultrasound scan. Apparently the implant hasnt moved at all and the recon is fine. Its the lower part of my breast that’s dropped a bit!
So dont know where we go from here now, he wants to see me again at end of Sept to review it but he said sometimes these procedures take up to a year or more to settle down and it may take a better shape in time.
Love Bev xx

15

Bev, Im guessing you feel a mixture of relief and exasperation at having to wait again?! at least your not going to lose your implant. Is it the actual Flap that has dropped? when i had one of my surgeries my surgeon uplifted my flap as he felt that it had dropped at the side. I think its dropped again but have been putting it down to not having an implant in. It annoys me that after all we have all been through we have to fight to get what we want to try and be happy with our bodies again!!!

deed
x

16

Hi deed, you’re absolutely right. I’m relieved there’s nothing medical to worry about but disapointed that it looks mishapen! The recon’d breast looks bigger than my other one, starts higher up,so to speak, on my chest and rests lower down than the other one. So it looks sort of “long” if you know what I mean. The flap is in the same place in the middle - its just the area below that seems to have dropped/sagged. The scan showed that it was all in the right place.
They said at the time that I couldn’t have this type of recon done without an implant due to all the radiation I’d had previously. But I know people who’ve had it done without one and have had perfect results with the same surgeon.
It makes you feel that you’re bothering about nothing doesn’t it?
And I don’t want to seem ungrateful either, but I wish it had stayed as it was when I first saw it!
But at least he’s going to see me again on 29th Sept to review it.

Bev xx

17

Hi everyone
I’m going in on thursday to have a LD Flap, wanted to hear from anyone who as had this op, and what good or bad points?

chic chick

18

Hi Chic Chick

My LD flap was an immediate recon - I’ve posted this before, hope it helps.

I had MX to left breast and immediate LD flap +implant recon on the 26th Jan.

I didn’t have enough tummy fat to consider diep option. Even if I could have had the diep option, I’m not sure I would have taken it. It sounded like a massive op and my main hobby is horse riding, for which good tummy muscles and core strength are more important than arm and shoulder strength.

My plastic surgeon (who took over once the BC surgeon had done the MX and lymph node removal) has done a great job of matching my ‘new’ boob to the old one - even down to the right level of ‘droop’!

Had hardly any pain post surgery - didn’t need morphine pump. Had op late Fri, out of bed just standing on Sat and walking the corridor on Sun. A week in hosp - they didn’t let me go til all drains removed. Did get a seroma on back that needed draining a few times, but that resolved itself quite quickly. I was driving and back at work (part time for a couple of weeks at first) 6 weeks post op.

Six months post surgery and the new boob is really starting to feel like it belongs to me - obviously don’t have the level of feeling and it still feels a bit firmer and heavier than the other one, but improving all the time. The PS warned that it does take a long time to completely settle down. It’s a bit bigger than the other one and a bit perkier (they are now nicknamed Pinky and Perky) than the other, but all of this is totally unnoticeable in bra and clothes - as is the slight bulkiness under my arm where the muscle was put through. That felt enormous for weeks, but again is starting to feel more natural and is unnoticeable to everyone else.

My scars around where the nipple was and on back are improving all the time (I do use Bio Oil). I can see that the nipple area scar will be difficult to spot in a year or two. The scar on my back is bigger and more ‘serious’, but still improving and is covered by my bra strap.
My shoulder and under my arm still feel a bit stiff and tight, but I have virtually full range of movement and am back gardening and horse riding. Chemo does make the recon feel worse at times, but this is temporary.

I am having rads. This was a calculated risk I took.
The implant won’t affect the effectiveness of the rads, but it is likely that the rads will affect the implant - my plastic surgeon said that even if get capsulation round the implant and, worse case, down the line I need the capsulation removed and a new implant, the final cosmetic result will still be better than a delayed recon.

If I am going to get capsular contraction it won’t start to show for a while - my PS said it can take up to a few years before it gets that bad that you need it removing and a new implant.

My recon boob is slightly bigger that the other, and I have a port in the implant where they can pump it up or let it down, so I’m hoping that if I only get minor shrinkage and contraction, they can let it down a bit and that will do the job.

I still don’t regret my decision to have an immediate recon. Various studies have shown that we can do better mentally and physically, and even if I do need to have another op, it’s a small one compared to a full delayed recon.

Hope this helps
Dx

19

Hi

I’ve been reading this thread with interest, and hope someone can give me some advice.

I had a bi-lat LD flap recon last April (the 4th). I went into surgery with a right side mastectomy and boob on the other, so the PS was to do another mastectomy and recon on both sides.

I have very small implants behind the back muscle flaps.

It was clear from pretty early on that the right side (cancer side) was a different shape from the other side. The upper part of my chest on that side has always been much fuller than the left side. Now that things have settled somewhat, the left side - upper part - is very slightly concave, whilst the right side - upper part - is very slightly raised. I’m very self conscious about this, even though my friends and family say they cannot hardly see the difference. The annoying thing is that after my original right side mastectomy, my upper chest looked totally fine!

I feel like I’ve had recon (on both sides to achive better results), and ended up with a more deformed looking upper chest area.

I went to see my PS on Monday, and voiced my concerns. He was slightly dismissive, and said that maybe the right implant was sitting higher and more to the side than the left one. He talked about trying to move it, but said he’s have to wait longer just in case it moves of it’s own accord.

I asked him about fat grafting to the concave area, and again, he was a bit dismissive.

I’ve got to wait now for 3 months again, and then go back to see him. I dunno what to ask next time I go :frowning: I REALLY want to try to get the recon to look better, even though it’s not too bad as it is.

Has anyone got any advice for me please?

x

20

Hi Sarah
It sounds like your problem is almost identical to mine, regarding the shape and size of the reconstructed breast. My right one now looks much fuller at the top and higher on the chest than my left one, especially when the muscle is flexed! It seems to pop up even more then. But when my surgeon scanned me, he said it was in the right place and hadn’t moved at all sa i’d initially suspected and I now have to wait till the end of Sept so he can review it again. He did tell me it could take up to a year to settle down, but I can’t imagine the shape of it changing that much now. It makes you feel a bit disappointed when it looks so strange.
Looks like we’ve both got a bit of a wait before we see the surgeon again. I’ll let you know what mine says.

Take care!
Bev xx