Failed "Flap” Breast Reconstruction: What Are Your Options
By: Dr. Minas Chrysopoulo
At PRMA Plastic Surgery, we believe the DIEP flap is today’s gold standard in breast reconstruction. There are also other great autologous (tissue) flap options available today giving patients options to use their own tissue to reconstruct a warm, soft, “natural” breast. The most advanced flap procedures involve microsurgery– this means the tissue is disconnected from one part of the patient’s body and transplanted to the chest to create the new breast.
Due to the expertise required to perform these procedures with a high success rate, it is important to make sure your surgeon is board-certified by the American Board of Plastic Surgery and has extensive experience in microsurgery. The most successful microsurgical practices performing surgeries like the DIEP flap boast success rates of 99% or higher.
All surgery has risks and unfortunately, for some patients things will not go according to plan. This can happen to anyone, even in the hands of the best doctors.
What problems can women experience specifically after “flap” breast reconstruction that can impact the final results?
In about 10-15% of flap cases, some of the fat in the flap can turn hard and cause “lumps”. This is known as fat necrosis. Usually the areas involved are small and nothing needs to be done. Large areas of fat necrosis can cause a contour deformity and even pain. If conservative treatment fails, large areas of fat necrosis can be broken up, shaved down or removed depending the size of the area involved.
Problems Due to Radiation Therapy
Despite tolerating radiation much better than implants, flaps are also impacted by radiation. Radiation after a flap breast reconstruction can cause the reconstructed breast to shrink and become firmer. Unfortunately, this is a common scenario (in varying degrees of severity) and sometimes creates significant breast asymmetry. Patients facing radiation after flap breast reconstruction should know that there is a significant risk of needing further reconstructive surgery to correct changes and symmetry issues caused or exaggerated by the radiation therapy. Fat grafting can be a good option to “plump up” the breast after radiation, improve contour defects, and in some cases even help reverse some of the radiation changes and soften the breast.
Radiation before flap breast reconstruction can also cause breast symmetry issues. Many patients who have had “delayed reconstruction” (after the breast cancer treatment has been completed) often complain that the reconstructed breast is too flat and lacks shape. Recontouring the existing reconstruction along with fat grafting can help reshape the breast and add more projection to create a more cosmetic breast appearance.
No two breasts are alike, so slight differences between the two breasts will always exist. However, severe breast asymmetry can make finding well-fitting bras almost impossible and dramatically reduce quality of life if not corrected. As mentioned above, reconstructed breasts can be revised in a variety of ways to improve symmetry. A procedure on the other breast (eg lift, reduction) may also be needed to achieve the best overall results.
Donor Site Problems
The term “donor site” refers to the location the flap was removed from before being transferred to the chest to reconstruct the breast. For example, the DIEP flap donor site is the lower abdomen. Removing tissue from another part of the body creates additional scarring which most patients consider an acceptable trade-off for a “natural” breast reconstruction. Donor site complications include wound healing problems, ugly scarring, and in the case of the abdomen, bulging or even a hernia.
Partial or Complete Flap Failure
Unfortunately, flap reconstruction also comes with a very small risk of part or all of the flap dying due to an inadequate blood supply. Thankfully, in very experienced hands this is a rare event. When this does occur, the affected tissue has to be removed which can be devastating for the patient. In the vast majority of cases, further reconstructive surgery is an option.
What can be done?
Breast reconstruction is usually performed in stages and most patients need a revision surgery for “fine tuning” to achieve the best results. In some cases, more than one revision is required. Previous radiation or complications during the initial reconstruction increase the likelihood of needing more than one revision surgery for the best cosmetic results and symmetry. The extent of the revision procedure required depends on the severity of the deformity and can include fat grafting, breast reshaping, scar revision, recontouring of the donor site, or even further reconstructive procedures.
If you have experienced an unsatisfactory result after breast reconstruction, PRMA is here to help. Learn more about your options by filling out our free virtual consultation form today!