In case of hematoma formation, operative
exploration of the surgical site and evacuation of
the hematoma are required. To maximize sterility and
minimize potential injury to the expander or implant,
evacuation of the fluid is performed in an operating
If infection occurs, the entire expander or
implant must be removed and the implant pocket
drained. A Jackson-Pratt no. 10 fully perforated
drain is used. The drain is placed into the implant
pocket once the expander/implant is removed and
remains in position until the output is less than 30
cc during a 24-hour period. Perioperative,
broad-spectrum antibiotics are given preoperatively
to the patient and continued until all inflammation
has subsided. Prior to surgery, cefazolin is given
intravenously, followed by oral doses of cephalexin
for ten days. The selection of antibiotics may change
based upon cultures obtained during implant removal.
Following a six month interval, reconstruction using
the expander/implant technique can again be
The fibrous capsule surrounding the implant can
contract to such a degree that may result in
deformity of the shape of the breast mound as well as
pain. In symptomatic patients, the only option is to
perform a capsulectomy (removal of the implant
capsule) and replace the implant.
TRAM FLAP COMPLICATIONS
Hematoma formation requires immediate operative
evacuation and exploration of the surgical sites to
control any ongoing bleeding. The procedure is
performed in an operating room to maximize sterility
and minimize risk of infection.
- Wound Healing Difficulties
Wound healing difficulties are most commonly the
result of necrosis of the mastectomy flap edges
and/or the abdominal wound closure edges. If tissues
appear necrotic the patient is immediately brought to
the operating room, the necrotic portions excised,
and the wound re-closed. It is vital that the tissue
is removed promptly in order to avoid bacterial
colonization or infection.
Poor perfusion can lead to loss of the umbilicus.
If the umbilicus becomes necrotic, the tissue is
excised and the abdominal wall is closed. Again,
excision of the necrotic tissue is performed
immediately to avoid bacterial colonization or
infection. Reconstruction of the umbilicus can be
attempted after six months.
Abdominal wall laxity may occur in the area from
which the rectus abdominus has been harvested.
Treatment requires repair of the abdominal wall
laxity using marlex mesh.
- Partial/Complete Flap Loss
Partial flap loss is rare. Should it occur,
excision of necrotic portions is required, followed
by wound closure.
Complete flap loss is very rare and typically
occurs during elevation. If the flap is not viable,
it is discarded. The abdominal incision is closed
using the method described in the TRAM donor site
closure section, whereas the mastectomy wound is
closed without reconstruction. Reconstructive
alternatives are then discussed with the patient
after recovery from surgery.
© 1997 - TRANSMED