Failed Breast Reconstruction Procedure Leads to Paralysis and Scarring

Case Overview

Questions to the Plastic Surgery expert and their responses

Do you have experience with this type of patient?

I have had experience with this type of patient.

Do you perform the procedure in question?

I do perform the procedure in question.

What alternative procedure could have been done?

There are many other options other than this surgery, such as tissue expanders and/or implants, latissimus flaps, and regional flaps.

What makes a poor candidate for this procedure?

Someone of advanced age is not an absolute contraindication for TRAM flap, and I have done this procedure for patients in their 70s. But 75 is older than anyone I have done. I would strongly recommend another procedure in this case due to the impact on the abdominal wall strength. The older patient who has a TRAM flap is at increased risk for many types of complications including DVT/PE, hernia, and UTI. If the patient had any other risk factors for wound healing, like diabetes, lupus, arterial disease, history of blood clots, etc., then I would absolutely not proceed. This would fall below the standard of care in terms of surgical judgment and patient selection.

About the expert

This highly qualified, double board certified plastic surgeon has over fifteen years of experience in the field of reconstructive surgery. He received his undergraduate degree from Brown University in Psychology, his M.B.A. from the University of North Carolina, and his medical degree from the University of Pittsburgh. He completed a residency in plastic surgery with a focus in breast reconstruction and microsurgery at Emory University, and subsequently a fellowship in surgical critical care at The Hospitals of the University of North Carolina. He is heavily published on various aspects of the plastic surgery process, from pre-operative procedures to the administration of antibiotics post-operatively for prosthetic breast reconstruction surgeries. His work appears in respected medical journals such as Breast Disease, The Annals of Plastic Surgery, and Pain Medicine. He has over 50 publications in total. He is a former Associate Professor of Plastic Surgery at the University of North Carolina Medical School, and is now the current Chief and a Current Professor of Plastic Surgery at a major medical university.