Necrosis after mastectomy. Do I have enough skin to close a reincison? (Photo)

Question

12 days ago I had a bilat skin sp mast with TE placement Immediately after surgery I was "bruised". went in for my 7 day f/u and they mentioned necrosis and To watch for the 2 weeks and return for follow up surgery to remove dead tissue and close up with healthy skin margins. my necrosis is worse than any pictures I've seen. Small blisters/ bleeding/draining slightly. Surgeon said as long as the incision hadn't opened we're ok. I had very little skin Do I have enough skin to close a reincison?

Joel M. Stewart, Jr., MD · Answer

This happens. In general, deflation of some or all of the fluid in the expanders is the first step. Usually, a return to the operating room is necessary to best examine and deal with the area of tissue loss.Often after decreasing the fluid in the expander, the skin can be closed primarily. If not, then a flap might be necessary.Work closely and frequently with your plastic surgeon during this time. It is a frustrating event for the both of you and only by working together can you get through this common postoperative situation.

Winfield Hartley, MD - Account Suspended · Answer

From your photographs, you will need to have an operative revision of your mastectomy flaps with removal of all of the necrotic tissue and re-closure of your incisions.  this may or may not require removal of your tissue expanders, but the procedure should be performed sooner rather than later before the tissues become infected.  Good luck!

John Y.S. Kim, MD, FACS · Answer

I would follow your PS's advice and allow the tissue to demarcate and then determine whether a flap or primary closure will be necessary.  It is difficult to assess skin elasticity and tension from simple pictures so having your doctor help you assess this with an examination is important.  There are local wound care instructions such as silvadene and nitropaste and antibiotics that may help.

Kiranjeet (Kiran) Gill, MD · Answer

Skin necrosis after mastectomy can happen.  You will need to follow closely with your surgeon.  I agree, if your expander has been filled, it is a good idea to deflate the expanders by removing the saline.  This will give the areas of your skin that are marginal the best chance of surviving. Should your expanders become exposed, they will need to be removed and depending on the amount of skin that you loose, it may or may not be possible close your incisions while keeping the expander/implant based reconstruction.  The good news is that there are other methods of reconstructing your breasts, i.e autologous tissue reconstruction.  Using advanced techniques your breasts can be reconstructed using your latissimus muscle and your abdominal tissue (DIEP flap).  Good luck to you

Steven Wallach, MD · Answer

You will have to follow closely with you surgeon, and he will have to make a decision as to how much skin will need to be derided.  You might need an alternative flap to recruit healthy tissue.

Nicholas Tarola, MD · Answer

I'm very sorry to hear of your complication.  Rest assured you are not alone.  Many women have suffered similar situations following breast reconstruction.  It does not appear that you will have sufficient skin to close over your existing tissue expanders without bringing additional skin from a latissimus flap.  You have several options:1.  Try to salvage the expanders with latissimus flaps2.  Change immediately to a TRAM flap or DIEP flap reconstruction3.  Remove the expanders, debride the necrotic skin, and allow your chest to heal completely,  Then, in a delayed fashion several months following healing, proceed with either a TRAM flap, DIEP flap, or latissimus flap with tissue expanders.To be sure, discuss your options with your plastic surgeon.  Follow up with your surgeon sooner than later and make sure your surgeon is notified immediately of any changes.Best wishes!

Joseph Franklin, MD · Answer

Sorry to hear about your wound healing problems following mastectomy.   There doesn't appear to be enough skin to re-close the incisions.   You will likely need a muscle flap for reconstruction.   Would recommend seeing your plastic surgeon sooner rather than later.

Kamran Khoobehi, MD · Answer

The amount of skin loss is hard to tell based on pictures only. Your surgeon can help you. If there is not enough skin, you can get tissue reconstruction with abdominal tissue.

Darryl J. Blinski, MD · Answer

Based upon the posted photos in my over the internet opinion you need removal of implants and aggressive debridement of the necrotic tissue. No you do not have enough skin for closure. Most likely will need a flap repair. PLEASE seek in person evaluations ASAP.

Arian Mowlavi, MD, FACS (license on probation) · Answer

Skin loss following breast reconstruction should be treated with1)removal of all fluid from expander to minimize tension on your skin flaps2)local wound care3)Nitro paste4)Topical antibiotic5)Hyperbaric oxygenWhen demarcation of dead and alive skin has been completed, then you can determine the next best action.

Necrosis after mastectomy. Do I have enough skin to close a reincison? (Photo)

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