Latissimus dorsi flap
The plastic surgeons' answer to breast implants
Otherwise known as The Surgery
Pamela G. Dowd- 1997(modified 2001)
In 1975, I became one of the nation's youngest victims of breast
cancer. Since I had never been sick, that was a totally unexpected diagnosis. The surgery that saved my life was a radical
mastectomy. The surgeries that have destroyed my life began on the day in 1980 when I walked into a smiling plastic surgeon's
office in Boise, Idaho and he said, "Don't tell me what I can't do. Let me show you what I CAN do for you?
The hour that followed was filled with slides of "successful" surgeries. Each step of the way, I was shown the "new and
improved" method of reconstructing a breast. I was never shown or told the negative side to breast reconstruction. The first
step to reconstruct my radical mastectomy was transplanting a portion of the latissimus dorsi muscle to the chest wall.
the same time, Dr. John Hendricks and Dr. Eugene Sullivan, Idaho Plastic Surgeons, did a subcutaneous mastectomy on the right
side. This was done to combat the fibrocystic disease in the breast that I was later told was pre-cancerous. A small portion
of skin in the shape of a football was grafted to the chest to help form the pocket.
Two months later in Jan 1981, I entered the hospital again to have breast implants put under the muscle of the chest.
These were Heyer Schulte implants. In March, I noticed that one side of my chest was flat and I could fold up the skin. At
the same time, I noticed a soft squishy mass in my abdomen. It didnt hurt and felt like a nerf ball. A local doctor thought
I had a hernia and wanted to do abdominal surgery to repair the hernia. However, since it didnt hurt and I could press it
without pain, I didnt worry about it, and instead, called Dr. Hendricks about the flat chest. While in his office, I told
him about the soft mass in the abdomen. By then, it had flattened. He referred me to a Dr. Brown, a surgeon in his building.
Dr. Brown examined my abdomen and determined that I did not have a hernia and recommended no surgery. (Medical records do
not show I ever told them about the squishy mass.)
I returned to Dr. Hendricks and prepared for a replacement implant.
This too was a Heyer Schulte. No one mentioned that this implant might be having a higher than average replacement rate in
his office. The surgical notes do not indicate the condition of the implant upon removal. It was not sent to Heyer Schulte
for evaluation, nor was I offered a free replacement or medical reimbursementHeyer Schulte policies that existed during that
time, but apparently seldom offered in Idaho.In between surgeries to replace the ruptured implants, as part of the reconstruction,
the nipple had to bedivided and grafted from the right side.
To help it have a little bit of form, cartilage from
my ear was placed under the nipple. The areola was dermabrazed and I had to sit daily with the nipples exposed so the skin
would darken. That procedure did not work. They were then tattooed. The color came out an interesting shade of orange. Today
that color has faded completely.
In Jan. 1982, in an attempt to do minor surgery in the office, I went into convulsions.
I was referred to Dr. Steven Asher, a neurologist. That was the first time I had an abnormal EEG. He also detected a slight
click in the heart, that he called a mitral valve prolapse. From that point on, all surgeries were done in the hospital, even
By the summer of 1982, I noticed once again that one of the implants was noticeably smaller than
the other. Again, on October 6, 1982, I had another Heyer Schulte implant replacement. Only then did the suggestion come up
that radical mastectomies were more difficult to rebuild than other breast surgeries, especially in a case like mine where
the original incision started at my left shoulder and reached almost to my waist. Why, oh, why didnt he tell us that before
he made the first incision???
Immediately after the surgery, I began to have constant coughing spells. My general practice doctor would put me on antibiotic
and sinus meds and I would clear up for a short time. The coughing was so hard, it felt as if I were about to cough up my
insides.Then came the morning of extreme pain.
In 1987, I got up one morning to the most excruciating pain you could
ever imagine. It felt as if thousands of needles were poking me all at once. My husband rushed me to the hospital and I informed
the nurse in ER that one of the implants had probably ruptured. Not having any experience with that, she told me that implants
didnt rupture. They gave me cortisone for the pain and sent me home. At home, my husband gave me two of his Tylonol 3 pills
(with codeine) and I was soon asleep. Four hours later when I awakened, my chest was flat on one side.I called Idaho Plastic
Surgeons and told them what happened. No one told me I should get them out as soon as possible. Instead, I kept that ruptured
implant in my chest until August 1988. I was so tired of surgeries and just didnt feel like facing another one.
I tried to pad the breast with foam pads. Those made what was left of the implant heat up. In 1988, Dr. Hendricks replaced
them with Mentor Becker Expanders. He said they liked these implants better. The truth is, the Heyer Schulte implants werent
being made anymore.
From 1988 until I had them explanted in 1995, I continued the constant cough. I couldnt be in
the sun, as those implants would get hot and feel like boiling water pots in the chest. My chest constantly itched, and I
had a red rash. I began to strangle on my own saliva.In 1992 I was admitted to the hospital with pneumonia. My throat was
closing off. Three years later, at the National Jewish Hospital in Denver, CO, I was diagnosed with dysfunctional vocal chords.
The vocal chords were so damaged, they did not open enough to fill my lungs with air, nor did they close enough to keep me
from choking on my own saliva.
I was suffering with cold flushes in my face.
My bladder became incontinent and my bowels became embarrassingly loose.
I was on city council at the time and these incidents kept me in fear of what my body would do to me in public.
By 1994, my vision began to get worse and I not only needed glasses, I had to have bi-focals.
By the end of 1998, I was diagnosed with Glaucoma.
In 1995, I was diagnosed with atypical connective tissue disease. My ANA and SED rates were abnormal.
The diagnoses grew from IBS to Fibromyalgia, peripheral neuropathy, Sicca/Sjogrens, and border line lupus.
In 1998, a physical therapist informed me that the missing latissimus dorsi was probably the reason I didn't walk straight
any longer. She said the latissimus dorsi muscle is needed to keep the shoulders straight. It was the first I heard that the
latissimus dorsi muscle was also critical in helping us walk. All those years I had thought it was just a little muscle taken
from the back. Instead, I learned from her that the latissimus dorsi went down the back and covered the top of the hip bones.
When that piece was removed from the back, it threw my body out of alignment.
By the summer of 1999, I was experiencing problems with the heart, although the local doctors were reluctant to do the
In July 2000, I had a black out spell while driving the car. Again the doctor was reluctant to test for heart complications.
In Oct 2000, my neurologist ran another EEG and discovered two abnormalities in the brain that were independent of each
other. A tumor was ruled out.
I then tested positive for Sjogrens (with a saliva biopsy) and Raynauds (using the ice water challenge).
In Nov 2000, an EKG was abnormal, but the local doctor did not think it was anything to worry about, although he did
diagnose me with peripheral arterial disease. While seeing an endocrinologist for an elevated thyroid in July 2001, they immediately
referred me to a cardiologist. The cardiologist diagnosed me with arteriosclerosis.
This site has dealt with breast
implants. I want to tell those of you who are contemplating a latissimus dorsi flap as part of reconstruction what you are
really doing for your body. Removing muscle from your back is a serious decision and should not be taken lightly. This procedure
loosens part of the latissimus dorsi muscle from your back, tunnels it under your arm, and then is tied into place on your
chest to form a breast or a cavity to hold an implant.
Over the years since the first reconstruction surgery, I have
never had a pain free day in the surgical site. Bowling and golf had to stop as the strain across that incision caused a pain
that put me on pain pills for three or four days. I cannot hold my arm up for any length of time, even to do my hair. I have
dropped and broken things without even the feeling of letting go. I have had to mentally "tell" my hand and arm to function.
I dont walk as I once did. And, latissimus dorsi patients seldom get a good nights sleep once they undergo this surgery. It
was years before I realized that I could no longer turn over at night without pulling myself up and helping myself make the
turn. Women may experience temporary paralysis on the effected side. I had to relearn how to use my hand and arm again. You
may lose grip in your hands that may be permanent. You may experience numbness in some parts of the arm, burning in others.
You may experience cold flushes to the face from the pressure on the nerves. You will think you are having a stroke, but you
In 1996, when I spoke with a plastic surgeon in Utah, he said he had done this surgery many times, but had
to admit he had "never stuck around to see the long range results".
In the spring of 2000, I attempted to gain information from the ASPRS regarding the number of reconstruction patients
that needed repeat surgeries. I wanted to know what long-term studies their member use when they encourage women who have
had breast cancer to undergo reconstruction with these surgeries from hell. They had no long-term studies. In a response to
a letter making the same request, Dr. Gary Brody (former president of the ASPRS) told me to call doctors and develop the figures.
The fact is, the ASPRS has never tracked patients over a long period of time following these surgeries. There are
no statistics. My belief is that if there were statistics, they could not sell these expensive, painful surgeries to vulnerable
women.In my body, the latissimus dorsi muscle has attached itself to either the ulnar nerve or the medial cordor both. The
damage is permanent. The results are lasting.
I will never again believe a slick slide show in a doctor's office.
This is the surgery from hell but they make $$$$$$$$ by promoting it. I think I bought a new race horse for my doctor. What
will you be buying?
Copyright Pamela G. Dowd 1995/2001