LD Flap
Latissimus Dorsi

by S

I was diagnosed with two areas of DCIS in January 2005, after my third mammogram. The position and spacing meant that a mastectomy was recommended. I did try to get them to do a bilateral but was unsuccessful. Because DCIS does not require further treatment it was suggested that I had an immediate reconstruction. An implant didn't feel right so I was looking at LD [op time about 6 hours recovery time about 4 months] or TRAM [op time about 10 hours recovery time 6 months or more]

An immediate reconstruction sounded attractive because it appeared to be the only way I could be physically balanced for the rest of my life. With a recon I would have a reduction of the other breast about 6 months later, with a straight mastectomy I would have to wear a huge prosthesis to match my remaining natural breast. Bilateral mastectomies would have solved the problem but that was refused.

When I met my surgeon he described how the operation would be done if just a mastectomy and at that point I wondered where the skin would come should I later decide on a recon. I chose to have an immediate LD flap recon. This recon has the highest success rate as the blood supply is moved with the muscle.

Before the operation my surgeon drew a line where he wanted to make the cut on my back so that he could be sure it would be concealed by my bra. Once he said it was the 'spare tyre' at the back that would be used I said I didn't mind if it did become a C cup.

I woke up apparently wrapped in clingfilm and with 3 drains in the left hand side. On the right I was hooked up to a drip and had morphine on demand. Oxygen was delivered to my nose. As I was unable to use a bedpan [that was me not a result of the op] I was given a catheter.

The big surprise was that I wasn't in pain. There was discomfort but I really didn't feel the need for the morphine. I used it when told but it simply made me itch without changing the way I felt. The surgery disturbs nerves and leaves sections of your body numb, which is a bonus after surgery.

I think the oddest part of having an LD flap op is the way it feels afterwards. I lay in hospital trying work out how to describe it. The area that was affected felt as though it was covered by a balloon. If you think of holding a balloon against your skin and then moving your fingers over the outer surface you will get some idea of how it feels to have the skin touched around the operation site. Another way was to think that a mailed hand had a gentle hold on you - the back of the hand near your spine and the fingers tapering back from under your breast. Not painful or unpleasant - just odd.

You are extremely aware of the muscle being tunneled under your arm - in the balloon analogy it could be thought of as being inflated and colour it goes is quite spectacular. I remember wishing I knew how long it would stay like that. Strangely I can't tell you. I think it was nearly 3 months before the colour was normal and can assure you that the swelling does go down, a bit. Any excess is sorted at the 'tidy up' stage.

The operation was on the Tuesday afternoon and I left hospital on the Saturday morning. I solved the seat belt problem by putting the diagonal strap behind my back and relying on the lap part.

The 'clingfilm' dressings mean that you can shower almost immediately after the operation but not soak in the bath.

I felt remarkably well. For the next few weeks I was making regular visits to the hospital to have the seroma on my back drained as well as for checkups. Only stamina was lacking.

My results showed that both the areas of DCIS were actually invasive and that one of my lymph nodes had cancer cells in. As they were oestrogen positive I am now half way through 5 years of arimidex. Chemotherapy wouldn't have had much impact on my chances of survival and radiotherapy isn't used after a mastectomy at my hospital - at least not on cases like mine.

One odd thing was floating in a swimming pool between the operations. It was obvious when I thought about it but amused me when I realised that I was floating lopsided. The reconstruction didn't provide as much flotation as the, much larger, natural one.

I can't say how long before I went back to work as I don't work. At the time I was doing a course that involved 2 full days a week at college. I returned after 3 weeks for half of each day - my husband took me there and friend brought me home. I didn't actually do much.

At 4 weeks my team filmed a charity fashion show. My husband took and collected me and I spent most of the night sitting on the floor taking still photographs. I did about half an hour on the largest video camera that was sitting on a tripod. At the end I needed to crawl over to a chair to use it to stand up - but I don't think that anyone else noticed :)

All this proves is that you will be able to function quite effectively if you need to - but take it easy because you won't have much stamina.

I didn't drive for the full recommended 6 weeks and when I did I noticed that my new breast was helping me change down through the gears. This is a very odd and not entirely pleasant sensation. Sometimes it amused me but more often I hated it. Bending forwards had the odd effect of apparantly causing it to cling on desperately though it was a long time before I noticed that this was visible.

Seven months later I had the tidy up and reduction of the other breast. The nerve to the recon was cut so that the strange behaviour stopped. Both breasts are currently mammogrammed annually.

I now float level again :)