What can be done about thin/thinning skin after a bilateral mastectomy?

Question

What can be done about thin/thinning skin after a bilateral mastectomy? No radiation done. Have Alloderm with silicon mod implants but still have rippling, puckers and divots. Is there anything I can do to help remedy this? Thank you for any help!!

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.I do a lot of fat grafting to correct this.If it is very thin internally I may consider a dermal matrix.The best way to assess and give true advice would an in-person exam.Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.best of luck!Dr Schwartz

C. Bob Basu, MD, MPH, FACS · Answer

You may want to consider autologous reconstruction.  Many women prefer to utilize their own excess skin and 
fat on their tummy (essentially using excess tissue that would be thrown
 away in a cosmetic tummy tuck) with a procedure called a DIEP free 
flap (tummy tuck breast reconstruction).   In this procedure, we move healthy tissue with its own bloody 
supply and healing potential to restore the chest wall and breast after 
cancer treatment.  Autologous (using your own tissue ) reconstruction is
 especially powerful after radiation therapy. As you are learning, there are limitations with implant based reconstrction.  Autologous reconstruction helps to restore a soft supple breast using your own tissue.   
 Please see a board certified plastic surgeon who is well versed with 
autologous reconstruction to learn more about your options.Dr. BasuHouston, TX

Mark A. Brzezienski, MS, MD, FACS · Answer

The answer is a bit complex.  There are many means by which the problem can be addressed depending on its severity.  Fortunately, radiation therapy is not contributing to the problem.This skin can be supplemented with another layer of Acellular Dermal Matrix (ALLODERM) added over your breast implant.  If the implant is not of the Form Stable type...it might be worth exchanging them.  Form stable implants are less likely to deform and ripple.I have been very impressed with the improvements that fat injections produce for thin envelope problems, and I use fat routinely for this purposeIf the soft tissue envelope is very poor, then a Latissimus Dorsi muscle flap can be added between your skin envelope and the implant.Finally, a completely autologous reconstruction like a DIEP or a Free TRAM can be considered.

Samir Shureih, MD · Answer

Rippling of the breast implant after mastectomy can  be dealt with in many ways. this is an issue with the type of implant, the thickness of tissue coverage. There are ways of dealing with it and many options. This is a long discussion with you to choose the right option for you and the issue of the tissue coverage. Change implant to form stable implant . use of alloderm, fat graft, and use of latismus dorsi flap.

Steven Wallach, MD · Answer

If you have thin tissue and have rippling, you  may need fat injection or might consider autologous tissue reconstruction.

Sara Yegiyants, MD, FACS · Answer

Best way to correct contour irregularities and camouflage rippling of implants post implant based reconstruction is fat grafting.  I use this procedure often to improve the shape of the reconstructed breast by filling out the upper poles and contour irregularities.  Fat grafting also improves the quality of skin in patients who have undergone radiation.

Mark Gaon, MD - Account Suspended · Answer

Thin skin and rippling in the upper pole of the breast is not an entirely uncommon phenomenon after mastectomy. There are many ways to address the issue from simple to complex. In my practice, autologous fat grafting is a nice way to minimize this issue. Fat is harvested for another part of the body via liposuction and is then transferred back into the thin areas of the breast through small blunt needles. Oftentimes fat grafting is combined with exchanging the implant to a more form stable gel device that is slightly larger or has slightly taller dimensions than the original implant in order to add more volume back where it is needed. Additional alloderm or dermal matrix can also provide more thickness to areas with otherwise meager tissue coverage over the implants. Lastly, converting to an autologous tissue flap reconstruction will always work, but involves more major surgery and a longer recovery. Make sure you consult with a board certified surgeon with extensive experience in both primary breast reconstruction and revision reconstruction for best results. Best of luck!

Melek Kayser, MD (retired) · Answer

Thank you for your question. The mastectomy flaps essentially removed all of the breast tissue which invariably leaves defects and contour irregularities to the remaining skin. Although implants are good for creating the breast mound, this does not correct these irregularities. Without question, the use of fat grafting has taken breast reconstruction to a whole new level. The placement of fat into the soft tissue not only restores the irregularities butt can fill the hollowing that an implant would not otherwise be able to do. I use fat virtually without exception in all my breast reconstruction and have found this to be a very powerful tool. I would discuss this with your plastic surgeon. I hope this helps and have a wonderful day. Dr Kayser - Detroit

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