I Had a Bi-lateral DIEP Flap Procedure Done 3 Months Ago. Having Healing Issues?

I have had issues starting at about 6 weeks out with it healing. A section about 6cm long and 2-3 cm deep had opened up. I was on a regimen of using medihoney every other day until 2 weeks ago (one day of 3 months from surgery) when something opened up and drained all over my clothes (there was tunneling). I am now on antibiotics for infection and packing it every day. I am also appear to look 3 months pregnant. Is there a chance that it is just swelling since the wound has not yet closed?

Doctor Answers (4)

Delayed Wound Healing with DIEP Flap

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I am concerned that you have a retained fluid collection (abscess or seroma) that is not adequately drained.   I would recommend close followup with your surgeon and possible evaluation with ultrasound or CT scan to fully evaluate your abdomen.  

 
This should give you answers to the source of the problem.   It is possible that an outpatient procedure or assistance from a wound care center may be necessary to help resolve the issue.

 

I am sorry for your prolonged recovery.   Infection and delayed wound healing are risks that exist with all surgical procedures.     Please maintain close followup with your plastic surgeon and be diligent with your wound care and nutrition.

 

I wish you a safe and healthy recovery.

 

Dr. Gill


Houston Plastic Surgeon
5.0 out of 5 stars 40 reviews

Bilateral DIEP flap healing issues

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I'm sorry to hear that you are experiencing some healing issues after your bilateral breast reconstruction.  It sounds as if you had a fluid collection or abscess that drained out and you are packing your resultant wound to allow it to heal by itself.   Given this delayed healing, you are likely very swollen in this area.   And this swelling will takes weeks to resolve.   Please also see your reconstructive plastic surgeon to make sure you are also not experiencing a rare "bulge" or hernia that can manifest in your abdominal donor site.  These are rare but can happen.  Regardless, continue following up with your plastic surgeon for wound management.  Your plastic surgeon may also work with a wound care center to assist with your care.  Don't worry, this will pass but it will take time.  Good luck.

Dr. Basu

Houston, TX

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 124 reviews

Healing issues after a DIEP

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I am sorry you are having healing issues. Unfortunately, this can happen due to the tension of the abdominal tissues closing after the DIEP, as well as other factors such as smoking, diabetes, etc. Even without the wound it is still too early at 6 weeks to really know how your abdomen is going to look. It takes several months or more after the final healing to know how the abdomen will look. Most of the healing after any surgery takes place in the first weeks after surgery, but there is still more healing going on slowly over the months after surgery. It is difficult to wait as the process is slow, and particularly with wound healing issues, but you will need to give it more time before you are fully healed. At any time you have concerns about the wound or the possible swelling you should speak with your surgeon about it.

Brice W. McKane MD
Houston Plastic Surgeon

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DIEP flap, Brest cancer, DCIS

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Healing issues exist in the area where the flaps were placed to the stress of the mastectomy on the skin of the chest and on the abdomen due to the stress placed on the tissues where the flaps were taken from initially.  The abdominal wound is closed under tension usually.  The most likely place to have issues is just above the pubic area.  Factors that effect wound healing are the size of the patient (BMI), health of the patient which includes conditions such as diabetes and of course other issues related to the treatment of cancer.  In addition smoking and a diet low in protein play a role in delayed wound healing.

Three basic forms of breast reconstruction exist. You can use your own tissue, implants or a combination of the previous two techniques. Your own tissue can be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting. Implants can be done in one stage or two stage. Two stage reconstructions are started by placing expanders at the time of mastectomy. Once they expanders are placed they are able to be inflated as determined by wound healing. The final time consists of combining any of the above techniques.

If you are interested in being seen in Austin please give us a call. I know this is a difficult time for you. The majority of my practice is devoted to reconstruction for women with breast cancer or who are BRCA+

Robert Whitfield, MD, FACS
Austin Plastic Surgeon
5.0 out of 5 stars 14 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.