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Prophylactic Mastectomy 3 Months Ago - Why Do I Continue to Drain? Can It Be an Alloderm Reaction?

I am a 30 year old woman. In Sept. I had a prophylactic mastectomy with tissue expanders and alloderm. 8 weeks post op the bottom of my rt breast opened (not the incision) The skin turned purple and opened. The same started happening with the left. My ps removed the expanders thinking it was infection. No infection present. Removed drains after surgery and my skin opened again and is draining blood, alloderm and stitches. I have open wounds draining Surgery to remove alloderm is next week. Ideas?

Doctor Answers (9)

Prophylactic Mastectomy 3 Months Ago - Why Do I Continue to Drain? Can It Be an Alloderm Reaction?

+1

You do need to have the wound explored ,debrided and re sutured with drainage

Once healed ,in several months, you can review your options


Boca Raton Plastic Surgeon
5.0 out of 5 stars 5 reviews

Alloderm and Infection

+1

Any surgery carries a risk of infection or wound healing problems once the skin barrier to the outside has been openned.  Foreign bodies such as an expander, Alloderm, sutures, etc increase that risk varying amounts.  The initial removal of your expanders was a reasonable recommendation.  If the Alloderm was adherent, there is general no indication to removed unless there is frank infection.  Since removal of the expanders did not solve the issue, then return to the operating room to look and remove that Alloderm is not unreasonable.

Roberta Gartside, MD
Reston Plastic Surgeon
5.0 out of 5 stars 13 reviews

Alloderm post mastectomy

+1

The use of Alloderm in breast reconstructon can provide several benefits especially when using tissue expanders and implants:

  • better coverage of the implant
  • support of the lower portion of the breast implant
  • improved positioning of the breast expander / implant

In your case, after removal of your expanders and with a wound that has not healed properly, you may need:

  • return to the operating room for exploration of the wound and removal of any necrotic (dead) tissue / skin and removal of the alloderm, once this is done, healing should proceed much more rapidly
  • once complete healing has occured, a decision with your surgeon regarding reconstruction options can be made

Sean A. Simon, MD
Miami Plastic Surgeon
4.0 out of 5 stars 27 reviews

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Prophylactic Mastectomy 3 Months Ago - Why Do I Continue to Drain? Can It Be an Alloderm Reaction?

+1

This is does happen after the placment of  Alloderm or other Acellular Dermal Matrix. Sermoas have been reported as well as infections. The rates are some what lower then when origenally used due to a learning curve. It sounds that your body is rejected ( has not incoperated ) the Alloderm and it needs to be removed!

Good Luck

Tal T. Roudner, MD, FACS
Coral Gables Plastic Surgeon
5.0 out of 5 stars 80 reviews

Drainage after breast reconstruction

+1

If you still have an open, draining wound  after the expanders have been removed, then I would suggest a return to the operating room for a complete exploration of the wound. If there is any non-viable tissue in the wound it must be removed. It may be that some or all of the Alloderm did not "take" and if this is the case, it could be the source of the problem.

Mark Preston, MD
Columbus Plastic Surgeon
4.5 out of 5 stars 10 reviews

Draining breast with Alloderm

+1

Although it may not look like an infection, if the Alloderm is draining out of your body, then it needs to come out. Once all the foreign material is out, than healing is much more likely.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
5.0 out of 5 stars 18 reviews

Breast Reconstruction Problems

+1

Alloderm can produce seromatous fluld.  This is why in tissue expander/Alloderm reconstruction closed suction management is important.  Your issues should resolve once the alloderm is removed.  Just follow you surgeon's instructions.

Dr. ES

Earl Stephenson, Jr., MD, DDS
Atlanta Plastic Surgeon
5.0 out of 5 stars 8 reviews

Wound healing problems

+1

Persistent wound healing issues are usually related to infection or foreign body reaction (permanent sutures, etc).  Alloderm isn't a problem, in and of itself, but it can become infected, just like the rest of your breast. A smoldering infection indicates removal of all foreign bodies (suture material) and scar capsule.  Your surgeon seems to have a sound plan.

Carmen Kavali, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 18 reviews

Breast Reconstruction Complications

+1

Regarding: "I am a 30 year old woman. In Sept. I had a prophylactic mastectomy with tissue expanders and alloderm. 8 weeks post op the bottom of my rt breast opened (not the incision) The skin turned purple and opened. The same started happening with the left. My ps removed the expanders thinking it was infection. No infection present. Removed drains after surgery and my skin opened again and is draining blood, alloderm and stitches. I have open wounds draining Surgery to remove alloderm is next week. Ideas?"

Respectfully, your description is confusing and without photographs of what happened it is hard to follow much less advise you. As best as I can understand, you had

Surgery 1 - September - Mastectomy with expander / AlloDerm reconstructions

Surgery 2 - November - ?loss of blood supply to the lower portion of the breast VS infection leading to Bilateral removal of expanders (leaving AlloDerm behind).

Surgery 3 - December - Planned removal of AlloDerm due to continuously draining open breast wounds.

It is unclear what process caused "The skin turned purple and opened". Why would the skin blood supply be compromised as far as 2 months after surgery?  Overly tight bra? Infection? Smoking? Diabetes? or other factors. Under such circumstances, your surgeon should have lowered the volume in the expanders to lower pressure on the skin and if that did not improve he would have acted appropriately by removing the expanders.  Since that did not correct the situation, we can assume the AlloDerm is either colonized with bacteria or infected and removing it is reasonable.

You will need to allow the areas to heal. Further reconstructive options may need to include microsurgical techniques. You may also want to look into the use of the BRAVA system with fat grafting. Several procedures may be needed but if they work out, the results are quite good.

Good Luck.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 61 reviews

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