What happens if your doctor can't close you up after a mastectomy? Am I eligible for a flap and skin graft?

Question

Hello, I had a double mastectomy and one side has not healed. The skin died, leaving me with a huge hole in my chest. My doctor has continued to cut away the dead skin and flesh but I am worried that he is out of options. Am I eligible for a flap and skin graft? what happens if the area isn't healthy enough for those?

Manish C. Champaneria, MD · Answer

Thank you for your question.Wound healing problems after mastectomy can happen. Typically, when there is a large wound, wound care is performed with daily dressing changes or a wound VAC. More often, though, a flap is typically performed to close the wound and also shape a breast. Typically flaps are the latissimus dorsi flap (from your back) or a deep inferior epigastric perforator flap (from you belly). In my opinion, consult with your plastic surgeon about the next steps. Regards,Manish Champaneria, MD

Leslie Memsic, MD, FACS · Answer

I am so sorry to hear about your post mastectomy problem. Debridement (removal) of dead skin is important for healing, but if the muscle is healthy, you are a candidate for a skin graft ( from anywhere on your body - generally your thighs or buttock) or a rotation skin/muscle flap closure of the hole.This can come from your back (Lattissmus) or abdomen. This will be much more comfortable for you and easier to care for. A wound vacuum ("vac") is easier than changing bandages multiple times a day over the wound but is somewhat cumbersome. If you do not feel your surgeon is offering you options, definitely seek a second or third opinion. You need to resolve this so you can get on with your life. Hopefully once the wound is healed you can proceed with actual breast reconstruction - as opposed to wound coverage, and return to a more normal life. Good luck and take care.

Steven Wallach, MD · Answer

Sometimes the mastectomy flaps die.  This can be for many different regions.  Treatment is local wound care or a flap depending upon the extent.

Joseph Franklin, MD · Answer

Wound healing problems following mastectomy are not uncommon.   Initially, the best options are to do dressing changes or to use a negative pressure wound closure device (like a Vac).   In some cases, your surgeon may want to refer you to a local wound clinic.   Otherwise, local rotation flaps (like a latissimus dorsi) can be used to close the defect.   Skin grafts are not traditionally used on the breast.   Best of luck in your recovery.

Samir Shureih, MD · Answer

Loss of skin after mastectomy can be treated very effectively.it is important to have the wound cleaned of all the dead tissue, debridement. Also no infection.Then the treatment options are several1: conservative wound care with wound VAC, and that will take 6-12 weeks to heal2: If the tissue is healing well and no infection a skin graft would close the wound3: best is to have no infection. Then debride all dead tissue and close with flap. either a TRAM flap or a Latissmuss Dorsi flap. On the long run a flap coverage is best and allow for future breast reconstruction if desired. Consultation with a Board Certified Plastic surgeon can resolve the issue fairly quickly

What happens if your doctor can't close you up after a mastectomy? Am I eligible for a flap and skin graft?

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