Tissue Expanders

I didn't have infection after reconstruction but I was put on antibiotic for 20 days form the day of the surgery and forward to prevent any infection from settling in. Since with chemo I landed twice in hospotal for long stays because of infection, that was judged to be the best prevention possible. Also, a year later, when I finished second chemo tx i had the nipple graff that caused an infection. Again received 20 days (two full course) of antibiotic to fend it off and prevent implant from being infected. Now, 3 months later, I don't have an infection and didn't have to get my implant removed. I didn't have an infection but I am concerned because I see this is an unanswered question. I'm afraid I have more questions than answers.

Are you on antibiotics for an infection? Does it look like there is an infection.... are you running a fever?

The thing with those expanders is they can be uncomfortable (particularly as they get "overfilled"). Mine appeared to have a weird shape.

How long ago did you have the surgery and what is your surgeon saying?

More questions than answers but I think I wanted to let you know I am listening.

AnneMarie

Infections can occur following any type of surgery. The risk of getting an infection after breast reconstruction is low because the immune system can help defend the body from bacteria if they have invaded and are trying to multiply. Antibiotics can also be used to specifically fight different types of bacteria following certain surgical procedures and are sometimes given preventively. When an infection does occur it is because the defense mechanisms have been compromised and the invading bacteria grow. Specifically with implants the bacteria may enter through a wound healing problem. They attach to the implant shell and hide from the bloodstream that normally delivers the body’s immune response as well as antibiotics.

The management of this type of infection is difficult and almost always requires removing the implant. When the infection resolves and the area is healthy then it is possible to restart the process. Usually it is 3 to 6 months before it is safe to try another implant. It is occasionally possible to save the implant when the infection has been caught early and treated with antibiotics and surgery to wash the implant pocket and to put a new one in. This approach usually involves antibiotics for a long time and uncertainty about recurrence of the infection weeks or months later when the powerful antibiotics have been discontinued. It is important to realize that the antibiotics may resolve the outward signs of infection at first but it only takes the surviving bacteria hiding on the implant to restart the infection when the antibiotics have been discontinued. With each new infection the bacteria may become more difficult to control because of resistance to the antibiotics. At this point it is usually my advice to consider a new option for breast reconstruction that does not involve an implant. Usually the skin and fat can be transferred from the tummy, buttock or thighs. This can be done without sacrificing any of the important muscles. In my practice 30 % of my patients have had problems with implants and we a can successfully replace implant problems with healthy tissue and obtain a permanent natural result.

James E. Craigie, M.D. Infections can occur following any type of surgery. The risk of getting an infection after breast reconstruction is low because the immune system can help defend the body from bacteria if they have invaded and are trying to multiply. Antibiotics can also be used to specifically fight different types of bacteria following certain surgical procedures and are sometimes given preventively. When an infection does occur it is because the defense mechanisms have been compromised and the invading bacteria grow. Specifically with implants the bacteria may enter through a wound healing problem. They attach to the implant shell and hide from the bloodstream that normally delivers the body’s immune response as well as antibiotics.

The management of this type of infection is difficult and almost always requires removing the implant. When the infection resolves and the area is healthy then it is possible to restart the process. Usually it is 3 to 6 months before it is safe to try another implant. It is occasionally possible to save the implant when the infection has been caught early and treated with antibiotics and surgery to wash the implant pocket and to put a new one in. This approach usually involves antibiotics for a long time and uncertainty about recurrence of the infection weeks or months later when the powerful antibiotics have been discontinued. It is important to realize that the antibiotics may resolve the outward signs of infection at first but it only takes the surviving bacteria hiding on the implant to restart the infection when the antibiotics have been discontinued. With each new infection the bacteria may become more difficult to control because of resistance to the antibiotics. At this point it is usually my advice to consider a new option for breast reconstruction that does not involve an implant. Usually the skin and fat can be transferred from the tummy, buttock or thighs. This can be done without sacrificing any of the important muscles. In my practice 30 % of my patients have had problems with implants and we a can successfully replace implant problems with healthy tissue and obtain a permanent natural result.

James E. Craigie, M.D.

Hello! I am 2 years now with implants following tissue expanders. At first after surgery, I wore a bra all the time (even to sleep) not because I needed the support but because it was more out of habit. I stopped wearing one, though, not long after my implant surgery and have not missed wearing one. Then you get into the discussion (if you have not had nipple conserving surgery) about nipple reconstruction because some people decide they don't want the trouble of dealing with 'headlight's which negates the - I don't have to wear a bra now!' positive aspect of no bra liberty. But we can save that discussion for another QA! Best wishes to you and congrats on being out of those uncomfortable expanders! Hello! I am 2 years now with implants following tissue expanders. At first after surgery, I wore a bra all the time (even to sleep) not because I needed the support but because it was more out of habit. I stopped wearing one, though, not long after my implant surgery and have not missed wearing one. Then you get into the discussion (if you have not had nipple conserving surgery) about nipple reconstruction because some people decide they don't want the trouble of dealing with 'headlight's which negates the - I don't have to wear a bra now!' positive aspect of no bra liberty. But we can save that discussion for another QA! Best wishes to you and congrats on being out of those uncomfortable expanders!

It takes time to get used to the reconstruction. I had bilateral mastectomies with saline implants 3 years ago. It's only now that I can lay on my stomach with little discomfort. It takes time to get used to the reconstruction. I had bilateral mastectomies with saline implants 3 years ago. It's only now that I can lay on my stomach with little discomfort.

Yes to both parts. While the criteria for post-mastectomy radiation is evolving, it is often offered for tumors greater than or equal to 5 cm, positive or close margins, skin involvement, and involved lymph nodes. Historically, 4 or more lymph nodes positive were the indication with regard to lymph node positivity, however, recent studies have shown a benefit to post-mastectomy radiation even in patients with 1 to 3 lymph nodes positive, especially in pre-menopausal women. Also, if patients received pre-mastectomy chemotherapy, depending on their initial disease, post-mastectomy radiation may be indicated.
We often deliver radiation with expanders in place, however, we require the expansion to be complete or not changed from the time the radiation is planned until after the treatment is completed. Yes to both parts. While the criteria for post-mastectomy radiation is evolving, it is often offered for tumors greater than or equal to 5 cm, positive or close margins, skin involvement, and involved lymph nodes. Historically, 4 or more lymph nodes positive were the indication with regard to lymph node positivity, however, recent studies have shown a benefit to post-mastectomy radiation even in patients with 1 to 3 lymph nodes positive, especially in pre-menopausal women. Also, if patients received pre-mastectomy chemotherapy, depending on their initial disease, post-mastectomy radiation may be indicated.
We often deliver radiation with expanders in place, however, we require the expansion to be complete or not changed from the time the radiation is planned until after the treatment is completed.