Q: After being diagnosed in November 2016 with DCIS, I opted for a double mastectomy with lat flap reconstruction which I had on Feb. 7, 2017. Since Feb. 8, 2017, I have been in constant pain with a feeling like dental floss is wrapped around my back to the front and is being pulled very tight. Is there anything that can be done for relief? I also have 2 lumps just under the armpits that are very tender and sore.
I live in Kernersville, North Carolina and was wondering if you could recommend a physician in the Greensboro area.
- If you don't mind, for the first part of my reply I'm going to "cut-and-paste" a reply to a previous inquiry, as complaints about problems after latissimus / implant reconstruction have actually become pretty common.
"There is no question that some women have trouble after latissimus flaps, and sometimes surgery can help, depending on the nature of the problem. Some surgeons divide the nerve to the latissimus when it is originally used, others do not. The few patients on whom I have operated successfully for post-latissimus pain (3 or 4, I think) presented with intermittent, not constant, pain, apparently associated with contraction of the latissimus muscle. They did experience relief from division of the muscle and/or nerve.
“It is possible that the latissimus flap could produce more nearly constant pain from scarring, but this would be a little harder to diagnose, and potentially may respond less well to surgical treatment."
This problem requires careful analysis, in-person after examination, as the problem could be caused by several different things. We would also need to eventually determine if the problem could be solved while salvaging your present reconstruction (completely or partially), or whether a new reconstruction (with your own tissue) would be best.
In other words: 1) Best case scenario - minor revision to flaps, discomfort fixed, reconstruction otherwise unchanged
2) Next best case - fix discomfort by revising reconstruction (an example of revising might be remove implant, adjust latissimus flaps, use fat grafting to add volume, possibly in several stages)
3) Most involved option - remove implants, adjust or remove latissimus flaps, use tissue from your abdomen (DIEP) or buttocks (sGAP) to provide new, all-natural breast mounds.
I can recommend Dr. Mike Robinson in Charlotte (we trained him), he has a lot of experience with DIEP flaps, but I'm not sure how much experience with revisions he has. Of course, I would always be delighted to see you in person, if you could make the trip.
Dr. James Craigie