flap surgery for an unhealed wound

tovahsmom

I'm a two-time breast cancer survivor. I've been radiated twice on the same breast. I was diagnosed with four atypical vascular lesions (AVLs) in July. AVLs are a rare complication of radiation treatment and I am the only patient at NYU Perlmutter Cancer Center that has this and one of only 200 cases worldwide I was told. I had surgery to remove the four lesions in August and the surgical wound never healed due to the skin being radiated twice. I went to a wound doctor at NYU who told me I had two options, both involving more surgery. He said I could do a debridement down to the bone (under general anesthesia) and then 40 consecutive treatments of hyperbaric oxygen therapy, or a flap surgery/breast reconstruction. I had a mastectomy without breast reconstruction in 2019 and I did not then, nor do I want now, a new breast. But this was his strongest recommendation since he did not believe the hyperbaric oxygen therapy would help. He said because the skin was radiated, it is like trying to heal through concrete and the best option is to remove all the radiated skin. I am so disheartened by this. I've had five cancer surgeries already and this would be my sixth. I understand it's a big operation. If I go this route, I want to tell the plastic surgeon to just do what is necessary to heal the wound and to not give me a new breast. Has anybody else been through anything similar? This is what the wound looks like on my mastectomy scar:

LW422

Patricia--so sorry you are having to go through this. I suppose one question that pops up immediately (for me) is why a breast reconstruction? Seems to me that a skin graft from some other area of your body could be used to replace the removed skin. Of course, what do I know but I wonder why reconstruction would be the recommendation. My very best to you for a successful outcome.

MinusTwo

Patricia - so sorry for your troubles, but the rule for BCO is no pictures. Perhaps you could remove that. I have heard really good results about hyperbaric O2 treatments.

Pessa

If the MD does not think the hyperbaric oxygen will help, I would trust his judgment, rather than rely on anecdotal information.

tovahsmom

Thank you Pessa, MinusTwo, and LW422 for reading and responding to my post. I met with my primary surgeon yesterday and he said that yes, I could have a flap surgery without reconstructing a breast. I am so happy about that. He also agreed with the wound doctor that the hyperbaric oxygen therapy would not work. He is holding off on the flap surgery to give the wound time to heal on its own so I am thrilled that surgery is not imminent for now.

LW422

Patricia--that is good news, and I hope the wound will get busy healing! Take care and let us know how it goes.

MinusTwo

Great news/ Thanks for posting.

littleblueflowers

Hi there! I had a similar issue, but did decide to go ahead with DIEP flap reconstruction. The flap was very successful in healing my skin, as there is evidence that the healthy stem cells and blood vessels infiltrate the radiated tissue. I regained a lot of movement and lost a lot of pain in my chest wall. I would assume a skin graft without intent to build a breast would have the same success. Good luck!