My experiences with Dr. Greenspun and his staff have been all positive. I was initially under the care of another PS and suffered for two years with an ugly and uncomfortable implant, having been told I was not a candidate for DIEP. In fact, I was told that perhaps that was just my new normal. I am now sadly aware that many plastic surgeons push their patients towards implants because that's what they know, not because it is what's best for the patient. For certain, implants are definitely not the best option for those of us who have had radiation. Thankfully, I found Dr. Greenspun! He is highly skilled, specialized and experienced in all aspects of flap reconstruction, and truly dedicated to his field and the care of his patients. My new body is more comfortable, natural, symmetrical and healthy. With the help and care of Dr. Greenspun, I feel like me again.
I also agree. Smartlipo and a periareolar lift will only work well for very small reductions. In order to get the best possible shape, you will have to be willing to accept the trade off of scars for breast size and contour.
I agree with the other surgeons- obtaining coverage can be difficult, but it is not necessarily impossible. Whether or not you are eligible to have insurance coverage for surgery will depend on how severely you are affected and on your insurance plan's "specific plan benefit". The specific plan benefit is essentially the contact you have with your insurer that specifies whether of not such surgery might be covered or is automatically excluded from coverage. If it might be covered, you will need to have your doctor send a letter and clinical photographs for medical review by an insurance company doctor. In some cases, we have been successful in obtaining coverage for surgery when the situation was clearly reconstructive. In the event that surgery is not covered, many plastic surgeons will work with you to try to find a financial arrangement that is comfortable. Best of luck.
I agree with the other surgeons who have responded. Wound complications and infections can occur after DIEP flap surgery and it sounds like your surgeon is working to help get the wound closed. The human body has a remarkable ability to heal in situations like this. Make sure you continue to see your surgeon regularly. It sounds like this will take some time to fully heal, but in most cases, it will not compromise your results in the end.
The simple answer is yes- it is certainly possible to have breast reconstruction after a MRSA infection. In my practice, I always use preoperative antibiotics to help prevent infection-in the case os women who have had MRSA before, I choose an antibiotic effective against MRSA in case they are still carriers of MRSA on their skin or mucous mambranes. We all have lots of bacteria on our skin, and carrying MRSA does not mean someone is more likely to get an infection, it just means that different antibiotics are effective against MRSA as opposed to non-MRSA bactera.
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 women who undergo implant reconstructions, regardless of whether the radiation is administered before or after the implant is placed. Natural-tissue reconstruction has the benefit of bringing non-radiated, healthy, well-vascularized tissue to the mastectomy site, and this can actually aid in the healing process. Because of the potential complications associated with implants, breast reconstruction using natural tissue is generally considered the best method for women who will require or have already had radiation. Based upon the brief description you provided, consideration should be given to removing the implant and then proceeding with a natural tissue reconstruction a few months later (when the infection has fully cleared). Most women do not have nough tissue to reconstruct a breast using an LD flap without an implant, but other locations on the body frequently do have enough tissue to reconstruct a breast in proportion to a woman's body. The buttocks, thighs, abdomen and love-handle areas are all possible options for donor site for tissue for breast reconstruction. While radiation therapy can complicate breast reconstruction surgery, with proper preparation most women can achieve a satisfactory reconstruction even if radiation therapy is part of their treatment plan. Perforator flaps including the DIEP flap, SIEA flap and SGAP flap are all used routinely with excellent results to reconstruct patients who have required radiation therapy.
