Reconstruction Do-Overs

Breast reconstructions may need to be redone years later.

Carpenter says redos that involve scar tissue from surgery or capsular contracture present some significant challenges. Radiated tissue presents another set of problems because these patients generally don’t have implants, he says, meaning they have some sort of flap reconstruction and may need another flap in the redo. 

New “free flap” procedures, meaning the tissue is completely detached from the blood supply from the stomach, hip, or buttocks and then reconnected with microsurgery, have provided surgeons additional options, but they take a very experienced surgeon because of the complexity of reattaching tiny blood vessels, Canady says.

For example, the deep inferior epigastric perforator (DIEP) free flap spares the abdominal muscles, taking only skin, fat, and blood vessels from the abdominal area. These new techniques “are thrilling,” says Canady, but the issue will be whether the insurance companies will fairly reimburse a 10- or 12-hour reconstruction. Again, Canady says to shop for the right plastic surgeon and not to feel you are getting something less if it’s not a multiple-hour microsurgery.

My second surgery gave me back the nice replica, but some infection issues delayed really enjoying them. It leaves me repeating my favorite mantra when it comes to breast reconstruction: It’s a lot harder to put it back on than it is to take it off.  

—Lacey Meyer contributed research to this article.

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