Mastectomy with a Tissue Expander; Heating Pad Burn?

I have treated many patients who had skin loss after mastectomy and immediate reconstruction. The mastectomy flaps are often thin and can be lost because of lack of circulation. A loss caused by burning is similar. It is important to intervene before there is a skin break down and contamination of the implant. Once it is determined that the skin is lost and will not heal there are several options:


 If the loss is small, one can remove it and repair. Partial deflation of the expander will help

If the loss is over a muscle, it could be skin grafted as long as the muscle is viable.

The area could be removed and replaced by a latissimous doris skin muscle flap.

The skin and expander could be removed and replaced by a TRAM flap

If there is any question of contamination or early infection removing the expander and the devitalised skin followed by closure is anther option.

I am sorry for your mother-in-law's burn. I too have seen this in a patient of mine after TRAM flap reconstruction (totally numb or insensate flap healing great until my patient wore a black T-shirt in the sun). Fortunately for my patient, she only had a huge blister and this healed uneventfully. I recently had a breast augmentation patient whose caring husband put icebags under her elastic bandeau at bedtime and left them there, causing partial thickness skin loss and scarring from frostbite. I have also seen heating pad burns in a buttock flap for radiation reconstruction, all because these tissues have reduced or no sensation.

Unfortunately, without personal examination, none of us can make a "better" recommendation to "overrule" your mother-in-law's own treating plastic surgeon. He or she really is the best judge of the situation, and delayed healing of a severe burn to the mastectomy flaps may compromise or fatally flaw the reconstructive effort, or prevent subsequent reconstructive efforts once the burn is definitively dealt with.

Other factors such as chemotherapy and/or radiation therapy need to be taken into account in making recommendations about how best to deal with this.

I know both you and she are bitterly disappointed at this turn of events. But unless you have reason to totally mistrust your plastic surgeon's advice, I'd recommend heeding it for a multitude of reasons in your mother-in-law's best interests. Good luck! Dr. Tholen

Another unfortunate demonstration of the hazard of using heating pads on lifted skin (as in mastectomy, face lift, tummy tuck). Not enough info here for a specific suggestion. All the best. 

Yes, I think that the recommend option by your mother-in-laws surgeon is the best option. Getting a skin graft will not be an option.

I have seen the skin burned on a patient that had  a TRAM in which the skin was insensate. If the burn is bad and full thickness, there may not be enough skin to close easily. Hard to say without an exam.

Hi.

We have certainly seen this, and almost always, the burn heals after several weeks applying Silvadene (antibiotic) cream.  But there are several important details.  For instance, waiting is a lot safer if the tissue expander is covered by muscle.  I have not treated this situation with a skin graft, but that is a possibility.  Removing the tissue expander will certainly leave a very difficult reconstructive problem.