Breast Reconstruction for Infected Breasts?
- Asked by avasmom in Naples fl
- 5 years ago
I have had breast infections due to Gamella bacteria first, then had a bilateral periductal fistula on both breast 3 times, then contracted HA MRSA. I underwent surgery for that. I still have infection but my breasts look terrible now. They are scarred from the many procedures, and the right nipple is actually at an angle now instead of horizontal.
I was wondering if there's any type of corrective surgery that would be helpful for my situation. We are still treating an infection, although unknown. The last culture was " normal skin flora". Thank you for your time.
Breast Infection: The treatment must be precisely planned and conserving
The breast, like many other parts of our body, are prone to infection. The ductal anatomy of the breast places it at risk for infection. The planning of surgery depends on several factors, the most important of which is to eradicate the infection altogether.
Once the infection is cleared and time has elapsed, the choice for reconstruction includes prosthesis, autologous tissue transfer, or a combination of the two. Breast implants are riskier because of the possibility of incomplete clearance of the infection.
Autologous breast reconstruction
You have a complicated problem. The first issue should be can a partial mastectomy removing the scar tissue create a resonable breast mound or is it necessary to perform a larger resection.
When dealing with breast reconstruction there is an important choice between using your own tissue (an autologous breast reconstruction) and using implants.
In an individual with multiple infections sometimes implants are the best choices. Implants are not resistant to infections the way your own tissue would be.
For both partial mastectomy (lumpectomy type) defects lat. dorsi (using a portion of your back muscle and possibly (depending on the defect) skin) can be effective ways to reconstruct small defects.
For larger defects pedicled TRAM, free TRAM and DIEP reconstructions all work very well.
I do agree with Dr. Cambre that it will likely require several surgeries and that you would be well served by clearing the infection first.
I hope this helps.
First you need to adequately treat the infection. Once that is completed, then you can work on possibly improving the reconstructed breast appearance.
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Breast Reconstruction for Infected Breasts
Having such a complicated course with breast infection makes me wonder about the underlying cause, be it trauma, diabetes, or immune suppression from medication or HIV. Have you been evaluated for an underlying cause?
There is a condition known as granulomatous disease of the breast that results in multiple abscess-like lesions, but this is seen on pathology, and doesn't usually cause multiple infections.
Once the cause of your breast disorder is identified and treated, you would need to be evaluated to see if you are a candidate for partial breast reconstruction, or whether mastectomy and complete breast reconstruction would be indicated.
Reconstruction for breast infections
Your history of breast infections sounds quite severe. Prior to any reconstructive procedure, the important goal is resolving the infections. Reconstruction then depends upon what breast tissue remains, what position it is in, and the degree of asymmetry between your breasts.
Some women have such bad recurrences of infection that they opt for mastectomies to clear up the repeated infections. If this were the case, I believe allowing your body to heal prior to reconstruction would be the appropriate approach. This is known as a "delayed" reconstruction. If the infections can be resolved without a drastic measure such as a mastectomy, I would be very wary of using implants to reconstruct your breasts given the extensive history of infection.
Web reference: http://www.drbogue.com
Control infection and reconstruct with own tissues
Pictures will be extremely helpful. Different techniques could be used to correct the breast deformity and remove the scar tissue. It is important for the plastic surgeon to coordinate with your infection disease specialist for the proper antibiotic prophylaxis etc. As expressed before by some of my collegues, implants might not be the best option for you and a combination of your own tissues (flaps or fat grafting) could be the way to go. Hope that helps!
Web reference: http://newportplastic.com/
Breast reconstruction with your own soft tissue
Sometimes when breast tissue becomes severely scarred, the best option is to remove the extensively damaged tissue. This does not mean you will require removal of the entire breast, but possibly a portion of it. Replacement with your own tissue by means of a flap (using the Latissimus Dorsi or Rectus Abdominus muscles) will bring new soft and pliable tissue with a healthy blood supply.
Get the infection cleared first.
Before reconstruction you really want to get the infection issue cleared up as much as possible. If repeat infection is a high risk in the future you want to consider tissue-based as opposed to implant-based reconstructive options. Implants do not do well in the presence of infection.
A Rare Occurrence With No Easy Answer
I am sorry you have experienced so many problems with your breast surgery. As I am sure your surgeon has told you by now, there are no easy answers as to how to proceed; still, however, there is hope.
In general, the first priority is to completely clear your infection. This means removal of the implants completely.
If there is severe deformity of the breasts as a result of the infections, the incisions, and the implant removal, you will most likely require a multi-staged reconstruction. Tissue expanders will need to be placed as the first stage, then slowly expanded and allowed to restore the shape of the breasts. A while after that stage is completed, you would have removal of the expanders and placement of breast implants as the second stage, perhaps with some scar revisions as well. Any final reconstruction of the nipple and areola would be done as the final stage, along with more scar revisions if needed.
It will undoubtedly be a much longer and rockier road than what you expected, but unfortunately a severe infection such as yours does occur rarely. Keep the faith, and eventually you will get through this problem.
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.