Reconstructive after skin grafting. Am I too deformed to fix? (Photo)

Question

I had a “Mommy Makeover” and subsequently developed a necrotizing soft tissue infection. My breasts and the lower portion of my abdomen had to have extensive wound debridement and partial thickness skin grafting along with an artificial dermis, called BTM. II’m hoping that I’m not left to look like this forever and hoping a plastic surgeon can at least make me look normal. I have no fat in the areas of skin grafting. Am I too deformed now to fix?

Vishnu Rumalla, MD · Answer

Thank you for letting us contribute our thoughts toward your recovery.  Sorry for your traumatic experience.  These infections can be fatal.  As you consider your options, it is best you first find very experienced plastic surgeon to personally discuss your options.  Secondly you will need to patient because a staged approach will be needed.  On the breast through a breast reduction pattern of scars you can starting removing some of the intact skin and replace the grafted tissue.  This will take probably two operative trips.  On the abdomen, you should ask about tissue expanders, and also used a staged approach and slowly replace grafted skin with normal skin.  Wish you the best of luck.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding reconstructive plastic surgery after skin grafting after necrotizing soft tissue infection on your abdomen and breast.  Thank you for your question regarding whether you are too deformed to fix.  I am sorry for your misfortune.  Yours is a complicated case, and I would suggest you align yourself with a University Hospital with a plastic surgery residency program.  Travel out of state or country if you must.
Regarding the breast, many plastic surgeons would suggest the insertion of tissue expanders.  Tissue expanders are artificial balloons that are slowly inflated.  As the balloon is inflated, new skin is formed.  The breast would be inflated in your case to approximately a triple D or possibly E., after the tissue expander has been fully expanded.  The skin has grown, then the tissue expander is removed, and the excess skin is removed.  The excess skin in your case would be the skin graft.  Alternatively, you could proceed with a significant breast reduction with the removal of breast tissue and the areas of skin graft.  Once that is healed, you could insert a tissue expander, expand the chest, and after several months, replace the tissue expander with breast implants.
Regarding your abdomen, this becomes a more complicated case.  In plastic surgery, there is a reconstruction ladder.  That means plastic surgeons go from easier treatment plans to more difficult ones based on the type of wound.  In your case, skin grafts have already been used.  The next step is local tissue and random flaps; however, these are too small and cannot be used to close this area.  You could consider tissue expanders placed on the lower abdomen or the back.  After the skin has grown, the tissue expander could be removed, and the flap could be advanced.  Additionally, there are surgeries where soft tissue is taken from the back, namely, the latissimus dorsi muscle.
The muscle is removed from the body with a pedicle of skin.  The blood vessels are then reconnected to your femoral artery and vein.  Another alternative is harvesting muscle, fat, and skin from the upper portions of the buttocks.  This is called a gluteus maximus flap.  This would then be removed and reattached to cover the lower abdomen as a free flap.  The blood supply would be reattached to the femoral artery.  Most plastic surgeons would suggest you look for a hospital specializing in free flaps and microsurgery.  Look for big cities like New York, Chicago, Dallas, Houston, and Los Angeles.  I wish you luck.   Sincerely, Dr. Katzen, MD, MBA, FACS, FICS ( Plastic Surgeon, President of  the American Society of Bariatric Surgeons, Certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery,  and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)
.

Zoran Potparic, MD · Answer

You have had a very unfortunate events! So sorry. However, this is a time for healing. Well planned series of surgeries will bring you significant improvement. It almost looks that abdominoplasty can be done in one surgery, but that may be overly optimistic? Use of your skin flaps, breast reduction (done in stages) will create nice result in breast area. Be paytient, find a good surgeon and stay positive. This can be significantly improved. Good luck.

Connie Hiers, MD, FACS · Answer

No, things can be done to slowly remove the skin grafts and bring normal tissue back together. This will involve the use of tissue expanders and will be multiple surgeries. Your surgeon can discuss this farther with you.  Your breasts would do much better to be reduced first.

Michael S. Wong, MD · Answer

Dear Phenomenal148309,
Thank you for your questions and pictures. I am sorry this happened to you.
 As you can imagine, this is going to be an involved series of reconstructive surgeries. For your abdomen, you could have tissue expanders placed in your upper abdomen to expand or stretch out the remaining unaffected skin. This tissue would be stretched out over time by filling with increasing amounts of saline. Once enough tissue has been recruited, this skin could then be pulled down to the lower abdominal incision, after all the skin graft is removed, redoing the skin redraping of the tummy tuck.
As for your breasts, tissue could be taken from your back and transferred to the breasts to resurface with non-skingrafted skin. Both sides could be treated with latissimus flaps to resurface the breasts after removing the skin graft. This will create donor scars on your back, so you need to decide if it is worth it to you to have improved skin over your breasts at the expense of new scars on your back.
I encourage you to seek out a board certified plastic surgeon in your area for a consultation with you to develop a plan that makes sense and works for you.
Best to you as you look forward.

Mats Hagstrom, MD (license on probation) · Answer

There will be reconstructive options for you.
And situations like you’re on despite how traumatic this may be it is important to slow down and move forward at the right time.
You need to recover emotionally and physically.
All scar tissue needs to be completely mature before considering the next step.
It’s hard to tell if you have enough skin on your upper abdomen to be able to close the defect on your lower abdomen. it will require a careful assessment and you need to be very selective in choosing the correct providers.
If there is insufficient tissue on your abdomen to close the defect the tissue needs to be brought to the front using free tissue transferred or free flap surgery. this involves harvesting blocks of tissue with its own blood supply, micro vascular re-anastomosis of blood vessels to keep the tissues alive in the new location.
These are complex operations that are usually more commonly done at academic medical centers.
It may require being in the hospital for more than a week including stay in the ICU.
Tissue can be taken from your back such as a free latissimus flap or from your inner thigh.
I suggest you talk to the plastic surgeons who did your initial reconstruction where you were treated for the necrotizing fasciitis.
Consider consulting at academic medical centers in your area.
Reconstructive options would never make you hold like you were before your procedure but should get you looking better than you are currently.
Borrowing from Peter to pay Paul or taking tissues from other areas is sometimes justified and sometimes not.
This type of work may be outside the scope of summer plastic surgeons.
You’re definitely going to stay with surgeons who do complex reconstructive surgery on a regular basis.
While there are plenty of plastic surgeons who do complex reconstructive surgery in the community this type of work is often done at academic medical centers.
I recommend all patients have multiple in person consultations before choosing any surgical procedure or provider and the same is true for you.
If you move forward with reconstructive options and these are going to be very involved complex and invasive operations.
You have to ask yourself if you’re willing to go through the inherent risk that goes with having those types of procedures. recognize that there is inherent risk with reconstructive surgery as well.
In regards to making quality assessments and delivering a levels of success it is paramount to choose the right provider.
I suggest having at least five consultations preferably with local plastic surgeons who have extensive experience reconstructive surgery especially with free tissue transfer. 
Best,
 Mats Hagstrom MD

Reconstructive after skin grafting. Am I too deformed to fix? (Photo)

Answers (6)

More Mommy Makeover Questions

5'1", 125lbs , 2 kids, am I a good mommy makeover candidate? (Photos)

Would I be a better candidate for a mommy makeover or just a breast reduction?

Are there less issues associated with smaller breast implants? can this be done at the same time as a tummy tuck?

48 y/o interested in BBL and breast fat transfer - do I have enough fat for both procedures? (photos)

What are the BMI requirements to have a tummy tuck?

Am I a candidate for a Mommy Makeover? (photos)

WE SEND PRETTY
EMAILS