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Reader Question – After Mastectomy, Alloderm, Expanders – Wounds Won’t Heal – Picture Alert

Posted Feb 05 2010 12:00am 1 Comment

Dear Dr. I had a double mastectomy in mid December. I had tissue expanders and alloderm put in right away. My problem is I am not healing. I had surgery six weeks later to try to close the wounds again but here I am with open wounds again. You can see the alloderm. It is very painful also. I am so afraid because it has been so long. I see a regular surgeon and a plastic surgeon. Do you have any thoughts that might help! Please I am so afraid. Thank you so much.

After mastectomy breast reconstruction can be challenging. It is usually performed in multiple operations or Stages. In these cases the overall goals of surgery are to remove all the cancer but still leave enough tissue to allow for a good reconstruction. When tissue expanders are chosen for that reconstruction, the condition of the remaining tissue after the mastectomy is crucial to the success of the operation.

Your images (which I placed on the following page for those who may not want to look) show that soon after the mastectomy and tissue expander placement surgery skin necrosis appeared. When this develops it is concerning as it indicates that the wound may have the blood flow needed to heal. You show this problem on both sides.

At six weeks following your first operation, the skin necrosis started separating from the other tissues and the wound seemed to open on at least one side. Your surgeon at that point decided to go back to the operating room to try to remove this non healing tissue and salvage the reconstruction. In cases like these my concern is whether or not these wounds even if they are able to heal can do so without excessive scarring and hardening. Depending upon how things looked on examination, I would consider removing your expanders to allow the wounds to heal and the tissues to soften to allow reconstruction at a later date. This is a clinical judgment that your surgeon needs to make. He or she may have discussed something like this with you already.

Although I have not been involved in your care I am sorry you have had such difficulties and hope that things can be improved later down the line.

Best Regards,

John Di Saia MD

Comments (1)
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I recently had a bilateral mastectomy with expanders. I also am not healing. I go back to the dr on Tuesday. In this article you said you posted pictures of what the area looks like that is not healing. I cannot find that please re post
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