Post-Mastectomy Breast Infection. Expander Removal?

With your history of breast radiation combined with recent infection, I recommend that you strongly consider either a latissimus flap or DIEP flap reconstruction of your left breast.     By bringing healthy non radiated tissue to the left breast, you will minimize your chance of recurrent infection or scar tissue formation

Here is my recommendation:

1.  Extensive infection: remove the expander and give your left breast 4-6 months to heal and be free of infection.   Then come back to reconstruct with latissimus dorsi with tissue expander or a DIEP flap.

2.  Mild Infection:  remove the expander and its surrounding capsule, then place a new expander with latissimus dorsi flap.

I wish you a safe and healthy recovery.

 

Paul S. Gill, M.D.

Gill Plastic Surgery

Houston Double Board Certified Plastic Surgeon

You may have to consider removal. An exam is the only way to know this for sure.Salvage with antibiotics is appropriate but after a while the source of the infection (the expander) need to come out.

While attempts to salvage infected implants with antibiotic treatment are sometimes made, surgery is often needed to remove the implant in order to allow the infection to resolve. The chances of salvage are lower when radiation therapy has been used as part of a patient's treatment.

Once an infected implant is removed, the period of delay until further surgery will often depend on the method of reconstruction that one chooses. If another implant reconstruction is going to be attempted, most surgeons would typically wait between 6 and 9 months before another implant is placed. If a woman's own tissue is going to be used for the reconstruction, surgery can usually be performed safely after a much shorter waiting period. 

Following radiation therapy, the chance of achieving a successful reconstruction with natural-tissue (procedures such as the DIEP flap or TUG flap) is generally much better than if an implant reconstruction is attempted. This is because an implant is avoided altogether and healthy, well-vascularized tissue--capable of helping the healing process--is brought to the mastectomy site.

Hope this is helpful information.

If  the expander is infected you should have it removed and wait three to six months to have a new reconstruction.

Prosthetic reconstruction can be difficult after radiation with difficulty healing, poor expansion, infection, etc.  It may also be difficult to clear the infection with the tissue expander in place.  It may be necessary to remove the expander if the infection does not resolve and then consider LAD , TRAM flap or other method of reconstruction.  As noted, it is difficult to give advise without knowing  complete history and continued followup with plastic surgeon is most appropriate.  Good luck.