So many complications

eschofi · June 2017

Just hoping I can find someone who has had a similar experience who can send some hope my way...I had a bilateral nipple sparing mastectomy on 4/13, on the advice of my Plastic Surgeon. I was not especially concerned with saving my nipples, but he encouraged it repeatedly saying I was a good candidate. My surgical pathology showed lymph node involvement and my Oncotype came back at Intermediate risk, so chemo was advised. Three weeks later, I went back in for revision surgery to remove the nipples which had become necrotic. After doing some research, I had a hard time believing he had ever recommended it as am overweight, had just quit smoking and had a small tumor close to my nipple. regardless, I had agreed to the procedure, so there isn't much to do about that. Since then, I have had a wound on either side, that was not healing. Finally, four weeks after the second surgery, I told him we needed to do something about it as the wounds were holding up me being able to start chemo. He debrided both wounds and gave me a cream to use and advised we would be able to start chemo in 3 weeks.

On the advice of my breast surgeon, I went and saw a wound specialist. Within two minutes, he had discovered tunneling wounds that I can only assume the plastic surgeon knew nothing about. After a week of packing the wounds with silver, he is now advising the right tissue expander be removed as the top of the wound is exposing it. I don't feel super comfortable with my PS right now, so I am trying to see if my BS will remove it.

I am now 10 weeks past my initial surgery, my oncologist says if we can't start chemo in the twelve week window, we will have to explore other options, and I am beyond frustrated. I have opted to be very aggressive throughout my treatment so I could have the best possible long term survival rate. I never thought this process would be so long or so difficult. I still can't pick up my 18 month old son, for fear of opening this wound any further.

Does anyone have any experience with non-healing wounds, recovery time from removing tissue expander, or delayed start to chemo? I need some kind of hope right now.

kira1234 · June 2017

I personally have not. That being said your very close to being outside of the window for chemo. If you want to do chemo then you need the implants out asap. I am 6 weeks out from double mastectomy no reconstruction which is why I'm unable to advise. I would ask your breast surgeon for taking them out though for sure.

SpecialK · June 2017

I had a number of complications between a skin/nipple sparing BMX and chemo, which included necrosis and delayed healing, and 4 additional surgeries prior to beginning. I had surprise positive nodes that were removed in an ALND surgery, and I had three skin repairs and finally the removal of the left tissue expander. All of this occurred in the 14 weeks after BMX. There was no option of skipping chemo as I was node positive, Her2+, and had a nearly 3cm grade 3 tumor. I was aware that there was an optimal "window" for the start of chemo, but there is not a hard and fast line that indicates there is no longer any benefit outside of that window. Studies have shown there may be an increased risk of recurrence with delay, but as with many aspects of cancer treatment, it is not an absolute. I was able to start chemo and Herceptin about three weeks after the surgery to remove the expander, and it was replaced six weeks after I finished chemo.

eschofi · June 2017

SpecialK, thank you so much for your response. Aside from our HER2 status, it seems like our situations are very similar. I met with the plastic surgeon this morning and the tissue expander is coming out later this afternoon. He believes he will be able to close the wound and with a drain, thinks I will be able to start chemo in 2 weeks. I am crossing my fingers, but really appreciate you taking the time to share your story.

mustlovepoodles · June 2017

eschofi, I haven't had your exact experience, but i did have a terrible time healing after my BMX. I had a ton of necrosis on the right, with deep tunneling--it looked like a wolf had snatched a chunk of my chest off. I also had an enormous seroma on the left that once opened poured gunk down my side, despite the two drains. My DH couldn't even look at it, beyond the first glance. I was mutilated.

My PS started me off on wet-to-dry dressings on the right, but it soon became clear that the wound was far too involved for that. She put on a wound vac that had to be changed every 2-3 days in her office for 7 weeks, after which she changed to some other kind of special dressing that I changed every 3 days at home. All the while, this huge seroma on the left had to be packed and unpacked with string-gauze twice a day. Total healing time was 16 weeks for each side.

My two consolations were that the wounds never got infected and I didn't have immediate reconstruction. No doubt, I would have lost it all. Still, the scarring is substantial and the skin is adhered to the chest wall. My new PS says he can revise all of it when he does my DIEP (yes, I fired my other PS. Totally lost confidence in her.) This has by far been the worst experience of my life.

I wish you all the best.

Kicks · June 2017

I have no experience at all with the horrible issues your are having to deal with so I really can't give you any ideas. My only thought/question is, have they done any cultures of the areas to see what infection is going on? Tunneling wounds?

It is quite possible to start Chemo with a drain still in. At least I did. It was 3 weeks post UMX when I started adjuvant Taxol with a drain still in. It was taken out the next week.

MTwoman · June 2017

eschofi, I am so very sorry you are experiencing so many complications. I don't have any personal experience, but have found a site that may provide you with some additional information:

http://www.woundsource.com/blog/negative-pressure-wound-therapy-and-tunneling-wounds

the author is a certified wound therapist (actually didn't know there was such a thing) and Wound Educator. One of her suggestions was optimizing nutrition (especially if you have diabetes or high blood sugar). Optimizing nutrition (could give you a task, while your medical providers work on theirs). I'm not sure if this is applicable to you, but thought I'd give it a try.

Good luck!! and warm ((hugs))

groucho2 · June 2017

I had a seroma that blew out after scar revision surgery and that turned into a tunneling wound. My surgeon (and her nurse) kept telling me it would heal, but after 8 weeks of no visible progress, my GP (not my surgeon) referred me to a wound center.

I had a 9 cm tunneling wound. I am still in treatment for it. I pack it daily with a petroleum based packing that is moistened with a concoction brewed in house at the Center. Currently, the tunneling is 4cm after 7 weeks of treatment. The care I receive at the Center is great and they carefully document and celebrate my progress.

Unfortunately, I can't advise you on tissue expanders recovery time (I went flat from the beginning) or delayed chemo (I was hospitalized for an infected seroma 6 weeks after my BMX, but I still made the 12 week time slot for chemo).

I can say that I blame my surgeon for letting the wound get this bad. I believe if I'd had an earlier intervention, I'd be fully healed by now.

I wish you the best as you work on healing and beginning chemo.

eschofi · June 2017

Thank you all for your kind words. I did have the Tissue Expander removed yesterday by the Plastic Surgeon. I was hesitant to have him be the one to do it, but it was really my only option. The good news, I am completely closed up (hopefully, I will stay that way). I meet with my medical oncologist on Tuesday, and I guess she will give me the cut-off date for starting chemo. My fingers are crossed that she will extend the window a bit, so we can this done.

kira1234 · June 2017

I'll keep my fingers crossed for you eschofi. Hopefully the insision will stay closed.

Tlj1972 · July 2017

All, I had a double mastectomy on May 31,2017. No lymph nodes effected but my oncotype score came back in the medium range, so I opted for chemo. Unfortunately, my right breast is still being drained weekly, and my left breast isn't healing properly. My ps said chemo had to wait. What is the 12 week window I keep hearing about and the tunneling? I'm so confused, scared and overwhelmed. What if the cancer cells that was left is, spreading because chemo is put off and my ps said I may lose my reconstruction. What happens then? I haven't even had my expanders filled yet. Any advice would be so helpful.

Moderators · July 2017

Hi Tlj1972-

We're so sorry to hear about the complications you've had! We know these setbacks can be devastating. Have you read through our chemo forum? Lots of great info there, and members who can help put your mind at ease regarding the delay in starting treatment: https://community.breastcancer.org/forum/69.

Please keep us posted on how you continue to heal!

The Mods

eschofi · July 2017

Tlj1972,

I know the frustration! I would have a talk with your plastic surgeon and also your Oncologist. Chemo will cause problems with healing, so most doctors opt to wait to avoid any further complications. My PS and MO had weekly phone calls about me and my healing status. My chemo start date was pushed so many times, I lost count!

The 12 week window, is what the medical community considers the optimal time frame to start chemo. Studies have shown it mat be less effective after that point. To leave you with a little hope, I am due to finally start chemo next Monday, which will 12 weeks and 4 days for me.

macb04 · July 2017

In addition to extra nutrition being critically important for wound healing, has the Wound Care Center thought about Hyperbaric Oxygen Therapy (HBOT)? I had HBOT at my local Wound Care Ctr to help with healing after surgery. I had alot of trouble healing from Reconstruction surgeries because of the severe Radiation Fibrosis. The HBOT was a big help for me. It seemed to be a big help for the other people who were there getting HBOT at the Wound Care Center for their own nonhealing wounds. I spoke with some of them when I was there and heard from them about their progress, when nothing else had worked for them.

Hope you get better soon.

Promote Surgery Recovery With Supplements

Surgery can be a painful and hard process to go through. Luckily, there are certain supplements that can be taken before and after the procedure to prepare your body for the intricate process of repairing itself.

Some nutritional supplements help speed wound healing while others reduce bruising, swelling, and discomfort such as pain and itch. Others are recommended to prepare your body for the intense experience and increase resilience.

Optimizing your post-surgical diet by eating healthy foods and taking supplements also improves the immune response and prevents wound infections, sepsis (blood poisoning), and other possible complications.

The following vitamins, minerals, antioxidants, and bioflavonoids are recommended to promote surgical healing:

Vitamin C

vitamin C

Vitamin C supplementation is highly recommended by experts. It helps promote healing and it is the key nutrient required for making collagen, which is what heals your tissue together.

It plays an essential role in collagen formation, a resilient immune function, and as a tissue antioxidant. Also, it is a free-radical scavenger.

Without proper amounts of vitamin C proper healing is not possible. Additional vitamin C intake before, during, and after the operation is especially recommended for those who smoke and others who may risk being deficient.

Read more about the role of vitamin C in wound healing.

"As a plastic surgeon, I put all my patients on post-operative vitamin C because you need vitamin C to heal. I also recommend it to boxers following a fight," "In fact, I'd recommend 2,000 milligrams of vitamin C to anyone with an open wound because there is evidence that it helps them heal faster." "But I do recommend it following an injury to the skin because it builds collagen, and I have long used it post-operatively in my surgical practice."

says Michael A. Fiorillo, MD, a New York City area plastic surgeon who serves as a spokesman for the AAPRP (American Association of Professional Ringside Physicians).

Zinc

zinc supplement

The next supplement and possibly one of the most important is zinc. Medical research has shown that zincsupplements can increase the speed of healing dramatically.

Zinc has reduced healing time after surgery by 43% in some cases. It plays a vital role in the immune system can reduce inflammation, bacterial growth, and scar tissue creation, whereas a deficiency can worsen the scar.

Zinc also helps to aid proper metabolism, balance blood sugar, and increase sensory perception.

Additional supplements that help you reduce post-surgery healing time

Vitamin B

Vitamin B has just recently been noticed for its benefits in the healing process. However, there is limited information on its exact benefits and function in the healing process.

Vitamin B complex is thought to speed up wound healing, increase protein synthesis and the amount of repair cells at the wound. It also prevents excessive inflammation. Vitamin B5 is particularly beneficial right after the wound occurs.

Opt for either a Vitamin B complex or a multi-nutrient that contains 25 to 50 mg of the B complex vitamins.

Vitamin A

Another important supplement is vitamin A. it is required in cell growth (especially epithelial and bone formation), which is very important in the healing process that takes place after surgery.

It is known to activate production of connective tissue, including collagen (promotes tissue synthesis), and helps new blood vessels grow , which is necessary in nourishing newly formed tissue. Vitamin A also enhances resistance to infection by stimulating the body's immune function.

Arnica

Arnica montana flowers

A very popular supplement is arnica montana. Arnica is a mountain extract that has been used for many years.

It helps reduce and clear bruising and it also speeds the healing process after surgery. Available as a cream and in capsules. One of the most popular brands of capsules is SinEcch.

Bromelain

Another well-known and popular substance is Bromelain. It is used to reduce bruising, swelling (edema), pain, and healing time. Certain claims are disputed because studies show mixed results.

Various studies however indicate that Bromelain reduces swelling, bruising, pain after surgery and physical injuries, and healing time. Bromelain is often used in conjunction with Quercetin. Quality brands that offer both in one are NOW Foods and VitaMedica.

Quercetin

Quercetin, a plant pigment naturally found in foods such as onions, is a so called bioflavonoid. It promotes histamine release in the body and thus acts like an anti-inflammatory. Usually after surgery inflammation is a common response by the body.

While it is totally normal, it can be quite uncomfortable and sometimes painful. Luckily Quercetin is known for its anti-inflammatory traits. On top of that, it is also know in speeding up the healing process. More about bromelain and quercetin.

Protein

eggs, a great protein source

Don't underestimate the benefits of protein. Protein, boosts the immune system. In the human body it breaks down into amino acids.

Adequate dietary protein is absolutely essential for proper wound healing. Especially L-Arginine and Glutamine are very important and commonly used to shorten post-surgery recovery time.

They can increase the amount of reparative collagen, help white blood cells and fight of bacterial infections. Glucosamine appears to be the rate-limiting substrate for hyaluronic acid production in the wound. (hyaluronic acid is naturally present in the human body and plays a role in injury recovery)

Probiotics

Probiotics are not only known for their specific healing benefits regarding certain surgeries but they are known to have beneficial effects in general.

Surgery patients often receive antibiotic treatment. This disrupts the gut flora and may create fungal disorders (including yeast infections), digestive problems, and diarrhea.

Probiotics can help neutralize these unwanted effects.After surgery, it's recommended to use a strain that contains acidophilus and bifida bacteria.

CoQ10

Clinical evidence demonstrates that Coenzyme Q10 is especially useful when undergoing heart surgery. Mayoclinic speaks of "promising evidence to support the use of CoQ10 before heart surgery."

A study compared patients undergoing cardiac surgery. One group was given CoQ10 supplements while the other group got a placebo during 2 weeks before the operation. The CoQ10 group showed improved healing and strengthened heart function.

Another study demonstrated that oral coenzyme Q10 therapy for 7 to 10 days preoperatively could improve clinical outcome.

Marchz · August 2017

I had a lumpectomy and reincision in April. I had a seroma that was drained and did physical therapy lymph massage and thenstarted radiation. Half way through treatment I developed what looked like a blister and is now a very deep open wound. I was able to finish radiation and now go to a wound clinic. They have tried debriding the wound and the latest debridement unveiled a part of the seroma in the wound bed. The wound clinic and surgeon say the next step is back to the OR to surgically debride the wound /seroma so it can start to heal. Sounds like it will be months .

ANyone have a radiated breast wound heal??? Discouraging but hoping better days are ahead.

I've tried to see another surgeon for an opinion and none are interested at this point of my course:path

Barbmak · August 2017

I have been dealing with an open wound since finishing my brachytherapy. Surgical wound was healing beautifully and then it opened up (seroma ) Every doctor has a different reason why it opened. Radiation/ radiation device (savi)/ methylene blue dye...at this point I don't care what did it, I just want it healed. My surgery was 6/7; finished radiation on 6/30. Seeing a certified wound specialist since 7/25. Have had debridement a few times and am on my second round of the vacuum dressing. I am working and having a hard time with the little "pump" I have to carry around in my pocket. Today surgeon said it looked better....but I've been taking pictures all along the way and I think it looks horrible...I just want it to close! It is depressing. Taking a multivitamin for 50+; Biotin; extra 500 mg of C; not sure what else I should do...any ideas?