Failed tissue expanders - what are my options to achieve normal size breasts? (Photo)

Question

I had a nipple sparing double mastectomy in July and had expanders put in at the same time. I developed a really bad infection and had to remove expanders. Now the breast that was infected is completely contracting and is really hard and lumpy. What are my options moving forward to achieve at least my normal size breasts before surgery? I was 34c. I'm 5'7' and 30 years old.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  Your scenario is not common but does occur from time to time.  Later not, you should be able to have attractive breast with a well planned surgery by an experienced plastic surgeon.  Need weight about 6 more months and then perform fat transfer in any of the areas that are stuck to the chest wall.  After this, you would wait about 3 to 4 months and place expanders.  In your case, I would remove the redundant lower pole skin and perform a mastopexy-breast lift.  I have seen a few these cases in my career and the outcome has been much better than expected.  Best wishes to you.

Adam Levy, MD · Answer

HI Godiva031,Expander/Implant infections are a dreaded (but not uncommon) complication after mastectomy. In some cases, the expanders can be replaced after a period free of infection. It is difficult to correct the fibrotic and contracted skin you are experiencing, though this will improve somewhat after replacing the lost volume of your breasts with either soft tissue (skin/muscle/fat) or implants. Later on, fat grafting may also be helpful to address residual lines or wrinkles that persist from the scarring and improve the skin quality. 
I would recommend you investigate options for autologous (tissue based) reconstruction of the breasts. This often allows replacement of damaged or scarred skin with healthy skin and fat. It is impossible to provide specific recommendations without examining you personally for availability of tissue donor sites. Most commonly, tissue is moved from the lower abdomen (e.g DIEP flap) or back (latissimus flap) for breast reconstruction. It is important to discuss with a board certified plastic surgeon or microsurgeon who offers all of these options prior to determining your next steps.

Vinay Gundlapalli, MD · Answer

Really sorry to hear that you lost the tissue expanders to infection. It can happen rarely. The options going forward would be consider abdominal tissue based reconstruction, or Latissimus dorsi flap based reconstruction, or potentially placing another tissue expander in a slightly different pocket. Like if your Initial reconstruction was over the muscle reconstruction. Now under the muscle reconstruction can be considered. The other things need to be considered before reconstruction are radiation treatment. Fat grafting can also be a good option to improve the quality and thickness of the skin before any other reconstructive surgery

Daniel Barrett, MD · Answer

Dear Godiva031,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Neil Tanna, MD, FACS · Answer

There are many options for breast reconstruction, including:a. implant onlyb. flap onlyc. hybrid flap and implant
The first thing is to re-establish the skin envelope with tissue expander replacement.

Failed tissue expanders - what are my options to achieve normal size breasts? (Photo)

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