This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question. Question: I have been undergoing reconstruction with implants for the last couple of years. My last surgery was January 26, 2015. I have a z-plasty across the breast under the nipple reconstruction scar, not very aesthetically pleasing. Also left with a left small B, right D and pain when I sneeze in the right implant rib cage area. The small B is fine with me. One other issue that has come up is the outbreak of skin blistering which my doctor cannot account for and is ongoing. My question is how do you determine when a patient should have a flap procedure to rebuild a breast given previous medical history? Answer: I’m sorry you are having problems with your reconstruction. The issue of when to abandon implant reconstruction and pursue natural tissue reconstruction is sometimes very straightforward (for instance, if you put a tissue expander in a radiated mastectomy wound, and it falls out during expansion), and sometimes less obvious. Although the majority of non-radiated patients reconstructed with implants do well, a significant minority have problems, some such as you have described, and ultimately pursue reconstruction with their own tissue. The decision is often not just a straightforward medical one, but often is very dependent on what your specific goals are for your reconstructed breasts. We would be happy to talk with you more about the specifics of your specific situation, if you wish. Thanks for your inquiry.
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