Post Radiotherapy my Tissue Expander Became Infected. Will the Skin Survive to Stretch for Another Expander/implant?

I've had a left side mastectomy and lymph removal. Post radiotherapy (feb 2013) the port of my tissue expander was infected with staph aureus and removed. The infection returned. I've been advised to have the expander out and leave it for 3 months before attempting reconstruction. What will happen to the skin that is left? I'd like to avoid flap surgery as I'm very slim and it's major surgery. What are the chances of the skin surviving 3 mths for another expander and implant rather than flaps?

Doctor Answers 3

Breast reconstruction following radiotherapy to chest

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.

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!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Infected expander in radiated tissue....

leaves you with few choices except to remove your expander and allow yourself to heal and recover from your infection.  Is 3 months adequate?  No one can guarantee that as many wait 6 months before returning to attempt another reconstruction.  Ideally, you would use autogenous methods under your circumstances.  However, you can still choose to attempt another try with expanders, especially if you do not want the additional scars from using your own tissue and are prepared for failure, as it certainly could happen and don't desire to be very large.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Breast Reconstruction

Once the expander is infected it has to be removed, treat the infection. The skin will retract and swelling will remain with you for a long time because of the infection and radiation.

In the face of radiation , history of infection , most implant reconstruction will fail, or atleast will have multiple complications.

In the face of radiation flap reconstruction is the standard.

The other alternative in the face of radiation and infection is Latismus Dorsi myocuateous flap with or without implant, if one has to use an implant.

The Laismus muscle will bring in new blood suply and good coverage for the implant.

I know the insurance will not pay much for the flap but the plastic surgeon needs to be the advocate for patient safety and what is best for the patient not the insurance co. or the $$$$

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 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.