Post-Mastectomy Breast Infection. Expander Removal?

Left breast ( had radiations 2 years ago ) got infected after mastactamy and reconstraction with expander.I'm 2 weeks now with picc line with antibiotics,but infection still there. I have implant on the right breast , size C .If expander much be taken off, Is it possible to do LD flap or tram flap with implant to the left breast to look same with right ? Or, may be can give advice how to save expender and treat infection ? Thank you, Nataly.

Doctor Answers (7)

Tissue Expander Infection with history of breast radiation

+2

With your history of breast radiation combined with recent infection, I recommend that you strongly consider either a latissimus flap or DIEP flap reconstruction of your left breast.     By bringing healthy non radiated tissue to the left breast, you will minimize your chance of recurrent infection or scar tissue formation

Here is my recommendation:

1.  Extensive infection: remove the expander and give your left breast 4-6 months to heal and be free of infection.   Then come back to reconstruct with latissimus dorsi with tissue expander or a DIEP flap.

2.  Mild Infection:  remove the expander and its surrounding capsule, then place a new expander with latissimus dorsi flap.

I wish you a safe and healthy recovery.

 

Paul S. Gill, M.D.

Gill Plastic Surgery

Houston Double Board Certified Plastic Surgeon


Houston Plastic Surgeon
5.0 out of 5 stars 35 reviews

What to do with an infected implant

+2

You have had radiation to your left breast and with this comes poor blood supply and the resulting infection.  Normal treatment for an infected breast implant is to remove it and wait a minimum of six months.  In your case with the radiation, it may take longer.  I would suggest you wait 6 to 9 months or even a year before considering further surgery.  I would wait till the surgical site is soft and freely movable.  At that time you should consult with your PS and discuss your options.

Gary H. Manchester, MD (retired)
San Diego Plastic Surgeon
5.0 out of 5 stars 1 review

Infection and expaander

+2

If  the expander is infected you should have it removed and wait three to six months to have a new reconstruction.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

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Tissue Expander breast reconstruction infection

+2

Prosthetic reconstruction can be difficult after radiation with difficulty healing, poor expansion, infection, etc.  It may also be difficult to clear the infection with the tissue expander in place.  It may be necessary to remove the expander if the infection does not resolve and then consider LAD , TRAM flap or other method of reconstruction.  As noted, it is difficult to give advise without knowing  complete history and continued followup with plastic surgeon is most appropriate.  Good luck.

Stephen Delia, MD
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Post-Mastectomy Breast Infection. Expander Removal

+2

Very hard to give internet advise. We do not have your complete medical/surgical history, photos, etc. Best to discuss with your PS, your General Surgeon, additional PS's. My guess is removal , healing time, than either a lats flap or TRAM flap, or microsurgery flap. Best of luck from MIOAMI DR. Darryl J. Blinski, 305 598 0091

Darryl J. Blinski, MD
Miami Plastic Surgeon
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Expander infection?

+1

You may have to consider removal. An exam is the only way to know this for sure.Salvage with antibiotics is appropriate but after a while the source of the infection (the expander) need to come out.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.0 out of 5 stars 14 reviews

Implants in the setting of infection & radiation most often require removal

+1

While attempts to salvage infected implants with antibiotic treatment are sometimes made, surgery is often needed to remove the implant in order to allow the infection to resolve. The chances of salvage are lower when radiation therapy has been used as part of a patient's treatment.

Once an infected implant is removed, the period of delay until further surgery will often depend on the method of reconstruction that one chooses. If another implant reconstruction is going to be attempted, most surgeons would typically wait between 6 and 9 months before another implant is placed. If a woman's own tissue is going to be used for the reconstruction, surgery can usually be performed safely after a much shorter waiting period. 

Following radiation therapy, the chance of achieving a successful reconstruction with natural-tissue (procedures such as the DIEP flap or TUG flap) is generally much better than if an implant reconstruction is attempted. This is because an implant is avoided altogether and healthy, well-vascularized tissue--capable of helping the healing process--is brought to the mastectomy site.

Hope this is helpful information.

David Greenspun, MD, MSc
New York Plastic Surgeon

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.