Options for Breast Reconstruction After an Infection?

I had a bilateral mastectomy done, and I had breast implants placed in both breast. I had expanders put in, and had radiation along with a boost.

This past January, the implants where put in. Then in April of this year, right breast got an infection. The infection tore a large whole in my breast, so my plastic surgeon removed the implant in my left breast. I don't have much skin there because it was removed.

My reconstructive surgeon suggested that I get a TUG Flap. I am very concerned about this having this procedure done because I know that it is not performed much and is new. Do you have any suggestions?

Doctor Answers 6

Radiated mastectomy flaps require innovation

Have courage, know your body, lifestyle, aesthetic ideals and then have a chat with your PS. It's important to know your options. In your case, radiated chest wall, skin shortage and delayed reconstruction, will require innovation as well as good communication. Traditional teaching holds that your surgeon needs to import well vascularized tissue into the zone; a TUG flap is just one option. Microvascular (free) flaps, such as TRAM or DIEP flaps can easily solve your problem, especialy if you have excess fat around the abdomen. However you should assess both your surgeon's experience and the hospital's institutional commitment to such procedures; both need to be ready, willing and able to support you.

The pedicled Latissimus dorsi flap is also a "workhorse" option. Its chief disadvantages are the scar on the back as well as the potential for seroma. It can be rerouted over a tissue expander, which can later be exchanged for a permanent implant. If your PS is forward thinking, the back skin-fat can serve as the basis for the nipple reconstruction too. good luck.

Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Options for breast reconstruction after an infection?

Hello!  Thank you for your question.  After radiation, you have an increased rate of complications including wound problems, infections, thinning of the tissue, and decreased vascularity to the skin/tissue of the area.  The best method to reconstruct a breast following radiation therapy is with a flap.  The flap, which is skin, fat, and sometimes muscle, will serve to bring in healthy, well-vascularized tissue to the chest/breast area that will significantly ameliorate the radiation issues compounding the problem.  Microsurgical perforator flaps (such as the DIEP flap and SGAP/IGAP flap) are the newest and most-innovative procedures in breast reconstruction today.  As these are muscle-sparing flaps, the pain, morbidity, and complications such as those above, of these procedures are much less.  They are highly-complex procedures that few plastic surgeons performed and consult with one who is well-versed, trained, and skilled in these procedures if you are interested.  

There are many options to breast reconstruction including implant-based and flap-based procedures.  The complication rate with implants following radiation is reported as high as 60-70% in some studies.  Flap reconstruction is usually recommended, but there are several centers who perform implants following radiation with great success and results.  I typically prefer flaps, such as the DIEP flap.  Other flaps are the conventional TRAM, latissimus flap, SGAP/IGAP, and, TUG.  The TUG flap has been along for several years.

You are a candidate for other procedures, if you are willing to continue with your journey for a reconstructed breast.  Flaps such as those above, including others, are available.  The decision to continue with this will be your decision and what you are willing to go through.  There are risks and benefits with everything that we do in Surgery - discuss the various options with a board certified plastic surgeon who will educate you on all of the options and help you to decided if breast reconstruction or which procedure will be best for you.  Hope that this helps and best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Breast reconstruction, nipple reconstruction, breast cancer, DCIS, mastectomy, TUG flap, DIEP flap, Latissimus flap

It sounds like you would benefit from a flap procedure.  I would have to examine you to discuss all of your options fully.  I will make an assumption that you don't have enough abdominal tissue for a reconstruction.  I have also taken the entire abdominal flap and stacked them.  I also have removed all of the implant material and performed bilateral latissimus flaps.  This is tissue from the back.  I usually will perform fat grafting after that at a lateral date to improve the size of the reconstruction.

Breast reconstruction

You will first have to let things heal. Then there are many options for breast reconstruction depending upon your anatomy.  A TUG flap is just one of may perforator flaps that can be done.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast reconstruction after radiation

Dear Marzi,

Radiation is certainly a double edge sword as you have found out. It is not very often I am able to get away with an expander implant reconstruction after radiation. In those cases where I need a flap, and in your case it sounds like 2 flaps, 1 for each side. I would recommend either a bilateral TRAM flap or a DIEP flap as the 2 workhorse flaps in breast reconstruction to my reconstruction flaps.

Get a 2nd opinion as far as the reconstruction goes especially since this type of surgery is required by law to be covered by insurance.

Good Luck!

Steven Schuster, MD, FACS
Boca Raton Plastic Surgeon
4.0 out of 5 stars 8 reviews

Many different options for salvage of radiated and infected mastectomy wound

IF your physican is experienced in this procedure, he/she may be able to accomplish an excellent result. However, if you have any questions, I would suggest obtaining a second or third opinion.

In general the traditional, some would consider it old fashioned) but realtively reliable flap is the latissimus dorsi. It has tradiitonally beed used to salvage radiation complications.

Discuss the advantages and disadvantages with your surgeon.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 82 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.