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Topic: Diep Flap Has Fat Necrosis That Is Leaking Through Incision.

Forum: Breast Reconstruction —

Talk with others facing decisions about whether or not to have breast reconstruction, and if so, what type and when.

Posted on: Sep 8, 2021 01:29PM

Joanapple wrote:

I had a DIEP flap surgery on July 14th to correct a failed mastectomy implant which was done 8 years ago.

Fortunately I'm not dealing with cancer, but I've had several unexpected, distressing complications from the surgery - an infection which required removal of my tissue expander and surgery to remove a large hematoma. And just yesterday, after a week of whitish/yellowish/brownish discharge, my surgeon said I have fat necrosis which is leaking through the stitches. He opened a section of the stitches and squeezed some of the fat out. I'm now left with an open wound which I need to pack 3 times a day for several weeks. I'm very worried.

My doctor is at Stanford, a well respected institution, and I'm shocked that I'm having all these problems. I don't smoke and was in excellent physical shape going into the surgery, although I did have radiation which I know can be problematic

Also my doctor said I can resume all physical activities including heavy cardio, weights, yoga, etc. I'm an exercise junkie and as much as I need to get back to my routine, it seems odd to sweat and exercise at high intensity with an open wound.

Has anyone else had a similar experience? And what would you do regarding exercise?

Any input would be much appreciated.

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Sep 8, 2021 04:56PM Moderators wrote:

Hi Joanapple,

We don't have much advice for you, but wanted to send our good thoughts to you. Others will be by shortly to weigh in with their thoughts and experiences. Hoping you heal fully and quickly!

--The Mods

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Sep 8, 2021 05:20PM Joanapple wrote:

Thank you so much. Appreciate your good thoughts.

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Sep 29, 2021 07:44AM JaneSing wrote:

Hi Joanapple

I just saw your posting and hope my feedback is not too late. I had Diep surgery earlier this year and like you, I was perfectly healthy (non-smoker and no other underlying medical issues except dcis) but unfortunately encountered several complications post-op.

First was hematoma, which though not large enough to warrant surgical removal resulted in necrosis in about 10-15% of the flap. It was then followed by fluid build up that led to multiple aspirations for about a month.

And when I thought the fluid has finally stopped draining, the necrotic fat started liquefying (possibly inflammed as I felt some pain in those areas) and began to leak through the stitches.

My surgeon's advice then was to surgically remove the necrotic fat, since the stitches are already opened up and given potential risk of infection from the open wound. I was not keen to undergo another surgery (even though it was a very minor one compared to diep) and decided to 'wait and see'. Thankfully the leakage lessened over time and finally stopped after about 2 weeks. I believe the healing really started from then on, as the open wound slowly closed up and the entire flap started softening. The stitches are now barely noticeable after I religiously applied scar cream over it every day.

I am now about 3 months after the fat leakage stopped. I have a very small amount (<5%) of the necrosis remaining at the base of the flap. Even my surgeon is pleasantly surprised at how good the flap looks now, considering all the issues I have encountered.

I hope my experience would encourage you to stay hopeful as the body will slowly heal itself with time. Be diligent with caring for the wound /scar, eat well (I think turmeric and vit C helped in my case) and stay positive ! On the issue of exercising, I did not do any of that when the wound was open as I did not want to risk infection.

Hope this helps.

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