12/23/11 had prophylactic bilateral mastectomy(twin sister & sister with breast cancer)I was discharged with 2 jp drains 16 hours after surgery.Drains were removed 01/21/11 & drain on right was reinserted 01/25/2011-PICC Line inserted 02/18/11 & Oxacillin used for 11 days-Zosyn 03/03/11. Culture grew pseudomonas & staphylococcus aureus.I am still draining out the hole where the drain was. Still red & skin is cracking. I am being treated by an Infectious Disease Doc. I am 48 is this correct tx?
Reconstructive Surgery with Expanders - Infected
Doctor Answers (8)
Tissue expander infection
I am so sorry that you are experience what appears to be a cellulitis/skin infection. Its good that there is an infectious disease (infection and antibiotic) specialist on your team. It also sounds as if your team and you have decided to try to treat this cellultiis with IV antibiotic therapy with a PICC line. Now after an attempted treatment, if you still remain very red or are experiencing fevers, then your surgeon may need to remove your implant. Once the foreign body tissue expander implant has been removed, most implant related infections quickly resolve. I generally recommend waiting 2-3 months before you consider other reconstructive options. Should your implant need to be removed, don't worry, your plastic surgeon will have other options for you to come back a restore your breast another day. Best of luck.
In my experience it is very difficult (impossible) to salvage an implant or expander in the presence of this sort of infection. You need to have the expander removed and I am sure that you will find the infection will then settle very quickly.
Leave things to settle for a few months before thinking about further reconstruction. Good luck.
Your pictures look as though you may have to consider removal. Salvage with antibiotics is appropriate but after a while the source of the infection (the expander) need to come out.
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Breast reconstruction infection, tissue expander infection, breast reconstruction with DIEP flap
The most appropriate treatment to salvage the implant is being done. Downstaging infections is difficult but can be accomplished. You did not state whether or not a biologic material like acellular dermal matrix was used in your reconstruction. If the expander is unable to be salvaged then of course it can be removed. I have taken care of pateint's in this situation before and after their infections. Once it is resolved I hope you will be able to have a breast reconstruction with your own tissue. The DIEP flap is the procedure I most commonly perform to reconstruct the breast after these tissue expander infections.
Treatment of Infected Breast Implants for Breast Reconstruction
Based on the pictures and information in your question, I feel that the breast implants should be removed, cultures should be obtained from the wounds, and the infection should fully controlled first.
Once the infection is fully resolved and tissues have softened, then reconstruction with a flap breast reconstruction technique should be considered.
The flap breast reconstruction techniques do not use breast implants, so this avoid the problems of infected breast implants, displaced or exposed breast implants.
The flap reconstruction options create a breast that is entirely your own tissues resulting in a warn, soft, natural breast. You need a consultation and detailed discussion with a reconstructive plastic surgeon to determine if you are candidate for flap breast reconstruction such as a TRAM flap, or DIEP flap.
Sorry, but it sounds like you have an infected expander. More than likely this should come out and reconstruction should be delayed for a few months to allow things to settle down.
Breast expanders can get infected. It seems that your surgeon is trying to save your expander with local antibiotic irrigation of breast pocket as well as IV antibiotics. If your breast swelling and redness do not subside within one to two weeks, then you may need to have the expander removed. Most surgeons will then wait 3 months prior to undergoing the expander placement again.
Infected Breast expanders
There is no way you can salvage the expanders with antibiotics only. You need to have the expanders removed ASAP, Iv antibiotics to control the infection then 6 months later start thinking of your options in breast reconstruction. Your pictures show significant infection. SEE YOUR DOCTOR TODAY.