Follow-up Question - Double Mastectomy with immediate DIEP Flap Procedure, concerns about swelling and nipple reconstruction?

I am little over 3 months post op from Diep flap and had concerns over the swelling in the left. Dr Whitfield in Austin asked where the swelling was, In the chest or mastectomy site, and Yes the swelling is in the lower breast skin, not the flap. I have heard of lymphatic massage therapy before. Also need to CLARIFY about the areola tattoo. My PS wants to do the tattoo before nipple reconstruction. I've always heard it was nipple reconstruction first, then the tattoo. THANKS SO MUCH!!!

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Doctor Answers 2

DIEP flap reconstruction

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Yes the swelling in the remain skin and fat of the chest can retain fluid.  Lymphatic massage can help with redirecting this fluid out of the tissues.  If you fluid remain I have revised the area if I am performing fat grafting or other procedures to improve symmetry.  Tattooing in my practice is done at the end.  If you are having a 3D tattoo that is done when you are happy with size, shape and symmetry.  If a nipple is being made out of your own tissue it is created and then the tattoo is performed.  If it is done beforehand then it will need to be touched up later.

Swelling after mastectomy

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if this is new swelling, have your general surgeon check things out with ultrasound to see if it is edema (fluid in the tissue like a soaked sponge) or a seroma (a pocket of fluid that can be drained). Looking at lymph nodes to make sure they are still healthy and not part of the reason there is a back up is also a good idea. And how new is this swelling? If it was generally swollen after surgery and this part "stayed" swollen when everything else went down may mean it's not swelling at all- it may be just thicker native area skin and fat as opposed to thinner flaps adjacent to it creating a step off from the upper portion to the lower portion. 

Heather Richardson, MD, FACS
Beverly Hills General Surgeon
5.0 out of 5 stars 2 reviews

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