How to Repair Muscle Damage Due to Expander Extrusion Post Double Mastectomy?

2 months post double mastectomy-undergoing expansion-prepping for implant exchange. 3 weeks ago expander pushed through muscle (still under the skin-but palpable "bubble"). Released to begin exercise but now affected area is over 5 cm long & breast dropped 1-2 inches.

Am experiencing muscle spasms where Alloderm is attached. Concerned about exercise exacerbating problem and possibility of permanent muscle damage(am exercise freak).Don't care about size.Can dr. repair surgically?What to do?

Doctor Answers 5

Muscle damage with Tissue Expansion

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The muscle can likely be repaired at time of removal of Tissue Expander (TE) and replacement with a permanent implant.  Either the muscle can be repaired primarily or with additional AlloDerm.  It is possible that no repair is needed and just replacement of the TE with a softer permanent implant will solve the problem.  If all else fails, fat grafting can be done to soften the look.  Raising the fold can also be done at the time if permanent implant placement.  The muscle spasm is likely temporary.  If the muscle functions now, there is no reason to think that it will stop doing so after a repair.

Breast Reconstruction

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The "BUBBLE" you are feeling is probably the expander either buckled and went throuh the muscle fibers. or just the expander seperated the fibers of the muscle and now you feel it because of thin skin. With excercise you probably seperated the muscle fibers more.

Now repair depend on the examination, if there is buckling of expander and is not flattening with expansion, you may need surgery, becuse the buckled expander edge can erode through the skin.

If it is only seperation of the fibers because the general surgeon who did the mastectomy took out the fascia of the muscle, making it easy for the fibers to seperate, then continue with expansion slowly and at the time of exchange of the expander to the  implantthat seperation can be re-enforced with Alloderm.

If the muscle is that bad and the local skin muscle of the chest is that bad then convert to a latismus dorsi flap or tRAM flap reconstruction.Your plastic surgeon should be able to examine you and discuss your options, and hi/her findings.

Samir Shureih, MD
Baltimore Plastic Surgeon

Breast reconstruction

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Muscle repair can be performed at the time of implant exchange with an acellular dermal matrix such as alloderm.

David L. Abramson, MD
New York Plastic Surgeon

Tissue expander problem

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If the chest is expanding satisfactorily, then the muscle can be repaired at the time of implant exchange along with the alloderm.

Repair of muscle damage with tissue expansion

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I am sure you understand that no one can give you definitive advice without seeing you, but if there is an area where there is only skin over the expander then I would advise caution with vigorous exercise. Be sure to discuss the situation with you plastic surgeon. The repair may involve more Alloderm or direct repair of the muscle.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.