Breast Reconstruction: Q&A
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Multiple Infections - Should I Remove the Expander or Continue w/ LD Flap Surgery?
I was diagnosed with breast cancer in 2009; had a bilateral mastectomy and LN dissection with reconstruction done during this surgery (expanders placed). Underwent chemo and had radiation to the left breast. In December developed a cellulitis to the left breast took about a month of augmentin and was fine until a few days ago. Again I have pain and redness to the left breast and a fever. Is it time to say this cannot be saved and have the expander removed and go ahead with a LD flap in May?
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8 Doctor Answers |
Asked by
Cat1960
in Chicago
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Infection, Radiation and Breast Reconstruction
When radiation is used in the treatment of breast cancer, non-cancerous tissues in the path of the radiation are also affected. Radiation therapy can mean a significant loss of skin elasticity, which can profoundly affect the aesthetic results of breast reconstruction. And because the body’s wound-healing mechanisms are altered by exposure to radiation, complications from all types of reconstructive breast surgery occur at a higher rate.
Radiation is especially problematic for...
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Implant Complication in Irradiated Breast
Based on your history of radiation to the left breast and recurrent infection, I recommend that you consider a tissue reconstruction. Either a latissimus flap or abdominal tissue transfer would be suitable, depending on what you prefer and are a candidate for.
As far as the immediate issue, it seems that it will be necessary to at least remove the implant and all the capsule. An informed discussion between you and your surgeon is necessary to chose the...
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Breast reconstruction and infection
If you have a recurrent infection, you may have to bite the bullet and have the expander removed and then come back at a later time for a different type of reconstruction or a restart of the TE.
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Breast Reconstruction After Radiation and Infection
Based on the information you provided, your best option is to have the breast implant removed, the pocket cultured, and the infection aggressively treated. Once the infection has resolved, and your tissues are soft, then a flap breast reconstruction should be considered.
The choice of flap technique will depend on size of the breast that is appropriate for your body and other considerations that will be discussed by the reconstructive plastic surgeon.
Flap techniques...
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Post radiation breast reconstruction.
If you are experiencing a recurrence of your infection, then you may want to consider some form of autologous breast reconstruction (tissue reconstruction without implants). In addition, you are experiencing these problems on your radiated side. Remember, your history of radiation will significantly increase your risk of scar tissue formation around your implant. I generally do not recommend placement of final implants after radiation because of an increased risk of...
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Autologous reconstruction following failed implant reconstruction
Once you have failed expander placement, you are limited to undergoing your reconstruction with autologous tissue. these include local flaps such as LD, but also distant flaps, and even less invasive fat grafting.
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Infections after breast reconstruction
This is a choice you should discuss with your plastic surgeon. If the radiation has changed your skin and it is becoming infected, then you should consider the latissimus dorsi flap or TRAM flap. Long-term, breast reconstructions with implants after radiation do tend to have more problems.
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Breast Reconstruction
Most failed implant reconstruction is due to the effect of radiation.
Two episodes of cellulitis is enough to take the expander out and the capsule, treat the infection then discuss the timing and the options of breast reconstruction.
1: Latismus Dorsi flap with or without implant
2: TRAM flap
3: diep flap or other free flap reconstruction.
4: In some cases fat transfer
Baltimore Plastic Surgeon
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