Breast reconstruction after two tissue expander staph infections, advice?

Question

Hi! I had a mastectomy on the right side. I am small busted and chose a total mastectomy on that side. I have had 2 different tissue expanders on that side and both have had to be removed due to staph infections. I am going to try the latimus procedure in June with a tissues expander. I did not have radiation or chemo due to early detection. This is my second cancer. I had rectal cancer 8 years ago with radiation, chemo and a permanent colostomy. negative.

Ryan Rebowe, MD · Answer

In general, this would be an excellent plan after a failed tissue expander. Following expander infections, the remaining skin of the breast is often in bad shape. Placing the latissimus muscle deep to this skin not only makes the skin flaps thicker but provides uninjured tissue to help cover the expander. This new tissue will also improve the quality of the overlying skin typically. While a complete autologous reconstruction may also be possible from your abdomen or thigh, it is unlikely that you will have enough tissue over your latissimus for a complete autologous reconstruction. Therefore, a tissue expander is likely still necessary.

Chris Porter, MD · Answer

Following a breast expander infection you need to wait 6 months after your infection was cured before considering further breast reconstruction. You have the options of a latissimus doors flap with expander or implant, or using your own tissue with tummy tissue such as a DIEP flap (this may not be suitable if you are slim and have minimal tummy fat). The option of a latissimus flap is a very good option and a typically a robust flap. I have used this flap in similar situations to yours with excellent patient outcomes and satisfaction. Your rectal cancer background will have no effect on this form of reconstruction. All the best.

Robert Whitfield, MD · Answer

I would not use any implant material.  It is like to become infected because of the two previous infections.  I would use your abdominal tissue to reconstruct the area.  It will resist infection and give a soft, natural result.

Ben Brown, MD (license emergency restriction) · Answer

Hello, I am sorry to hear that you have had to go through complications following your mastectomy. A latissimus flap procedure is a great procedure to rescue skin coverage of a breast after complications following failed breast reconstruction. However, it is usually best to wait at least a few months after all infections have been completely eradicated and the affected breast has settled before trying other means of reconstruction, otherwise you could be susceptible to further complications. Having a good diet with high protein also is very helpful in wound healing, and this together with other factors specific to your state of healing will effect the outcome of any surgery that you have. Discussing what these are with your doctor should help to optimize your chances of having a successful breast reconstruction.
I hope that the latissimus flap is successful for you.

Ben Gbulie, MD, FACS · Answer

Hi 
Thanks for your question. I do empathize with your experience and hope you're holding up ok.
There are multiple techniques to redo failed reconstructions. Whatever technique is used would only work if all the infected and colonized tissue has been removed.
Typically a tissue based approach would be best but is limited by what donor sites you have available. If you had enough tissue for a DIEP or TRAM flap this would allow you avoid having an implant or expander and therefore decreases the risk of infection.
A Latissimus flap brings in healthy tissue into the breast and does minimize the infection risk but does not eliminate it if used with a device. Using an expander would mean needing to perform expansions which puts the device at risk for infection each time. You may consider accepting a smaller reconstructed breast so your PS would place a small implant under the LD flap so you would not get pistol expansions - this still has a risk of infection but less so than using the expander.
This is a complicated scenario and I encourage you to discuss these suggestions with your PS who knows you and can guide you through your reconstruction.
I hope this helps.....

Breast reconstruction after two tissue expander staph infections, advice?

Answers (5)

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