Post Mastectomy problem- Dying skin
Help Please....
At my postop appt with my PS he said that the skin on my former breast is dying. His remedy is to do a skin graft with skin from my back.
Has anyone had this type of problems after surgery?
He says that if I leave this alone it will become an open wound. Then I won't be able to have any chemo as it takes a long time to heal.
Any thoughts
Thanks,
Francine
Comments
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unfortunatley this does happen. It hasn't happened to me but am a plastic surgery nurse and know that it does happen. Skin grafting is a good treatment. I would recommend doing whatever you need to do to move forward in treatment as quickly as possible. When was your mastectomy? Did you have any reconstruction? and when would they do the skingrafting?
Tina
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ejlj
Thks for the quick reply. My mastectomy was on January 5th. I had an expander put in.I previously had a quadrantectomy with Plastic surgery on what was left of the breast in November but the margins were not clear. .
The doctor scheduled the new surgery for a week from Monday, January 26th. It appears to me from what he said that once skin begins to die it cannot be saved.I go back to him tomorrow.
My BS felt that waiting another ten days till the actual surgery was a good idea.
I am all in favor of moving forward in treatment as soon as possible but I know little about this stuff and do not want to make the wrong decision.
Any suggestions.
Thks again,
Francine
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Hi crusader1,
I am new to this site. I am in the same boat as you. I had a skin saving masectomy on right and prophylactic on left on 1/6/09 with immediate recon (silicone implant to left and tissue expander to right) and now have some dead skin on both breasts. My PS only removed some stitches and wants to see me next week. I never got them wet, even when she said I could for fear of infection. She said that I needed to get them wet. Does anyone know if there is anything that can be done for dying skin? Is it something that can't helped no matter what? And, is it okay to get the skin so wet that the skin turns moist? She hasn't told me that I need another surgery, yet. Please keep me posted - I have a feeling that I will be following your footsteps!
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I had a unilateral mx on Nov 20 and also had to deal with some necrosis. I also went back and forth between should I keep it moist with the antibiotic and covering (which seemed to make it "goopier"), others said the moisture keeps the wound from healing, etc. It was enough necrosis and dark black scabbing that a month later, in late December, the PS scheduled me for a procedure to take some of the saline out of my expander, remove the necrosis, then stitch the remaining good skin back together. I was totally freaking out because it would have meant losing some of my fill (and the sooner the fills are done the sooner I can get this expander out!) and having to deal with a really unpleasant looking wound. I'm such a baby when it comes to this.
Anyway, long story short, what I ended up doing was taking two showers a day, one in the morning and one in the evening, and letting the incision air-dry. I just kept a light t-shirt over it so nothing rubbed on it. By my surgery date in December, the PS said the scabbing looked dry enough to put the procedure off. Yea!! Now, a month later, the scabbing is still there, but it does seem to be continuing to get drier, and I'm super careful not to let the scab catch on anything, because you don't want anything coming off before it's ready. My breast "mound" certainly isn't pretty to look at, but it's holding its own, and hopefully it will until my exchange in March, and at that time the PS will remove the necrosis part then when he's doing the rest of the work, all during anesthesia.
My one caution, and one I'm a little worried about but plunge forward anyway, is that the expander will get infected because deep down there probably is something going on with that affected skin. But, so far, so good. I trust my PS, so I'm just going to keep doing what I'm doing.
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Thanks, Digger. I'm so happy that your skin issue is getting better!
I was originally putting tons of antibiotic cream and gauze to the incisions, too. I thought it was a good thing. My PS told me to not use anything and get them wet! I took my first shower yesterday and just put a t-shirt on, too. Hopefully, things will work out. They seem to be very dry and tight right now. Is that a good thing? My PS told me that she is holding off on my fills for at least a month due to the dead skin. My right breast had been radiated back in 2004, so the dead skin was not surprising to me, but my left side was fine and that one, too has dead skin. I see her on 1/29 and am hoping for good news. Did your PS put you on any antibiotics by any chance?? I am still on the antibiotic they gave me after the surgery. I should be done with it in a couple of days. Good luck! I'll say a prayer that you hold on until your exchange in March! -
Fea,
My breast is still dying. At the time of my surgery the PS put only 50 ccs of fill in my breast as he knew something did not look right.
I am now scheduled to have the implant removed on Monday and have all the dead skin debrided. The PS does not believe that he will be able to close the wound so I will go home with a hole in my breast and will have to wear a vac( portable machine) to take out fluids which prevent healing.
Before this decision was made I had to put twice a day on my breast, bacitracin or silverdyne, then a zeroform pad, then gauze and finally an ace bandage. The doctor felt moist was good.
You can send me a PM if you like and we can talk more.
Francine
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My PS thinks moist is best. I have an opening about 1" by 1/2" where the incision has split. He debrided it last week in the office and instructed me to keep it covered by gauze coated with a little neosporin. I change the gauze three times a day. When the gauze is removed it's actually good if it pulls off bits of old tissue as this makes room for healthy tissue to grow. Sort of like at home debridement. So now I have an opening with glistening pink/white tissue but no more dead tissue. I'm not sure how the sides are going to come together but he told me to expect it to heal just fine. I also worry about something happening to the expander because of this. Another worry is that the skin will be thin once the opening heals and cause expander problems. Plus, I haven't had a fill since surgery and like Digger, I'm desperate for fills so I can get this over with.
I did read on the web that the basics of wound care were to debride dead tissue so healthy tissue could thrive and keep the wound moist/covered. Also eat lots of protein and nutrient dense fruits and veggies and lots Vit. C. I'm glad we wound challenged, delayed fill girls found each other. I think we all have similar concerns.
Francine, I'm so sorry you're losing your expander. I do think the vac will help close your wound more quickly. Best wishes on your surgery.
Sherry
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Is this where Alloderm would help?
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Actually, looking back, what probably did help me was a debridement I had about a week and a half after surgery. I guess I blanked out on that because the plastic surgery resident did it in the urgent care center one Saturday morning, when I called the service because the wound was "leaking" and she said to come in. And yes, I was on antibiotics throughout all of that, including a couple days of IV antibiotics (back in the hospital) about a week into it. But I would say after about two or three weeks, I was off the antibiotics.
Throughout all of this, the PS has continued his fills, for the most part. I did keep asking him before each fill whether the incision would just burst and the expander come flying out (I think he thought I was crazy, but it sure seemed possible to me!), but, so far, it's still in there. I'm not sure if it makes a difference that I'm keeping the mound small in the first place. I started with 60cc at the time of surgery and am now at 300cc, which is all I really want.
I see the PS again in mid-February for a final look before March exchange, so we'll see what happens. As I said before, it sure isn't pretty looking, but I guess it could be a lot worse. I have a lot of confidence in the PS (he's at Sloan Kettering), so I'm just going with what he says.
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My PS wanted me to wet it in the shower, but no ointment. I think that ointment would make it softer, too. Unfortunately, I used ointment the whole time and this still happened. I will try a little neosporin on a gauze after my shower! My problem may have been not getting it wet at all, either. I have not had a debridement-Is this when they cut the dead skin off?
My skin is black looking only on part of the incision site-about 1in. in lenght and very small in width (not sure exactly but much smaller than 1/2 inch). My PS is hoping that it looks better on Thursday. It doesn't seem to look any different to me. It does get soft after a long shower, but then hardens back up!! Is this normal?
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Wow, fea, that sounds exactly like mine in terms of size. I just know for me, what worked was the showers, no ointment and letting it air dry a bit before putting on something really soft, nothing constricting. Now, two months later, the black part is much smaller and really crusted over. The PS, when I saw him this past Monday, told me to snip any parts of the scab that are kind of sticking out, so they don't get caught on something and just rip out before the skin underneath is ready to be "exposed." I haven't been brave enough to snip anything, so I'm just being super careful when changing any clothes.
I will say that I do continue to worry about the way the whole "foob" looks, in that it stil has that scab, albeit getting smaller, and, to me, seems pretty red where the new skin is showing. But, as I said, the PS has seen it this past Monday, he seems okay with it, so I'm trying not to stress too much (much easier said than done!).
In terms of daily activities, I have been careful not to bounce around at all, because for some reason I'm scared that will mess up the incision. I know some people run and hike and do all sorts of regular athletic activities when they've got an expander in place, but I've stuck to the treadmill and elliptical. Whether that's kept the incision from getting any worse, I have no idea.
Oh, and in answer to your question, yes, the skin gets soft after the shower, and then it hardens up. I do think that's perfectly normal, just like a similar scab would be on your knee, for example.
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Digger, I also have a hard piece of skin that could be snipped and WILL NOT touch it either! LOL. I figure it will fall off when it's ready! I also started to walk on my treadmill today - hoping it will get the blood flowing and help with my healing. I don't run, just walk at a fast pace. I was so worried about my right side (cancer side) TE getting infected....It turned out that my good side (L) that got the immediate silicone implant looks worse. The right side actually looks ok.....My "foob" is definetely smaller than the original, but I know once it fluffs out and this blackened skin is gone, it will look good. Right now its perfect all around except the bottom which is squared off due to the stitches.
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Hi Francine here,
Just took my shower and getting ready to go to the hospital for a 12:00 noon surgery. This time they will debried (Sp) the wound on my breast and try to close it.If they can't they will put on a vac to speed up healing. Will let you all know how things went later.
Wish me luck as I continue on this journey called Breast Cancer.
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Francine, I said some prayers for you. I hope everything went well. Will be waiting to hear from you.
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Francine,
My thoughts are with you as well and am anxious to hear how things went with you today.
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Sorry but this has been a long week.
I had my expander removed during the surgery. The PS had to cut out too much due to the dying skin so I had to have that VAC put on my chest this past Thursday. I have to wear it 24 hours a day. It is a tube that comes out from the area and connects to a machine that draws out air. There is a tube about six feet long that connects my breast to the unit. Oh yes you can remove a piece of the hose to shower.
I am managing and once again happy that I have incurred no pain at all. I will have to have this thing attached for three to four weeks.Then probaly chemo.
This stuff never seems to end.
Francine
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Francine,
Your strength is amazing. Very happy there was no pain as well. That expander coming out must feel good. When you get a chance, please explain why you need the VAC to remove air. Did you need the skin graft?
Rest rest and more rest. Movies are good too.
So sorry you are having to go through this...keep in touch.
Hugs,
Zerlina
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Francine-Don't forget that eating healthy with lots of protein will help the vac get you healed. I also consume a lot of vitamin C as I think that helps wound healing also. Another good thing about the vac is I think it helps prevent infection because it keeps the wound sealed so nasties can't get in as easily. Hopefully you'll find each day gets easier plus it gets exciting when the nurses measure the wound and tell you it's getting smaller!
Sherry
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Hi,
Zerlina,
The Vac makes negative pressure which the nurse says heals wounds, I guess no air is good also. You can hear the machine sucking the air out periodicly. I am getting used to this and hopefully my wound will heal in the next few weeks. I will not need a skin graft as the hole will heal on it's own. I really wasn't bothered by the expander .
Sherry,
Yes my husband and I do try to eat well. We also take fish oil, calcium and vitamin D. I have a really lovely nurse who comes three times a week to change the dressing. Her second time was today and she said that it already looked like it was beginning to heal. Her last time was Saturday.
Thks ladies for all the encouraging remarks. I guess part of my strengh comes from the fact that so many are cheering me on. It has been a very long journey for me. Unfortunately it is not over.
I will try to keep in touch periodically..
Hugs,
Francine
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Francine -
Sounds like such an ordeal, you poor dear. Sending positive thoughts your way!
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I must say to all this Vac sounds worse than it is. My cancer was early stage and I do not worry about my future . I will probably take chemo due to oncotype score but in a while this will all be in the pass.
Thanks for all the good wishes..
Hugs,
Francine
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Francine
I just saw your post (I don't log in often). My case is very different to you, since I'm lucky, mine was only a profilactic M (non nasty lump picked up by MRI and a very strong family BC history).
After 6 days in hospital, I was discharged, only to be readmitted the very next day with complications. In total, I was there for over a month. Operation 2 meant removal of one tissue expander, operation 3 the removal of the other tissue expander. After operation 3, I had two huge open wounds. Dressings were changed 4 times a day. Operation 4 closed up my wounds and meant the adding of the vacumn pump. Operation 5 took away the pump. A week later I was finally discharged. Two week later I had day surgery since one of my wounds had opened up.
What I had was diagnosed as "pyoderma gangrenosum". If you type "pyoderma gangrenosum" into the search engine, you'll come across my original post and the replies I received.
By the way, after a few days on the vacumn pump and by now about 3 weeks in hospital, I was looking ematiated. Then, I got really hungry. For two days I couldn't stop eating and craved cheese and salty biscuits.
The good news is, finally, I've now got new tissue expanders and am doing great. Hopefully you've mended well too.
Bronwen
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I had a bilateral mastectomy with immediate Diep flap reconstruction on January 23rd. January 24th was rushed back to OR for another 4 hour operation the right flap was failing. I am almost 4 weeks post op and have a large amount of necrotic tissue and both flaps. A couple of days ago I noticed a small hole at the bottom of my left flap. The next day the hole had gotten larger, as well noticed another one at the the top. Last night it looked like the whole thing was going to open. I sent photos to my plastic surgeon. They dont seem too concerned. I see her tomorrow. I am an emotional wreck over this. I am afraid to even look at my breast today. It is so depressing after eerything I have already gone through to have this happening now. Anyone else have a similar experience.
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Hi Ladies, never posted on this board before. Gigette1, I'm so sorry you are having problems. I hope your PS gave you hope on fixing the failed areas. I had a unilateral mastectomy Sept 2017 with immediate Tram Flap reconstruction. Part of that breast has hardened and they said I will need to remove it and replace it with other fat. I am too, devastated, after all that I have already been through, now this. I have a pre surgery appt. this week and seems we will use the outer thigh this time. Very scared.
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2brandy-I didn’t think anyone was still doing TRAM flap anymore because DIEP allow the abdominal muscle to be spared. Have they maybe looked at doing an SGAP from your hip instead of the thigh?
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Hello, Ladies. I thank you for this forum but my heart breaks for all of us that here. I am a newbie. I am 59. y.o., small very active, healty, green and organic lifestyle for over 33. Non-smoker. Never missed a screening mammo in 25 years. Diagnosed with TNBC small tumor Stage 1-2 in March 2018. Apparently I carry the BRCA1 gene mutation and is the first person in my family in 3 generations to ever develop BC. Let me state my Paternal side of the family has had Prostate and Ovarian cancers. I have told Docs this for the past 20 plus years. Everyone Poo Pooed me and said not to worry since my Mom and older sisters and Aunts had no Breast Cancer. Well, guess who was right? They finally tested me after the diagnosis. That's how I found out about the mutation. Hence my journey begins.
I adored my Oncologist and I have so blessed. Had Neoadjuvunct (sp?) first - 16 weeks of chemo then BMX on 8/23 with immediate tissue expander reconstrcution. FIRST LET ME SHOUT IT OUT THAT MY CHEMOTHERAPY TOTALLY ERRADICATED MY TUMOR BEFORE THE SURGERY! I believe in my heart this is God's hand, and a great gift of guidance from my docs. I was not and still am not one with a frame a mind that deals well with this experience. Not sure anyone ever does. Got wonderful news after surgery, No Cancer Anywhere, not in either breast or any lymphnodes. Praise God! I feel that I am over the hump and can finally begin to heal......BS did BMX, plastic surgeon started the TE reconstruction. Two weeks out, extreme pain which I expected, especially since I can't take narcotics, I notice this weird looking patch of yellow/brownish "stain" off to the side of one of the incisions. Funny, it was on the prophylatic breast removal side. The original BC breast incision was healing beautifully. I knew this was weird and felt it just wasn't right. Also extreme pain in that one area and not on the other breast.
Went in to have my first fill of 100cc's with PA, PS was out of town and he approved this. She saw the area and said "Oh looks like a small blister which will be absorbed by the skin." She filled each TE with 100 ccs. I was a large busted small girl (36G-H). I also found out at the time the PS filled my TE with 360cc's during surgery since I had existing pockets (submusclural) from a breast lift I had 14 years earlier. This seemed a bit much to fill, but I didn't know beforehand and he felt there was enough room for me to handle it. He said pockets were in good shape, did a bit of "updating" I guess and filled them.
NOW 18 days post-op I wind up in ER room under a Plastics REsidency who confirms my suspicion of necrosis! I just knew something was wrong. They said there was no infection, but small area of tissue was dying and sent me home with an RX for Silvadene cream, 2x day application to area, cover with gause and keep the surgical bra on. Of course, I am overanxious and freaking out.
MY QUESTIONS: Will the Silvadene cream really be enough to fix this? How long does it usually take? I don't understand why they won't give me oral antibiotics to prevent infection. I get it. Overuse of antibiotics are not good. He did give me an RX but said only to start if I see seepage and redness around the area of the incision. Thank God, none of that yet. But how do I know what's going on below the skin? Do I really need to wait for an infection to possible start. Is the sulpha antibiotic topical enough in the Silvadene to "slough off" the dead skin? I am so terrified. Have we all not gone through such hell already to only come to deal with this? I know there really are no answer to my last question. I have follow-up appts today with Plastics and again on Friday, when my doc is back in town. I am so scared because there is so much pain in that area where the skin necrosis has started. Although they tell me it "appears" to be only on the surface since there is no wound opening, oozing, or spreading, etc. I still wonder how they know what's going on underneath.
Thank you to anyone who reads this long, long post. I truly appreciate it. Ladies, I am so scared. I am so scared. Thank you again, love and support and prayers to all for what you have all gone through. Emotionally, mentally and physically I'm a wreck. I Know the worse case scenario. I just want to hear some stories of hope and success. I don't want to lose my reconstruction, but I will pull them if I have to. Life is more important to me. Thank you again, God Bless....
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ddweedee, I have the same questions you have regarding the silvadene. I had bilateral MX with reconstruction with stretchers. I'm having issues with skin necrosis and was given silver sulfadazine to put on twice a day but also given antibiotics (amoxocillian and levofloxacin). Im also wondering if this treatment will work and how I can help move this along and whether the dying skin is going to keep me from continuing the reconstruction process. My nightmare would be that the stretchers have to come out and I have to start over. I hope someone responds with a success story and helpful hints. . . fingers crossed.
Just an update. . .the silver sulfadazine worked and my skin is looking much better. PS says that the skin necrosis is no longer an issued. I used the silver sulfadazine twice a day for 3 weeks after a shower everyday. i was also taking the EmgercenC Immund D+ (contains zinc and magnesium) twice a day for about a week and that is when my skin showed a marked improvement. So there is hope if you are experiencing Skin Necrosis or dying skin.
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I don't have personal experience in this, but I've heard good things about wound care specialists. My SIL had a problem with an area of her abdomen not healing properly after a surgery, despite lots of products and processes. A wound care specialist was ordered and the combination of their expertise and a wound vac sped up the healing unbelievably.
Also have heard good results with hyperbaric chambers for increased oxygenation. And additional intake of protein and Vitamin C.
Wishing you all the best!
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