Implant Closure Split Completely Open. What Are My Options?

Bilateral mast with immediate expanders followed by chemo and radiation. L implant (radiation side) removed 2x, once prior to radiation, once following . Split open, could see implant. Implant removed and skin sutured not glued. I thought implants should be under muscle. Would you see it if skin split open (entire length of implant 6 inches). Since skin is adhered and immobile on chest wall can I ever consider new expander. Really don't want any flaps or additional Sx other than new expand

Doctor Answers 6

Breast reconstruction options

Given the extent of treatment you have received (specifically radiation), implants are not recommended at this point.  A free flap reconstruction would be your most reliable option to bring in undamaged soft tissue to provide with symmetry, volume and shape.  Reconstruction using DIEP flaps are the best way to go these days.  Make sure you see someone with expertise in this type of reconstruction, as well as other free flap options.  I would stay away from implants and tissue expanders at this point.

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 4 reviews

Time for a flap reconstruction

After two failed attempts at implant reconstruction in the face of radiation, there is really not much chance it will ever work for you.  Your better option is to consider a flap reconstruction where healthy non-radiated tissues are brought in to make the new breast.  Good luck.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Breast reconstruction after radiation and implant extrusion

Radiation and implants do not mix well.  You did make a good effort to try it out, as in some cases it can work.  Unfortunately it did not work for you, and if you still desire reconstruction your best option is some type of flap surgery, where you use your own tissues to help form the breast mound.  Consultation with a plastic surgeons who offer both types of surgical options is recommended. Good Luck!

Michel C. Samson, MD
Daytona Beach Plastic Surgeon
5.0 out of 5 stars 9 reviews

Breast reconstruction after radiotherapy

I'm sorry to hear about the problems you have had. It is difficult to comment on the position of your implant in relation to the muscle; many surgeons ensure "total muscle coverage" for an expander, but some do not. It is also possible that internal stitches came undone, or pulled through the tissues, which would expose the expander from a position under the muscle.

I would not recommend that you have a new expander. Unfortunately skin and tissues are affected by radiotherapy in ways that make the complications that you have had more likely. The risks of trying another set of expanders are too high.

Flap surgery is the mainstay of breast reconstruction for women who have had radiotherapy. However, you don't have to have this surgery and there is no urgency for you to make a decision about reconstruction. It sounds as though you've been through a lot. Many women that I see who are in your position are not willing to undertake any "lengthy" or "complex" reconstruction. You may find it worthwhile meeting with a plastic surgeon to learn what your options are, and then taking time out to get over your surgeries and treatments, knowing that if you wish to consider flap options in the future that it is a reconstructive possibility that is open to you. You may find it helpful to take a good friend along to the consultation with you, so that you have someone close to you who you can discuss the options (and your feelings) with later.

Jill Tomlinson, MBBS, FRACS
Melbourne Plastic Surgeon

Implant problems after Radiation, what are options?

Sorry that you have experienced so many complications. Radiation does terrible damage to the surrounding tissue and implants are usually not a good option. I would recommend a flap, there are various types and they all have their pro's and con's, discuss your options with your PS and best of luck.

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.9 out of 5 stars 87 reviews

Reconstruction after radiation

While we have made strides in implant reconstruction in patients with radiation, there are many factors involved and the risks will always be higher than implant reconstruction in a patient that did not receive radiation. It is not always an option. You have had two failed attempts at implant reconstruction. This is not hard to imagine, then, that it would fail again for you. Your options now are no reconstruction or the addition of healthy non-radiated tissue for reconstruction.

M. Susann Bedford, MD
Atlanta Plastic Surgeon
4.3 out of 5 stars 5 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.