Necrosis of the Tissue Flap

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When you have your breast reconstructed with a flap of tissue taken from another part of your body — such as your belly, buttocks, or thigh — in rare instances the tissue may not get enough blood circulation and may die. This is called "necrosis."

Signs and symptoms of tissue flap necrosis

Some symptoms of necrosis of the tissue flap include your breast skin:

  • turning blue or black
  • feeling cool to the touch
  • developing open wounds

Treatments for tissue flap necrosis

If there’s a loss of blood flow in the flap during the first few days after the initial surgery, your plastic surgeon may be able to save the flap by revising the blood vessel connections using microsurgery. Another possibility is that your surgeon might remove the flap and replace it with a flap of tissue from another part of your body or with an implant within a short timeframe. But if most or all of the flap has developed necrosis, usually your surgeon will just remove the flap and allow the area to heal. This is known as a “complete flap failure.”

If you originally had a delayed reconstruction (when the reconstruction surgery takes place some period of time after the mastectomy), you’ll lose some breast skin that was part of the transplanted flap when the flap is removed. If you had immediate reconstruction (when the mastectomy and reconstruction are done at the same time), the flap was placed beneath the existing breast skin so you’ll be less likely to lose some skin when it is removed.

A few months after the surgery to remove the flap, depending on your individual situation, you may be able to have your breast reconstructed again using a flap of tissue or an implant. If you want a flap surgery, you’ll need to work with your surgeon to identify a new donor site on your body for the tissue flap. Once you’ve already taken tissue from a particular donor site, such as the buttocks, inner thighs, or belly, it can’t be used again for reconstruction. 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. A tissue flap may be a better option if you lost a significant amount of skin and soft tissue.

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