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

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?

Doctor Answers 5

Chest wall necrosis

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.

Mastectomy flaps

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

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Wound closure after mastectomy

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

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Mastectomy skin loss

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. 

Joseph Franklin, MD
Durham Plastic Surgeon
5.0 out of 5 stars 8 reviews

Mastectomy

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 several
1: conservative wound care with wound VAC, and that will take 6-12 weeks to heal
2: If the tissue is healing well and no infection a skin graft would close the wound
3: 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

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.