Breast Reconstruction: Q&A
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Breast Reconstruction - LD Flap w/ Implant After Expander Infection?
I had radiation on left breast 2 years ago. Now I had mastactomy and reconstruction with expander , and have infection.2 weeks I have picc line with anibiotic, infection still there. Quation - if expender must be taken off,I was told , I can have LD Flap with implant ( My right breast has an implan long time ago. size C, I want to match. )But ,I do not understand, if I have infection with implan (expander) now, why LD Flap with implant can be better ? Thank you , Nataliya.
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11 Doctor Answers |
Asked by
timetimetime
in Los Angeles
+2
LD with implant after infection
Based on your history of radiation, you run an unacceptably high chance of implant related complications without bringing in some healthy non-radiated tissue. This tissue brings a healthy blood supply to protect against infection and capsular contracture (scar formation). I am unsure about the nature of your infection, but here are my thoughts:
1. LD with Implant: consider only if your problem was a threatened tissue expander exposure, not an active...
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LD Flap with Implant
Unfortunately, the risks of implant reconstruction after radiation therapy are much higher than for those who have not previously been radiated. It is difficult to eradicate an implant infection and the infection often will lead to the removal of the implant. This does not mean that you can not be offered reconstruction. After an infection has resolved, a secondary reconstruction can be considered, and a LD flap with an implant may be an appropriate option. This procedure adds fresh,...
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Breast Reconstruction with LD Flap after Infection
If your expander is infected, it will need to be removed and your body will need some time to clear away the infection. When the infection resolves, the tissues will be more fibrous and stiff as a result of the scar tissue tissue that will form. Also, because of your history of radiation, you will already have firm, scarred tissue there. The LD flap will provide new, healthy soft tissue coverage that will expand easily and fight off infection much better than the tissue...
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Latissimus Flap Breast Reconstruction After Irradiation
Dear Nataliya,
I am sorry to hear about your complications. There are a couple reasons I believe a latissimus flap + an expander as the first stage of your reconstruction would be beneficial.
1. You have had irradiation to that side of your chest which reduces the circulation to that area. This can make you more prone to poor healing and infection
2. Irradiated skin does not stretch well enough to produce an aesthetically acceptable breast
3....
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Expander infection
If you have an expander infection, you have to have it removed and then you should wait several months before attempting further reconstruction.
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Radiation and breast reconstruction
Radiation and expansion are a bad combination, increased risk of infection, poor healing and capsular contracture. Adding non radiated tissue from the LD flap helps all of this.
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Breast reconstruction and infected expander
It is very difficult to cure an infected prosthesis in an irradiated field with antibiotics. You might get a solution quicker if you remove the implant for a couple of weeks and then start over either with a new expander or the LD flap. I do not know what your specific situation is with your residual post-mastectomy tissue or the extent of your expansion so I cannot give a specific recommendation. A LD flap is commonly used to salvage or supplement the soft tissues of an irradiated...
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Breast reconstruction
Reconstruction with only implant after radiation have a large percentage of failure and problem rates. Radiated tissue is an injured tissue and can get infection easy.
When you bring the Latismus Dorsi Flap, you are bringing skin, muscle and fat. The muscle brings a well vascularized tissue to the area of radiation, this helps the radiation injury, and the implant is put under the well vascular Latismus Dorsi Muscle. Success rate is high, and achieving symmetry is much easier....
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Baltimore Plastic Surgeon
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Breast Reconstruction After Infected Expander
Your question expresses a very valid point. The presence of a breast implant under the latissimus dorsi LD flap, still presents a risk of infection.
I feel that a better option is to do a flap-only breast reconstruction such as a TRAM flap or a DIEP flap which eliminates the need for a breast implant and its attentant risks.
The first priority is to control and resolve the infection. This requires that the infected implants be removed, that you receive antibiotics...
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Breast Reconstruction After Infection and Radiation
When radiation is used in the treatment of breast cancer, non-cancerous tissues in the path of the radiation are also affected. Radiation is especially problematic for women who undergo implant reconstructions, and failure of an implant reconstruction in the setting of radiation is not uncommon.
Natural-tissue reconstruction has the benefit of bringing non-radiated, healthy, well-vascularized tissue to the mastectomy site, and this can actually aid in the healing process. While the...
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Options
Expander failure in the setting of radiation is fairly common. Bringing in healthy, non - radiated tissue in the form of a LD with tissue expander or using your tummy to reconstruct your breasts are your current options at this point. You can still get an infection with th LD but it is less likely than tissue expander alone.
Saint Louis Plastic Surgeon
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