American Society of Plastic Surgeons
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AmyJDS
7 months ago
Answered

Avoiding latissimus dorsi FLAP on radiated breast

Double NSM & beautiful pre pec reconstruction, but 1 breast developed an infection so implant was removed. Recon scheduled in 3 mos. This breast was radiated, so PS predicts being flat these 3 mos will cause elasticity loss. Lat Dorsi FLAP with expander is the plan, swap to implant in 6 mos. I prefer expander and no flap. Can I massage to keep skin flexible? Or anything else? I'll try anything!

Procedure: Breast Reconstruction
Type: Question

Replies 5

Stephen Vega
ASPS Surgeon

You need a flap for this to work. Good luck.

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Debra Johnson
ASPS Surgeon
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The radiation is the bugaboo here. You've already failed once....infection rate much higher in the face of radiation. If you try to expand this radiated skin, it is likely doomed to fail again. You need to bring in blood supply, thus the recommendation of the latissimus flap. I would listen to your surgeon, it's good advice. A latissimus will nourish the radiated skin and better protect you from infection.

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Gregory Dowbak
ASPS Surgeon

Agree you need a flap. Lat flap has probably been radiated . It will look great for a while but will later contract with capsule formation. Surgeon should choose a different flap.

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Nelson Castillo
ASPS Surgeon

Thank you for sharing your question. Unfortunately with the radiation the tissue will never get "better" and most likely you will continue to face complications if you try to expand the skin. I would favor the flap procedure to bring in healthier skin.

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Thomas Howard
ASPS Surgeon

Unfortunately, your irradiated tissue is unlikely to respond well to expander only reconstruction. The effects of radiation influence all tissues involved from a macro to micro scale. Radiation works well on reducing your chances of local recurrence but also creates a soft tissue envelope that will be more prone, significantly, to infectious complications and poor expansion probability. A flap, being non-radiated, brings in healthy well vascularized tissue that is able to expand and resist infection better. There are many flap options, including free flap, to discuss with your provider. I would be cautious on operating too soon and not allowing your body to defeat the previous bacterial infection. A lingering bacterial colonization within that breast pocket could jeopardize a second round of infection around an expander and more complications/surgeries. Good luck

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