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Mastectomy with Tissue Expander
Questions about Mastectomy with Tissue Expander.
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AskedPublicly Submitted Question
7/7/2011I will be calling to get an appointment from your plastic surgeon expert. I am now 9 months post modified radical mastectomy, chemo and radiation (May). The first plastic surgery left my thoracic nerve entrapped and "on" in constant muscle spasm, lymphatic cord entrapped, and excessive? scar tissue formation. The saline implants and reconstruction had to be re-done 5 months post op. The pain was 24/7.
I am now 4 months post the second reconstruction by a very respected plastic surgeon at a teaching facility which corrected the lymphatic cord issue. A one-step gel implant was placed but I am still in constant pain. RSD was ruled out (only have one criterion). My surgeon states I am progressing "right on schedule" but physically compared to nurses who have had the same reconstruction...by implant site has not changed, the pain is still 24/7. No practitioner has any "clue" as to what went wrong, or what is wrong, or how to fix. Removal of the implant may not improve the pain at all...I do not want to risk additional scar tissue formation from a third surgery. Has Dendrimer drugs to prevent excessive scar tissue formation been used at JHU???
Am I truly the only woman in medical history that has this issue?? Thank you for your help and service to the "unheard" nurse/patient.

RepliedJHU's Breast Center Reply
7/8/2011This is a very complicated question. Without examination we cannot account for why you are in constant pain. We do not think comparing your progress to the other nurse with implant surgery is a fair comparison because everyone reacts differently to radiation therapy and to implants ( which are a foreign body). Often, approximately 60% of patients with implants following radiation have this exact reaction ( increased scar tissue formation, tightness, lifting of the implant, and pain, also known as capsular contracture). The constant pain, especially with trapping of the thoracic nerve, sounds like it is neuropathic pain from the combination of the radiation therapy, mastectomy, and nerve entrapment. We would recommend you see a pain specialist if you have not already done so. We do not use Dendrimer drugs to prevent excessive scar tissue formation, and unfortunately your scar tissue has already formed. We have had some success with using a lastissmus dorsi flap ( back, skin, and muscle) to replace a woman's own breast skin and then placing the implant underneath this. By removing the radiated breast skin and nerves, the pain can often be decreased, but it is not guaranteed. Additionally, there is some success using fat grafting to the chest wall. The theory is the fat DNA is healthy DNA which has not undergone radiation, and then can grow normal tissue. Again this is not a guaranteed. A final option would be to sever the thoracic nerve, but this has implications in itself, and again is not guaranteed success. Hope this helps. Best wishes!

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