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Topic: Wound dehiscence after TramFlap breast reconstruction

Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.

Posted on: Mar 5, 2019 02:51AM

I_amzer3nity wrote:

Hello: I’m new here . I’m trying to find advice for my situation. On January 4, 2019 I had a left breast mastectomy with immediate TramFlap reconstruction. I was hospitalized for 6 days. After my post op appointment with the Plastic Surgeon, he removed the drains and later that night I noticed my abdomen wound started opening little by little. I followed up with him and informed him what was happening. He said it wasn’t a problem and to just apply bacitracin ointment to the area and it would close on its own. That didn’t help as the wound kept opening bigger and bigger went back to surgeon again, he told me to just pack the wound with wet dry gauze that didn’t help as the wound became infected and I was admitted to the hospital for deep wound dehiscence and infection I was hospitalized for 9 days given anti antibiotics, blood thinners, and sent home with wound vac treatment. I have a nurse come to my home 3x a week to change the vac dressing but I’m still in chronic pain and have been in wound vac treatment for 3 weeks and this wound is not closing and I no longer want to go back to that plastic surgeon but some doctor other than my pcp provider needs to monitor this vac treatment. I suffer day and night in pain taking regular Tylenol does not help much I don’t want to keep going back to the Hospital ER for this wound dehiscence but I’m in constant pain and psychology going out of my mind with not knowing why my wound won’t close and why I’m not getting a straight answer from my pcp provider.

Is there someone out there that can relate and if so could you please adviyand consult with me please I’m in such pain I feel like I could die

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Mar 7, 2019 09:42PM Leatherette wrote:

I didn’t have this happen, but I had to respond....so sorry this happened/is happening to you. That plastic surgeon ....@#$& him! Glad you already plan to not see him. My PS would have never dismissed that. Hope the wound vac does it’s work quickly.



Age 45 at diagnosis Dx 5/2017, DCIS, Left, 6cm+, Stage 0, Grade 3, ER+/PR+ Surgery 6/19/2017 Mastectomy: Left Dx 6/23/2017, IDC, Left, 1cm, Stage IA, Grade 3, 0/2 nodes, ER-/PR-, HER2+ (IHC) Chemotherapy 7/25/2017 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 7/25/2017 Herceptin (trastuzumab) Surgery 7/2/2018 Reconstruction (left): DIEP flap
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Mar 7, 2019 10:22PM I_amzer3nity wrote:

Thank you. I’m seeing my primary doctor tomorrow I think he’s going to refer me to a wound care specialist I hope he does and I hope it’s covered by insurance. I’m trying to keep a hopeful attitude. Thank you for replying

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Mar 8, 2019 12:30AM Kanona7795 wrote:

I'm going thru almost the exact same thing. I had my DIEP surgery on February 1st. I was in the hospital for 4 day before going home. They were so focused on my flaps surviving I'm not sure how much attention was paid to my abdomen incision. While I still had my drains I noticed my skin turning dark under my belly button. When I went to see my PS to get the drains out he told me to put Betadine ointment on that area 3xs a day and keep it covered, he would see me back in 2 weeks. Well the weekend before I went back I noticed a small hole open up at the incision site. When I went back to the PS he said don't worry we know how to treat this and told me to start a wet to dry dressing 3xs a day. He made sure to tell me this was going to get a lot bigger before it gets better. Went back to him this week and he seems to think it's doing better but its now huge and I refuse to look at it. My husband packs it so I don't have to do it. He even comes home at lunch to pack it. This week they tried to cut out all the dead tissue and fat so it can start healing from the inside out. The wound vac was mentioned but he thinks I can heal without it. My nerves and emotional strength is about gone. Sorry for the graphic pictures but I wanted you to know your not alone.

Part of the I-Spy 2 trial Dx 1/25/2018, IDC, Left, Grade 2, ER+/PR+, HER2- Dx 3/6/2018, DCIS, Left, Stage 0, Grade 1, ER+/PR+, HER2- Chemotherapy 3/27/2018 Taxol (paclitaxel) Surgery 10/17/2018 Lymph node removal: Sentinel; Mastectomy: Left, Right
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Mar 8, 2019 12:49AM - edited Mar 8, 2019 12:50AM by macb04

This Post was deleted by macb04.
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Mar 8, 2019 12:50AM macb04 wrote:

Ladies, had nasty infections in the past, and went to a Wound Care Center. I self referred myself, because the PS seemed kind of at a loss as to how to help me. I got Hyperbaric Oxygen Therapy (HBOT).

Made a HUGE, improvement. Even better, insurance paid for it. Went from not healing, to all healed up within about 10 days, give or take. I also took about 3 to 6 grams of Vitamin C per day to help with wound healing. I used to talk to these other patients there for big nasty wounds, diabetic ulcers, ect. They all healed up too with HBOT.

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Mar 8, 2019 01:08AM I_amzer3nity wrote:

Dear god ! Mine looks similar to this . I am really depressed and I feel like if I'd known the risks of TramFlap reconstruction, I would've opted out and just had the mastectomy alone. The pain and mental anguish I'm feeling is just not worth it! When I was referred to the PS who did my TramFlap, I was not thinking straight because of the diagnosis of bc in the first place. Yes the PS did tell my the surgery would take 6 hours and I'd be “sore" for about 6-8 weeks, and that I'd be in the hospital about 5 days. At no time did he mention wound opening, infection, etc. Not only do I have this wound opening issue, but I'm still very sore in my Rectus abdominis area I've been on wound vac therapy since February 14, 2019 and I still have drainage! I'm just so upset. I just wish I die. I’m not getting a straight answer from the PS or my primary of why this has happened I’m tired so tired I just want to die! I wish I died undergoing surgery it would be better than going thru this. I hope you get better, but I don’t think I’m gonna survive I know my body and I feel death coming over me and I embrace it. Best of luck to you. Thanks for reply me

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Mar 8, 2019 01:14AM I_amzer3nity wrote:

did you get this treatment inpatient or outpatient?

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Mar 8, 2019 09:54AM Kanona7795 wrote:

I live about 2 1/2 hours from my PS so we are doing this all out patient. I chose to go to a huge medical research hospital in the next state over.Yes this has taken a big emotional toll on me and my family but I have to remind myself there is light at the end of the tunnel. God got me thru diagnosis, chemo, and will get me thru this too. I hate that you are feeling so low but it will get better. I hope you have a good support system to lean on. I promise this is not the worse thing that will ever happen to you. Cancer sucks but it will make us STRONGER.Yes it's gross to look at and yes I do still have a lot of pain and discomfort at times. I was supposed to chaperone my sons spring break trip to FL but I can't go with this huge open wound. So it effects every aspect of my life which SUCKS!! I'm worried about what the scar will look like after it heals. All I know is my PS better do some magic when I finally have the revision surgery. I'm not blaming my PS at all he did everything right but unfortunately to many blood vessels where moved with the flap that my incision didn't have enough to heal.

Part of the I-Spy 2 trial Dx 1/25/2018, IDC, Left, Grade 2, ER+/PR+, HER2- Dx 3/6/2018, DCIS, Left, Stage 0, Grade 1, ER+/PR+, HER2- Chemotherapy 3/27/2018 Taxol (paclitaxel) Surgery 10/17/2018 Lymph node removal: Sentinel; Mastectomy: Left, Right
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Mar 8, 2019 02:13PM Imdtm23 wrote:

I totally feel your pain. I had diep flap in Dec and my abdomen opened up about 4 weeks later. They first tried just watching it then it opened even more. My PS scheduled me back for surgery. He cleaned up the wound and stitched my entire abdomen incision back up. A week later. I developed a seroma and they had to cut a section of it open and pack it. I had so much packing I felt like a magician doing the scarf trick. My PS stressed to me to eat PROTEIN, PROTEIN and more PROTEIN. I've been eating over 100g a day and it went from an 8cm hole to barely there in a month. I went back this morning and he said Im good to go. Can exercise and do whatever I want now. It will not open back up.

Hang in there!

Dx 9/12/2018, IDC, Right, 3cm, Stage IIA, 0/3 nodes, ER+/PR+, HER2- (IHC) Surgery 11/15/2018 Lymph node removal: Sentinel Surgery 12/9/2018 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 1/12/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Mar 8, 2019 08:42PM Kanona7795 wrote:

Imdtm23 - Thank you so much for sharing your story. I’m constantly looking or searching this forum for stories like mine. It helps to know others have gone thru it and to know what they did to help heal their wounds. I’m so going to load up on protein. If protein will help my body heal then I’m all for it. How is your scar now? I’ve seen pictures of how the skin heals after necrosis and it’s a little scary. Are you going to have a revision surgery

Part of the I-Spy 2 trial Dx 1/25/2018, IDC, Left, Grade 2, ER+/PR+, HER2- Dx 3/6/2018, DCIS, Left, Stage 0, Grade 1, ER+/PR+, HER2- Chemotherapy 3/27/2018 Taxol (paclitaxel) Surgery 10/17/2018 Lymph node removal: Sentinel; Mastectomy: Left, Right
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Mar 8, 2019 10:45PM I_amzer3nity wrote:

That sounds good. How do you know how much is 100 g of protein? Can you give me an example? Protein meaning meat right?

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Mar 9, 2019 12:07AM NancyHB wrote:

Protein can be meat, but can also include cheese, eggs, dairy, chick peas, seafood, and protein products like shakes and nutrition bars. I drank protein shakes every day because I couldn’t stomach eating as much protein as needed. An egg has about 6 grams of protein, while a quarter-pound if ground beef has about 20. Protein is vital for healing, especially after TRAM and DIEP

"Be happy for this moment. This moment is your life." - Omar Khayyam Dx 11/22/2011, IDC, Left, 1cm, Grade 2, ER+/PR-, HER2- (FISH) Surgery 12/5/2011 Lumpectomy: Left; Lymph node removal: Sentinel Chemotherapy 1/19/2012 AC + T (Taxol) Radiation Therapy 6/12/2012 Whole-breast: Breast, Lymph nodes Dx 1/27/2016, IDC, Left, 1cm, Grade 3, 0/4 nodes, ER-/PR-, HER2- Surgery 2/15/2016 Lumpectomy; Lymph node removal: Left Chemotherapy 3/1/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 7/21/2016 Mastectomy: Left; Reconstruction (left): DIEP flap Dx 1/31/2017, IDC, Stage IV, metastasized to bone
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Mar 9, 2019 12:23AM Meow13 wrote:

I had the DIEP and my surgeon was concerned he put many stitches in. I had a couple lumps he removed but he told me he is very concerned with wound opening. It never happened to me, looking at the photos I can feel the pain. Try the wound vacuum or maybe the treatment macb04 suggests. Wow, praying you guys heal soon.

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Mar 10, 2019 04:31PM Imdtm23 wrote:

I eat eggs, meats, nuts and Greek yogart. I supplement with protein shakes. I keep track with the app Lose it. I was mostly tracking for protein counts. I go back to my PS in 2 1/2 months to discuss phase 2. I'm a little worried about doing that since I had so much problems.

I cant post pictures of my scar yet.

Dx 9/12/2018, IDC, Right, 3cm, Stage IIA, 0/3 nodes, ER+/PR+, HER2- (IHC) Surgery 11/15/2018 Lymph node removal: Sentinel Surgery 12/9/2018 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 1/12/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Mar 10, 2019 05:29PM I_amzer3nity wrote:

I’m sorry for anyband all of people experiencing these complications. I’m really depressed as I’m hurting so bad and I don’t even leave the house anymore except for doctors s appointment because I have to be hooked up to a portable wound vac machine and people stare an I feel so ugly and indifferent. I’ve lost all hope for getting well. My treatment team still does not thoroughly explain what is happening and why do I need to be seen by an oncologist when I was told the tumor was removed along with the lymph nodes and there was no trace of the cancer left. I will not take chemo therapy for I feel I do not need it and the risks factors and side of effects of chemo frightens me. I just want this wound to close and the setons drainage to stop so I can get on with my life. I’m tired of the doctors, the pills, the insurance problem all of it I just want piece of mind

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Mar 10, 2019 05:30PM I_amzer3nity wrote:

thank you dear I really need all the prayers I can get for I feel so bad I just don’t want to feel anything anymore

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Mar 10, 2019 05:34PM I_amzer3nity wrote:

is canned tuna a good protein? I’m sort of dairy sensitive. And suspicious of meats available in the local grocery stores with all the things I’ve read about on the news and internet it seems that red meat can cause cancer and chicken causes salmonella. I’m not trying to be difficult I’m just scared and not sure what types of proteins are safe to consume

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Mar 10, 2019 07:45PM Imdtm23 wrote:

Yes canned tuna has a good amount of protein. I had that a couple of times over the past month. I always buy grass fed beef from the butcher.

Dx 9/12/2018, IDC, Right, 3cm, Stage IIA, 0/3 nodes, ER+/PR+, HER2- (IHC) Surgery 11/15/2018 Lymph node removal: Sentinel Surgery 12/9/2018 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 1/12/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Mar 10, 2019 07:57PM Meow13 wrote:

I still see my oncologist once a year, even though I have been cancer free for 7 years and I have been off AI drugs for 3. He still has me do a yearly blood work up, mri, and mammogram.

My insurance changed I used to never see a bill or a benefit statement. Now I see both I had to pay $5 of the $120 dollar office visit, still waiting for a $22 bill for lab work. My mammogram seems to have been covered in full, but I had to pay $95 toward the MRI. So a little over $100 a year for continued surveillance is worth it to me.

Before I used to pay $10 copay for office visit and mri and mammogram no charge. Still a really good deal.

Don't give up hope on the wound healing, if it doesn't improve inquire about other treatments.

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Mar 11, 2019 01:38PM Imdtm23 wrote:

I see my oncologist for my tamoxifen which I started in January. I saw her once a month for the first couple months and now its 3 months. I have to get blood work prior to every appointment. When I was picking the group of doctors I went with, my friend told me to make sure you are comfortable with your oncologist. You will see them for the longest time out of all the doctors.

I am grateful that my breast surgeon gave me information overload. She sent me to two PS and medical oncologist and radiation oncologist so I knew what to expect. I am lucky and have no node involvement and a low oncotype score so I do not need chemo but I have to take the tamoxifen daily for the next 5 years.

Hang in there, I felt like my wound would never heal and was regretting the whole procedure. But today I am back to work on my first day and feeling pretty good. and still eating my Protein!!

Dx 9/12/2018, IDC, Right, 3cm, Stage IIA, 0/3 nodes, ER+/PR+, HER2- (IHC) Surgery 11/15/2018 Lymph node removal: Sentinel Surgery 12/9/2018 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 1/12/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Mar 11, 2019 02:58PM Kanona7795 wrote:

Imdtm23 - How long were you off work? I had my BMX back in Oct and didn't go back to work until the first of the year. In between I needed a out patient surgery because my right nipple died and had to be removed. I was back at work a month before my DIEP and have been out ever since. My PS says if I feel up to it I can go back since I have a desk job. Right now I can't even imagine going back with this huge wound that has to be packed 3x's a day plus I'm worried sitting at my desk would hurt because of the location of the wound. I have taken your advice and I'm trying to add a lot more protein to my diet. I have gained so much weight since all of this has started I'm just falling into a huge funk!!

Part of the I-Spy 2 trial Dx 1/25/2018, IDC, Left, Grade 2, ER+/PR+, HER2- Dx 3/6/2018, DCIS, Left, Stage 0, Grade 1, ER+/PR+, HER2- Chemotherapy 3/27/2018 Taxol (paclitaxel) Surgery 10/17/2018 Lymph node removal: Sentinel; Mastectomy: Left, Right
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Mar 11, 2019 03:15PM I_amzer3nity wrote:

wow, I’m like really anxious about taking anymore medicine for cancer which I don’t understand in my case I was told when they removed the tumor and nodes it showed it had not mastisizrd so I don’t know why my doctor wants me to follow with Oncologist I told him I will not take chemo, radiation, or pills. I’m done with this and if I don’t last 5 more years I’m not worried. I’m done with all these doctors and treatments.

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Mar 11, 2019 03:51PM Imdtm23 wrote:

Kanona7795 -I had immediate reconstruction. Original they said I would be out of work for 8 weeks but since my abdomen reopened my PS wouldn't clear me until the wound was almost 100% healed (well 98%). I was out of the office for 12 weeks but I was able to work from home at 6 since I wasn't eligible to disability. I have a desk job too but he was concerned with the wound still draining while I was at work

. Sitting at the desk is very annoying plus today is the first day I am wearing fitted clothing since my operation and the button on my work pants is bothering my scar. I told my husband that my scar is angry (really red). It has been yoga pants and sweats for the past 3 months. I may go buy a couple pairs of elastic waist pants to get through the next couple of weeks.

here are pictures of my incision before my 2nd surgery and yesterday.



Dx 9/12/2018, IDC, Right, 3cm, Stage IIA, 0/3 nodes, ER+/PR+, HER2- (IHC) Surgery 11/15/2018 Lymph node removal: Sentinel Surgery 12/9/2018 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 1/12/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Mar 11, 2019 09:04PM Kanona7795 wrote:

Imtdm23- That scar looks great! If mine healed up that good I would be happy. I told my husband I was worried about it healing like a burn or just bad scar tissue. Now I know my PS will revise it during the 2nd surgery but at the moment it doesn’t help.The thought of wearing pants with a button just ain’t happening. I’m living in elastic waist pants like palazzo or flowy linen pants. I have never had a healing problem before I’m convinced 6 months of chemo just shot my immune system down. I’m also taking Femera every day plus a shot once a month to suppress my ovaries.

Part of the I-Spy 2 trial Dx 1/25/2018, IDC, Left, Grade 2, ER+/PR+, HER2- Dx 3/6/2018, DCIS, Left, Stage 0, Grade 1, ER+/PR+, HER2- Chemotherapy 3/27/2018 Taxol (paclitaxel) Surgery 10/17/2018 Lymph node removal: Sentinel; Mastectomy: Left, Right
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Mar 11, 2019 11:28PM I_amzer3nity wrote:

I applaud you for your bravery if it were me I’d probably would’ve died of shock. As it is my wound is still opened but I’ve been on vac therapy for about a month now and it seems to be closing but not as fast as I’d hoped for. Though mine was not as large as yours in my opinion, any surgical wound dehiscence is something serious as it can become infected and cause sepsis like with me. I had to return to the hospital 3times admitted and was given big guns of antibiotics and still haven’t been given a straight answer from my doctor why this is happening. I think all these doctors cover each other you know like cops do. Anyway, I’m just doing the waiting game now wait to see if I get better or wait to die

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Mar 12, 2019 05:51AM Imdtm23 wrote:

My PS gave me the option let it heal on it's own, which would take alot longer to heal or have a 2nd surgery and he would clean up the wound and stitch it up. I chose the surgery because I didn't like walking around with a wound opened like that.

Hang in there!

Dx 9/12/2018, IDC, Right, 3cm, Stage IIA, 0/3 nodes, ER+/PR+, HER2- (IHC) Surgery 11/15/2018 Lymph node removal: Sentinel Surgery 12/9/2018 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 1/12/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Mar 12, 2019 06:04AM Imdtm23 wrote:

My PS gave me the option let it heal on it's own, which would take alot longer to heal or have a 2nd surgery and he would clean up the wound and stitch it up. I chose the surgery because I didn't like walking around with a wound opened like that.

He explained that your abdomen incision has the most tension and everything you do stretches that area. When I sleep I keep with my back and my legs propped up to not have any tension. I think mine was cause by the elastic in my underwear rubbing it. I went and purchased some high wasted briefs (i call them granny panties) that helped.

Hang in there! My PS told me the good news (if you can call it that) with the longer healing is that all muscles have healed and shouldn't have issues with hernias. Now he wants me to.up my exercises. All I was doing was walking around the block.


Dx 9/12/2018, IDC, Right, 3cm, Stage IIA, 0/3 nodes, ER+/PR+, HER2- (IHC) Surgery 11/15/2018 Lymph node removal: Sentinel Surgery 12/9/2018 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 1/12/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Mar 12, 2019 06:14AM I_amzer3nity wrote:

My doctors are telling me they can’t stitch it up because it’s still draining. That’s why I’m on wound vac therapy. I don’t know what to believe anymore at this point. What I do know is that having state Medicaid insurance does not leave much to look forward to. I only had the surgery because my primary care doctor and my family were pressuring me into having the mastectomy and reconstruction. If I could go back in time I’d have opted out of the reconstruction knowing and experiencing what I’m going thru now to me it’s just not worth it and I should have just had the mastectomy

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Apr 6, 2019 06:15PM julied1962 wrote:

This is my same story! 4 weeks after DIEP, thought I was doing great, when my incision started opening up. I emailed PS right away, she had me come in to have it cleaned and looked at. they were not concerned at all, says its common and it will heal. Gave me some Aquacel silver and sent me home. It just got worse! Now it looks like someone took an ice cream scooper to my tummy and left a bunch of gunk in the hole! My tummy is still numb so I feel no pain, but psychologically, I'm a mess. I cried at dr's office (and I haven't cried all through my diagnosis and treatments so far) I'm on ativan just to keep my nerves together. I can't look at the hole in my stomach, when I change dressings I can't look in mirror. The mental stress is the worst!!

Next week I will be starting on Vacuum Assisted treatment, Dr says for about 4 weeks. Will be weird having the VAC device, but am very glad that I won't have to change my dressings anymore! Will be going to nurse 3x per week for changes.

This is considered a 'minor' complication. I didn't even know about the possibility of it, I had researched my surgery a lot and discussed what I thought were all my risks with my PS. I guess I had known there was a risk of wound healing issues, I just had no idea how HORRIBLE that could be! Wish I'd known this, probably wouldn't have changed my mind on the procedure, but I wouldn't have been so blindsided by this...

Good luck to you, wish me luck on my VAC treatment!

Dx 11/29/2018, DCIS, Left, 2cm, Stage 0, Grade 3, 0/3 nodes, ER-/PR- Surgery 12/9/2018 Lumpectomy: Left; Lymph node removal: Sentinel Surgery 1/2/2019 Lumpectomy: Left Surgery 2/28/2019 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Apr 7, 2019 01:17AM Meow13 wrote:

Wow, sorry to hear about that. I think I was very lucky my DIEP healed very well. I didn't realize that wound dehiscence was that common with DIEP.

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