Abs bulge 5 months post diep flap on 1 side and loss of pigment post nipple sparing prophylactic mastectomy. Can this be fixed?

Diep flap on rt. side, m/s free tram on left (mesh was used on left, no mesh on right). Can bulge (which gets bigger as the day goes on) be fixed by putting in mesh laparoscopically? U/S confirmed no hernia. Breast surgeon cut all around the areola in a nipple delay procedure prior to mastectomy. My NAC looked awful post op and I thought I would lose them. Nipple/areola did survive, but lost some pigment on rt. side. Will tattoo even things out? Very unhappy with results; look like a mess.

Doctor Answers 3

Uneven coloration after nipple sparing mastectomy

As far as the bulge is concerned, there may be redundancy of the tissues, but no hernia. Its hard to know if mesh would help strengthen this area. I would definitely give yourself more time for healing to occur as sometimes chronic swelling issues and fat necrosis can take up to a year to resolve. It sounds like your surgeon was concerned about poor blood flow issues to the nipple from the get go, because he/she performed a nipple delay to try to improve the blood flow before committing to the mastectomy. Does this doctor do a nipple delay for every patient? ...or just ones with smoking history, radiation history, vascular disease, or diabetes?  Do you have medical issues that would make him or her concerned that the blood flow would suffer? If your doctor does a nipple delay on every patient, every time, I would be concerned that nipple loss and poor blood flow is something that they may see regularly.  It sounds like the tissue loss and coloration change is because poor blood flow was the case after the mastectomy. Time is the best indicator of what can be done - in many cases the color can re-pigment on its own, in some cases, tattooing is needed.

Bulge and nipple issue

A bulge may be repaired sometimes by a simple onlay of mesh to reinforce the abdominal fascia. AS for the areola, tattooing may help the are of hypopigmentation.

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

Post op

would really like to see pictures before commenting. i dont really understand the delay of the NAC.. seems backward to me. but most bulges can be corrected. repost with pictures please

Jonathan Saunders, MD
Newark Plastic Surgeon
4.7 out of 5 stars 59 reviews

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