Thin skin tearing after final exchange

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saphanarie
saphanarie Member Posts: 5
edited July 2017 in Breast Reconstruction

Has anyone else had issues with their skin tearing?  I had a bi-lateral and the left side (cancer side) was left with very thin skin causing problems along they way.  I had my final exchange 7 weeks ago and during that surgery, the skin tore.  My PS used stitches, but when the scab came off, there was no skin underneath!  So now I have a hole in my breast.  My PS knew the skin was very thin, so during the surgery she opted to wrap the left implant with Alloderm to give that side some extra skin support.  So what I am looking at is the Alloderm vs. looking directly at the implant. 

My PS, at first, thought the skin might grow back over the AlloDerm, but at my last appointment she was discouraged that it wasn't making much progress.  She is roughing up the skin each week to try and generate blood flow to help it regenerate.  Now she is discussing my case with her colleagues to come up with a possible new plan. 

Anyone else go through this and have any suggestions?  Or is it just me.  I feel like it's just me.  This left breast has had 3 issues to overcome so far.  The first was my skin folded and stuck together from underneath immediately following my mastectomy, then my expander sprung a leak so we did an extra surgery to replace (she was able to release the folded skin during this surgery and it looks so much better), then a month later end up with a hole in my skin right after the final surgery.  Ugh!

I have the teardrop shape 320cc.  I'm on the smaller side, but I'm only 5ft. tall so 320 was plenty for me.  I was filled to 300 cc with the expanders so I wonder if that extra 20 cc caused the skin to tear?  Maybe my skin needed more time to settle before the final exchange?

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  • DiveCat
    DiveCat Member Posts: 968
    edited May 2014

    Did the skin tear at or near the incision? Where is the hole on your breast?

    The extra 20cc is not likely the culprit in itself. The TEs are hard and as a result seem to actually take up more space than the implants would, which are softer and conform to your ribcage and result in less projection than the TEs. It is not uncommon for PSs to put in a larger implant than the TEs to account for this "loss" in projection. However, the implant may have been too much for your skin at that time especially going through another surgery...whether it was 300cc or 320cc would likely not have made much of a difference. 20ccs is a pretty darn small amount...about 1.35 tablespoons, spread over the entire implant.

    How thin your skin is (assuming you did not do rads or anything) depends on how much the BS left, or did not leave. It is important in a skin sparing for the BS to leave some tissue underneath the skin, for blood supply to prevent the skin from dying, and for strength of the skin flap to support the implant. It is not unusual for a BS to leave thinner tissues on a cancer side than a prophylactic side, and even for a bigger implant then needed on cancer side because of this disparity. However, this also means more vulnerable skin on the cancer side. Your PS needs to watch as you expand for signs the skin is being stretched too much as well. 

    I have seen this happen before, meaning a "hole" developing through to implant/Alloderm, in different ways...either due to necrosis, or thin tissues, or an incision opening up. I'll be honest, if the skin can't be closed with the implant in place, usually what I have seem done is that the implant is removed, and either the skin is allowed to heal before a TE is placed, or a TE with minimal fill is placed right away. Alloderm is often used to add further strength and support, and sometimes a lat flap or something is considered, as well.

    I am very sorry you are going through this, but I do trust that there is a solution for you.

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  • saphanarie
    saphanarie Member Posts: 5
    edited May 2014

    Thank you DivaCat.  The hole is not by the incision.  I did nipple sparing and the hole is just under the nipple.  My incisions are out to the side only by my armpit and just up to the nipple line.  I was kind of thinking the same thing that I might need to have it removed in order to close the hole.  My PS is concerned that if she tried pulling on the skin to close it, that it will just tear more.  I find out on Thursday what her suggestion will be after discussing with her colleagues.  I will be disappointed to have to start over with TE's again.  Just when I thought I was all done.  Oh well, I'm practicing patience!

     

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  • sandra4611
    sandra4611 Member Posts: 2,913
    edited May 2014

    Divecat is right on the mark with everything she has told you. I did not have the same experience as you, but did have to deal with very thin skin on the prophy left side, not the cancer right side. To complicate that, I developed a bad gram-positive infection on the prophy side within hours of returning to my room after the BMX with immediate permanent implants. It took 3 days and 3 different IV antibiotics to get it under control, but not in time to prevent the lose of muscle, skin, and all the soft tissue under my arm and on the side of the implant. Now there was not enough skin to cover the implant so it had to go. An empty TE was put in and after a month of more IV vancomycin, the infection was gone & the drains were out. The TE was placed quite close to the other implant so as the PS expanded it, I was really weirdly lopsided but it was necessary in order to expand the best available skin on that side. The PS was so careful. As he did each fill, he constantly pressed a finger against the skin and then counted the time it took after he lifted his finger for the skin to pink up again. He tried to find a balance between expanding skin & muscle but not loosing the optimal capillary refill response which shows adequate blood flow. Without it, thin skin tears. After three months, the TE was taken out, the new skin was pulled over a new implant and there was enough of it. I was put on IV vancomycin prior to the exchange and stayed on it two weeks to ensure there would be no new infection.

    I've had to have more surgeries since then to repair the damage done by the infections and will have #5 next month. We still have to deal with the very thin skin on my upper chest which provides no padding and feels bruised 24/7. Even a stethoscope placed on my chest hurts! My PS changed the implants to gummy bears which are so much taller than rounds and that does provide some padding but it's obviously not enough. We'll go with fat grafting at the next surgery. Hopefully this will be my last surgery.

    Good luck. You'll probably need to lose the implant and get a TE, but it can work out fine. I'm living proof. 

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  • saphanarie
    saphanarie Member Posts: 5
    edited May 2014

    Sandra4611-Sorry you had such a bad experience. It's so frustrating when you think you will only have 2 surgeries and end up with 5.  I'm afraid you are right about needing another surgery.  I will probably be like you with a total of 5 surgeries.  I've had 3 so far.  I'm keeping my fingers crossed.

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  • sandra4611
    sandra4611 Member Posts: 2,913
    edited May 2014

    I'm with you, girl.

    image


     

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  • msdsmith55
    msdsmith55 Member Posts: 5
    edited July 2017

    my skin has torn open from my last expander fill. The skin on that breast was thin so when I got to 350 c.c the skin split. My PS is doing surgery on me tuesday. He will take muscle and tissue from my back and basically build a new breast and place the permanent implant in. I have read about this procedure and that seems to be the best fix for this problem.

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  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited July 2017

    Oh I'm so sorry. That sounds awful. Sounds like he's planning this type of recon https://community.breastcancer.org/forum/44/topics...

    I hope your surgery goes well. Take care!


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  • LibraGirl10
    LibraGirl10 Member Posts: 6
    edited July 2017

    I know this question is old, but I wanted to chime in with my own 2 cents in case anyone else has a similar problem.

    After my original surgery, I had tissue expanders rapidly filled to 540 cc. Then had radiation.

    Exchanged to gummy bear shaped implants 6 months later. 6 weeks later, my incision came apart. Leaving a 1/2 hole that I could see the implant through. PS tried closing it several times but it wouldn't hold. Developed an infection and he removed the implant. But now, that incision wouldn't heal either and I had a 3" non healing open wound in my chest.

    He recommended a Lat Flap with skin paddlesto get area closed and placing tissue expanders again. The area around the skin paddles also broke open. He was treating the open wounds with xeroform.

    By this time, I was sick to death of having open wounds, so my regular dr sent me to a wound care clinic. BEST DECISION EVER! My PS kept saying it was overkill, but after months of dealing with this, I felt I needed resolution.


    Wound care put me on a wound vac and prescribed advanced dressings. I had 3 wounds total, full thickness. Withen 3 weeks, all but one had closed. A week later, the last one finally closed.

    My recommendation... if your dealing with non healing open wounds... ask to go to a wound care clinic

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  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited July 2017

    What great advice libragirl

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  • macb04
    macb04 Member Posts: 1,433
    edited July 2017

    I agree, go to a Wound Care Center, and even consider Hyperbaric Oxygen Therapy(HBOT). I did that when I had Radiation Fibrosis and infections that wouldn't resolve, despite antibiotics when I was going through Reconstruction. I also got High dose IV Vitamin C at my Oncology Specialist Naturopath, with the approval of the Wound Care Center.. What a HUGE improvement, almost immediately.

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