Reconstruction revision due to necrosis
I was diagnosed stage zero DCIS this past April, and because of a benign surgical issue I had two years ago on the other side, opted for bilateral mastectomy with direct to implant reconstruction. I know I chose the nuclear option, but I wanted the least chance of recurrence possible. On the morning of the surgery, I was terrified going in, but I knew I was in good hands. My surgeons were pleased with how well everything went. I was pleasantly surprised with how fast I healed in terms of mobility, and actually really liked my new silhouette. I also got the great news that my cancer is gone and that my pathology looks good.
However, about a week after my drains came out, I began having signs of ischemia, and nipple necrosis, on the side that did not have cancer. So…a little more than three weeks after my initial surgery, I was back in the operating room for explant surgery, wound debridement, which turned into a large portion, including the NAC and lower section of breast skin being removed. The good news was that the wound was able to be closed, and my PS said I will have options going forward. I currently have a wound vac for about a week, and I know I have a long route ahead of me - he said it will be at least three months to heal before we can discuss beginning reconstruction again.
Despite the fact tgat I remind myself constantly about the positives I have to be thankful for, I am weepy whenever I look down. I know everyone's cancer and reconstruction journey is different, but has anyone had something similar and been able to do another implant down the road? I would like to avoid flap surgery for numerous reasons, including recovery time, and the fact that I would then have one breast that will age with me, and another that will not. Any input or words of encouragement would be truly appreciated.
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Rachael I haven't had this experience with needing to explant due to infection but dang I am so sorry it is happening to you. What a pain as if a diagnosis isn't enough to bother with. It is a lot to take in emotionally. I did direct to implant as well and the first time around I had tremendous discomfort (ok, pain) from scar tissue and the whole experience took the stuffing out of me. Once I did the revision surgery and worked on those issues I felt so much better and I hope the same goes for you.
((Hugs))
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Thank you so much for your reply…you hit the nail on the head with that one for sure. Emotionally it has been such a roller coaster, and I’m not that skilled at living in the gray area - I’m a planner for sure. Rationally my brain knows this will be ok and I’ll get through it….emotionally, I want to be there yesterday so I can get back to whatever normal is now
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Yes, I had this happen as well, and it all turned out OK - eventually. I had bi-lateral skin and nipple sparing mastectomy with immediate sub-pectoral placement of tissue expanders, filled to 200ccs after removal of breast tissue approximately double that volume. Things looked really excellent immediately after the surgery - surprisingly so. At about the two week point I started to develop scattered necrotic areas across both sides, markedly worse on the non-cancer side, but the nipples themselves looked fairly ok. Some of the spots started to spontaneously clear with the application of Silvadene cream, but some worsened - I had the unfortunate combination very thorough tissue removal, abnormally thin pectoral muscles, and thin skin. A week or so later, on the side with larger scabbed and necrotic area, the expander ruptured through the muscle/skin necessitating an emergency surgery. Right after that I also needed surgery for ALND as I had surprise positive nodes at the time of the mastectomy. I had subsequent surgeries two weeks later, and again two weeks after that, and the left side expander was removed. Once the expander was out the skin healed very well. I went on to chemo, then replaced the expander about six weeks later and expanded slowly. The exchange surgery was without incident about six months after the expander was replaced. I did go on to have some other issues - I have a lot of surgery noted in my signature line - and some of that is fat grafting, downsizing of implants, a silent implant rupture, implant swap, etc. - not necessarily having to do with this initial problem. I know this is a challenge and a disappointment - believe me, I totally get it. Try to keep your eye the eventual outcome and not get too bogged down in what I hope is a temporary setback for you. Easier said than done, right? I will be sending positive vibes for resolution with no more surprises for you, but feel free to PM me if you have any specific questions - or post here. Wishing you the best.
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Thank you so much for the words of encouragement and positive vibes… I’m sure you know this, but it really helps to hear that it turned out alright in the end for you, so thank you from the bottom of my heart for sharing. You’re absolutely right…it is so much easier said than done to keep the end in sight, but I am hoping this will indeed be temporary, and I am so glad to hear that your exchange was smooth. It gives me hope that this will turn out well. My PS wanted to try silvadene, but unfortunately, I have an allergy that prevented it - he didn't want to add a possible skin reaction to my issues, so we tried vashe soaks and petroleum dressings. Hard to say if they helped given the extent to the damage and short usage time before surgery though. Thanks again for your insight and willingness to talk.
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