Jeffrey Michael Feiner, MD

Thank you for the question. This is certainly a difficult question to answer with limited knowledge of your case specifics. There are situations where the plastic surgeon may be able to salvage an implant reconstruction with early and aggressive treatment in combination with antibiotics. Once the antibiotics are completed, it is important to carefully watch for signs of recurrent infection including pain, redness, swelling and a change in the breast appearance. This is typically followed quite closely by both your plastic surgeon and infectious disease specialists. 

Reconstructive failure is very uncommon, especially when done for prophylactic mastectomy.  The risks of failure increase when chemotherapy and/or radiation therapy are introduced in the setting of breast cancer. It would be interesting to hear more about what happened specifically with your mother’s reconstruction. Often failure in prophylactic mastectomy is due to issues with the skin left behind from a mastectomy( this risk can be significantly reduced when plastic surgeons and breast surgeons work closely together), infection, or issues with surgical planning. Either implant-based reconstruction or autologous (using your own fat) are viable options, each with advantages and disadvantages. A consultation with an experienced, board-certified plastic surgeon with extensive expertise in breast reconstruction would be a great first step to discuss your options and to customize a plan that meets your specific needs. 

Your results look excellent for three months and you should be very pleased with your reconstructive surgeon. Believe it or not, you are still in the healing phase and these big reconstructive procedures can take many months to heal fully. Scars and wounds can heal for a year or more after surgery. The swelling is an indication of healing. My question for you is whether you have received radiation on the left side after surgery or perhaps before with a lumpectomy as radiation can prolong the healing process and the swelling takes much longer to resolve in those cases. 

As for the Nipple reconstruction and tattooing, the timing depends on the technique your surgeon uses for the reconstruction. Most will tattoo at the end once the reconstruction has healed and the swelling resolved. 

Radiation poses significant challenges to the reconstructive plastic surgeon, especially in thin and active patients such as yourself. The problem is two fold. First, thin patients often have thin mastectomy flaps and tenuous coverage of implants. Second, the radiation can worsen the situation with its inherent impact on wound healing, increased scar contracture and fibrosis or hardening of the skin. Implant only reconstructions in this setting can be extremely challenging even for a confident and experienced surgeon. Many surgeons would recommend staged reconstruction in this setting with the placement of tissue expanders at the time of mastectomy. This will give you a chance to see how your skin and soft tissue will react to the radiation. If your skin is very thin and you have significant radiation damage, you may require flap reconstruction as an alternative to or in addition to implant reconstruction. The latissimus muscle flap is very commonly used, but it does have the disadvantage of sacrificing a large and important muscle in the process. Alternatives would be complete autologous reconstruction using abdominal tissue(DIEP). This can be limited in thin patients who don't have enough volume to match the breast size. Strategies to maximize this would be to use a stacked DIEP where both halves of the abdomen are used to reconstruct one breast or to use the DIEP over an implant. The DIEP can also be combined with other donor sites to maximize volume such as the inner thigh or buttock region. These techniques require a skilled Microsurgeon with extensive experience.  One final alternative to the latissimus is the TDAP or thoracodorsal artery perforator flap.  This utilizes the skin and fat from the back to cover the implant while sparing the muscle.  This is not something that all plastic surgeons are experienced with and you will need to do some research to find an experienced surgeon in your area.

This would depend on your other medical issues and overall goals for reconstruction, but the short answer is no. There is no age limit for reconstruction typically.