Tissue Necrosis After Flap Reconstruction Surgery

Skin flap necrosis or tissue necrosis is a rare complication of flap reconstruction surgery. Regardless of the type of flap reconstruction technique your surgeon uses, tissue can die if there isn’t enough blood or oxygen flow. But tissue necrosis is less likely to happen when surgeons use a flap that stays connected to its original blood supply (called a pedicled flap).

Sometimes surgeons use free flaps, which means the flap has to be disconnected from its original bloody supply and reconnected to a new blood supply. A DIEP flap is a type of free flap.

The signs of skin flap necrosis or tissue necrosis after flap reconstruction surgery are similar to the signs of skin necrosis after mastectomy with immediate reconstruction. Symptoms of flap necrosis tend to involve the tissue flap:

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  turning blue or black

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  feeling cool to the touch

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  developing open wounds

Look out for signs of nipple necrosis after mastectomy and breast skin necrosis. If you have any signs of skin necrosis, let your surgical team know right away so you can get treatment as soon as possible.

Although rare, some people can develop blood circulation issues in the first two days of free flap reconstruction, such as DIEP flap surgery, and need to have surgery again to try to save the flap. Your surgeon might be able to save the flap by fixing any necessary blood vessel connections with microsurgery. Depending on how much tissue necrosis there is, your surgeon might even be able to remove the flap and replace it with a flap from another part of your body or with an implant.

There are also rare cases of complete tissue rejection — also called flap failure or, if you had DIEP flap reconstruction surgery, DIEP flap failure. When there are signs of DIEP flap failure (or any type of flap failure), your surgeon must remove the entire flap. 

If you had breast reconstruction surgery with flaps at some point after mastectomy and there is complete flap failure, you are likely to lose some breast skin when the surgeon removes the flap. If you had reconstruction surgery at the same time as mastectomy surgery and there is complete flap failure, you are less likely to lose breast skin when the surgeon removes the flap because of its placement beneath the breast skin.

You usually have to wait between six months and a year for the area to heal before having breast reconstruction surgery again. To have your breast reconstructed with an implant after a complete flap failure, you need to have enough surviving skin and soft tissue to cover the implant. Reconstruction with a flap from another part of your body might be a better option if you lost a significant amount of skin and soft tissue.