Failed Reconstruction After Mastectomy Due to Persistant Drainage. What Are my Options?

asked 1 year ago by savealotmommy in Indiana
Latest answer by Fredrick A. Valauri, MD
Question viewed 593 times
Tags: age 25-34, infection, results, revision

I had a prophylactic mastectomy with tissue exp and alloderm. My skin opened 8 wks post op and I drained from open wounds on the bottom of each breast. My ps removed the expanders. No infection. Drainage continued. A 2nd surgery removed alloderm and stitches. My wounds healed. What are my reconstruction options since the 1st failed? PS is not sure what caused all the problems I am healthy, 30 yrs, no medical conditions, do not smoke Drains were used all 3 surgeries w/ less than 10ml before removal

10 answers to Failed Reconstruction After Mastectomy Due to Persistant Drainage. What Are my Options?

Failed reconstruction

Sometimes you just have to start over. More than likely the alloderm or expander became infected. You can try again with the tissue expander or you can consider autologous reconstruction.

Steven Wallach, MD
Manhattan Plastic Surgeon

Alternative Breast Reconstruction Techniques

It seems that there may have been a seroma/fluid collection that was retained or possibly the alloderm did not incorporate into your tissues. You still have multiple options to choose from. The best choice will be based on a detailed physical exam by a breast reconstruction surgeon to determine what you are a candidate for, followed by a detailed history of your goals and expectations. Typical options are flaps from the back (latissimus dorsi), abdomen (TRAM... more

Paul S. Gill, MD
Houston Plastic Surgeon

Alternative breast reconstruction techniques

Sorry you have had these troubles as a failed reconstruction can feel like another mastectomy to many patients. Your "uninfected" persistent fluid issue sounds mysterious and it may be that there was an infection that was just not caught on the cultures or that it was a kind of infection that they didn't test for. Either way, if you have some extra tissue, you could look into doing a microsurgical breast reconstruction using that tissue. These are... more

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Salvage Breast Reconstruction Procedures

What you have described in your question is unfortunately not uncommon. There is a high rate of re-operation for a variety of problems following implant expander breast reconstruction. For this reason, although longer and more complex, autologous tissue breast reconstructions such as TRAM flaps, DIEP flaps actually have lower complication rates and lower re-operation rate. Of course, any operation can have complications, so there are no guarantees. In... more

Fredrick A. Valauri, MD
New York Plastic Surgeon

www.drvalauri.com

Options for reconstruction

You are a candidate for delayed reconstruction. After several months and once completely healed with no signs of infection, you may consider implant reconstruction again. However, you may want to consider an autologous reconstructive modality using your own tissue such as a DIEP or muscle sparing TRAM flap. To be a candidate, you must be in good health and have enough excess tissue in your lower tummy area. Another option would be to consider a latissimus dorsi... more

C. Bob Basu, MD
Houston Plastic Surgeon

www.basuplasticsurgery.com

Options after failed reconstruction.

Persistent drainage despite negative cultures often means contamination of the expander or Alloderm with a bacteria producing a biofilm. This is a protective coating the bacteria create which allows them to persist and often does not grow in culture mediums used routinely to identify bacteria. The cure for this is often removal of the tissue or device to which this biofilm is attached. Once the area is cleared, it is appropriate to wait at least 3-6 months before attempting replacement of an... more

David Bogue, MD
Boca Raton Plastic Surgeon

www.drbogue.com

Breast Reconstruction Options

There are many options available for breast reconstruction, with the main decision focusing on whether to use one's own tissue (skin and fat). Most reconstruction today is done with tissue expanders and implants. More recent techniques have incorporated the use of acellular dermis implants in addition. Choosing the right surgery for you is based on both personal choice and consultation with your surgeon. Though you may be hesitant to try implants again, that is still a viable option as are... more

Asaad H. Samra, MD
Red Bank Plastic Surgeon

Options for failed first attempt at reconstruction with alloderm and expander

You could try another course of expanders without alloderm. Alternatively you could consider using a variety of flaps ranging from Latissimus or Tram (pedicled or free) or a DIEP flap among others. Alternatively you could try a staged course of fat grafting.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Breast reconstruction

Inspite of your unfortunate complications, YOU still have ALL the options in breast reconstruction 1: reconstruction with implant. Tissue expansion then implant 2: Reconstruction with your tissue, first TRAM Flap. Bilateral pedicled will weaken your abdominal wall significanly. 3; Latismuss Dorsi flaps, with or without implants. (scar on the back in the Bra line) 4; Free flaps see a plastic surgeon and discuss all your options and what fits your lifestyle... more

Samir Shureih, MD
Baltimore Plastic Surgeon

Failed Implant Reconstruction After Mastectomy- What Are the Options

I'm sorry to hear that you are having trouble following Alloderm/expander breast reconstruction. Unfortunately, complications from breast reconstruction with implants are very common. In fact, there is some emerging evidence that shows that reconstructions that utilize Alloderm may be at especially high risk of complications from seroma formation. It is not clear from the limited information in your description whether the drainage you experienced was related to infection or seroma... more