I had a bi-lat masectomy in Dec 2010. Tissue expander in left side (non-cancer side) got infected after 3 weeks. TE got removed and have been on strong antibiotics for 5 mos. now. The skin where the infection is stuck to the chest wall. PS is proposing doing a Lat Flap surgery to replace skin and muscle due to scar tissue. NO radiation only chemo & did not have chemo during recon. Is there any other surgery without cutting the muscle and skin that would have the best cosmetic result?
Bi-Lat Masectomy W/TE and Now Lat Flap Surgery??
Doctor Answers 5
Skin flap issue
It really depends upon the quality of your skin to determine whether another go around with a tissue exapander is warranted. There are many autologous tissue options based upon your anatomy. A pedicled TRAM, a DIEP free flap, etc.. are other options besides a lat flap.
Options for reconstruction
You could consider fat transfer to get some soft tissue cover on your chest wall, although this may be difficult if it is heavily scarred. I have treated patients with similar problems and fat transfers can provide useful covering and can be used to totally reconstruct a smaller breast or to provide a more favourable environment if you are considering replacing the implant.
A latissimus dorsi flap or DIEP flap from your abdomen will give you a good predictable result, but it is quite major surgery. Good luck.
The best result would be with autologus breast reconstruction
You had infection with the tissue expander and there is a lot scar tissue. You would get the best result with your own tissue. I offer my patients DIEP flap. This involve using your own fatty tissue from lower abdomen for the breast reconstruction.
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Alternatives after expander removal after infection
I would have to agree with Dr. Rand's assessment. Most of the time, the reconstructive option is that is best is the one most suited to your anatomy. Generally, a Latissimus muscular reconstruction would be better in a younger more athletic person, whereas a DIEP flap or TRAM flap (both from the lower abdomen) would be a better choice in someone with a little "extra" around the waist. Trying to put an implant back in a space after mastectomy and infection with damaged, thin tissues is frought with problems.
Breast reconstruction after an infection
If your implant needed to be removed for infection and the thin skin has scarred down to the chest wall, there is probably little hope that another round of expanders and implants will work well. Your doctor is trying to bring undamaged tissue into the field which will stretch and be maleable and give a better result. There are many forms of tissue reconstruction, the latissimus is only one.
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