Options for Breast Reconstruction After an Infection?
- Asked by Marzi in California
- 4 years ago
I had a bilateral mastectomy done, and I had breast implants placed in both breast. I had expanders put in, and had radiation along with a boost.
This past January, the implants where put in. Then in April of this year, right breast got an infection. The infection tore a large whole in my breast, so my plastic surgeon removed the implant in my left breast. I don't have much skin there because it was removed.
My reconstructive surgeon suggested that I get a TUG Flap. I am very concerned about this having this procedure done because I know that it is not performed much and is new. Do you have any suggestions?
Radiated mastectomy flaps require innovation
Have courage, know your body, lifestyle, aesthetic ideals and then have a chat with your PS. It's important to know your options. In your case, radiated chest wall, skin shortage and delayed reconstruction, will require innovation as well as good communication. Traditional teaching holds that your surgeon needs to import well vascularized tissue into the zone; a TUG flap is just one option. Microvascular (free) flaps, such as TRAM or DIEP flaps can easily solve your problem, especialy if you have excess fat around the abdomen. However you should assess both your surgeon's experience and the hospital's institutional commitment to such procedures; both need to be ready, willing and able to support you.
The pedicled Latissimus dorsi flap is also a "workhorse" option. Its chief disadvantages are the scar on the back as well as the potential for seroma. It can be rerouted over a tissue expander, which can later be exchanged for a permanent implant. If your PS is forward thinking, the back skin-fat can serve as the basis for the nipple reconstruction too. good luck.
Breast reconstruction, nipple reconstruction, breast cancer, DCIS, mastectomy, TUG flap, DIEP flap, Latissimus flap
It sounds like you would benefit from a flap procedure. I would have to examine you to discuss all of your options fully. I will make an assumption that you don't have enough abdominal tissue for a reconstruction. I have also taken the entire abdominal flap and stacked them. I also have removed all of the implant material and performed bilateral latissimus flaps. This is tissue from the back. I usually will perform fat grafting after that at a lateral date to improve the size of the reconstruction.
You will first have to let things heal. Then there are many options for breast reconstruction depending upon your anatomy. A TUG flap is just one of may perforator flaps that can be done.
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Breast reconstruction after radiation
Radiation is certainly a double edge sword as you have found out. It is not very often I am able to get away with an expander implant reconstruction after radiation. In those cases where I need a flap, and in your case it sounds like 2 flaps, 1 for each side. I would recommend either a bilateral TRAM flap or a DIEP flap as the 2 workhorse flaps in breast reconstruction to my reconstruction flaps.
Get a 2nd opinion as far as the reconstruction goes especially since this type of surgery is required by law to be covered by insurance.
Many different options for salvage of radiated and infected mastectomy wound
IF your physican is experienced in this procedure, he/she may be able to accomplish an excellent result. However, if you have any questions, I would suggest obtaining a second or third opinion.
In general the traditional, some would consider it old fashioned) but realtively reliable flap is the latissimus dorsi. It has tradiitonally beed used to salvage radiation complications.
Discuss the advantages and disadvantages with your 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.