7.5 weeks post bilateral, expanders placed. Last week, R breast draining thin-yellow-clear liquid. Breast filled w/fluid

Question

Bilateral mastectomy w/ expanders. PS back into right breast due to bleeding. Wk 3 drains out. Wk 5.5 lost right nipple. Wk 6.5 incision area not healed draining thin-yellowish-clear fluid. Today breast filled w/ fluid, slight draining & painful. No temp & on keflex as precaution. I have a great PS that doesn't seem worried about the fluid but I am. Armpit & breast painful and engorged. Will see PS again in 7 days. Do I need to worry & start thinking no recnstrct?

Nelson Castillo, MD · Answer

Thank you for your question and series of photographs.  I am sorry to hear of your complications after nipple sparing mastectomy and implant-based reconstruction.  Because of the acute issues in healing and the sudden degree of swelling in your right breast I would recommend reaching out to your surgeon sooner than later. An infection would need to be ruled out as the cause of your difficulty in incision healing as well as a possible seroma formation.

Brian Arslanian, MD · Answer

Sorry about your problems.  Unfortunately, that is very concerning.  I would be concerned you have an infected expander and wound breakdown with near exposure of the implant.  Keep in contact with your surgeon and if you start having fevers or chills or feeling sick let them know ASAPGood Luck"The above answer has been given without seeing this patient and cannot be substituted for actual in-person examination and medical advice; it is only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Jacob Bloom, MD · Answer

Thanks for your question, sorry you have not had a smooth postop course.   I would be in close contact with your plastic surgeon if things change in terms of fevers, chills, redness or drainage.   Even if your primary reconstruction fails, delayed reconstruction with implants or autologous tissue (your own tissue) may still be in option. Best of luck with your recovery

Kelly Killeen, MD, FACS · Answer

I'm sorry but I do not agree with your plastic surgeon.  A large fluid collection draining through what looks like an area of mastectomy flap necrosis needs intervention.  I would recommend calling your surgeon to be seen.  I would usually excise the non-healing area and re-close, sending fluid for culture in addition to swapping the tissue expander.  A rapid increase in fluid like you describe is not normal and commonly associated with an infection.

7.5 weeks post bilateral, expanders placed. Last week, R breast draining thin-yellow-clear liquid. Breast filled w/fluid

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