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Updated: March 2009

Lumpectomy Defect and Radiation, Latissimus Dorsi and Implants

Photo of Beth's Procedure
Photo of Beth's Procedure
Before
After

This patient has a significant right breast deformity after lumpectomy and radiation. She is shown before and after correction of this deformity with staged reconstruction using a latissimus flap and implants.

Beth's Breast Reconstruction Story:

 

Five years ago, at the age of 41, I was diagnosed with breast cancer. Given my family history with the disease, this should not have come as a surprise. My paternal aunt died from breast cancer at the age of 40, and two of my sisters-in-law had been diagnosed as well. I had yearly mammograms since the age of 30. Still, I was shocked.

My lumpectomy was scheduled and the tumor was removed. Unfortunately, the margins were not clear and a re-excision was scheduled for the following week. At this point, my son’s Bar-Mitzvah was less than ten days away. With reassurance from the surgeon that I would be fine for the ceremony, I had the second operation. It was probably a blessing that I was too busy to truly focus on my surgery.

Both operations left my breast seriously deformed. Then it was on to radiation. My first treatment was scheduled for December 2, my 42nd birthday. It was not the birthday celebration I had imagined. Radiation had a huge effect on my breast; the scars were bothersome, and with time, my breast looked less and less like a breast. My husband never said a word; his concern has always been about me fighting the cancer, not the physical scars. Nevertheless, I was not pleased with my appearance, and I certainly did not feel sexually attractive.

I decided to meet with a plastic surgeon. He showed me photos of other women who had the same kind of deformity and end result as I had. He explained the types of surgeries available to fix the deformity in my breast. Together, we decided on a latissimus dorsi flap reconstruction, followed by breast implants at a second stage. My decision to have this type of surgery instead of an abdominal flap reconstruction was based on the recuperation time. It was much more feasible for me to take two weeks to recover as opposed to two months. Throughout my treatments, I was happy that I missed only days at work rather than weeks. I wanted my children to know that their mom was a fighter, and would still be there for them. Even when I had radiation, I scheduled my treatments for 7 in the morning, I got the kids off to school at 7:30, and I was still on time for work.

My plastic surgeon assured me that the surgery would be successful, and it was. Although I have some numbness in my back and the nerves in the right breast never fully came back, my breast looks good and the deformity is no longer present. I feel sexually attractive once again.

Breast cancer certainly changed me. My sister always said that I was quick to judge others; not so any longer. The little things in life can wait. I’ve learned what’s truly important and when to pick my battles. I have never feared breast cancer, and I am grateful for science today and the medical advances that have been made. Perhaps if my aunt were born later she may have survived the disease.

The one regret that I have was having my children visit their grandmother in Florida during my latissimus flap surgery. What I did not realize was that they needed to see that I was really going to be okay after the surgery. I thought that they could get some sunshine and visit their grandmother while I rested. It did not quite turn out that way. They were frightened for me. I should have realized that cancer happens to the whole family. My reconstruction was something that they should have been a part of too. I think that being with me during the reconstruction process may have helped them gain the closure that reconstruction had brought me.

When I hear of other women who are diagnosed, I reach out to let them know that if they need an ear, I am happy to listen. We all know someone who has had breast cancer with different results. Become as informed as you can and remember there are no wrong questions. My advice to women just starting out on this journey is to find a team of doctors that they trust, and that they can depend on. With knowledge, determination, and the support of my family, cancer never got control of my life, and now I'm a better person for it.

 

Photos and Doctor Commentary

 

Photo of Beth's Procedure 

 

Photo of Beth's Procedure

Right breast deformity after lumpectomy and radiation

 

Photo of Beth's Procedure  Photo of Beth's Procedure

Pre-operative markings for excision of scar tissue

 

Photo of Beth's Procedure

Pre-operative markings for latissimus flap

After her right lumpectomy, Beth’s right breast is smaller and has a depressed scar.  Correction of this deformity was planned beginning with excision of the scar tissue.  The latissimus flap was designed to replace her scar deformity with healthy tissue from the right side of her back.

 

Photo of Beth's Procedure  Photo of Beth's Procedure

After correction of lumpectomy deformity with latissimus flap

The right breast contour was restored with the latissimus flap.  The elliptical shape of the skin island from the flap is seen here early after surgery.

 

Photo of Beth's Procedure
Photo of Beth's Procedure

After bilateral breast augmentation

In order to provide her with the fuller breasts that she wanted, Beth underwent augmentation with implants.  The scars from the latissimus flap surgery on the right breast have faded with time.

 

Photo of Beth's Procedure

Healed latissimus flap donor scar on back

The latissimus flap was initially designed to allow the final back scar to heal in a horizontal orientation. The scar is hidden when Beth wears a bra.