I derive a great deal of information from the surgeons and patient members of the Journey Facebook group. The questions they ask are pertinent to the healing process as well as various aspects and the decision to have breast reconstruction. When I have an opportunity to visit our physician members, I schedule time to do videos to answer questions patient members are asking. Knowing how demanding the schedule of plastic surgeons can be, I am honored once again to sit with Dr. Minas Chrysopoulo of PRMA in San Antonio at the end of his long clinic day to talk about the topic of breast reconstruction wounds and management, dedication I am grateful for. Thanks Dr. C!
Medical Comorbidities to Consider
We begin our discussion with a patient inquiry about a medical comorbidity (condition) called Factor V Leiden. Dr. C clarifies this is a clotting problem not a wound healing issue. In microsurgical procedures such as DIEP flap breast reconstruction the plastic surgeon transfers tissue from one part of the body transplanting it to the chest connecting blood vessels at the anastomosis. When a patient presents with Factor V Leiden, increasing a patient’s risk of blood clots forming, it has the potential of flap failure if a blood clot occurs after it is transferred. It is important for patients to report this medical comorbidity at the time of their breast reconstruction consult. At PRMA the microsurgeons take measures to decrease the risk of flap failure in a patient with Factor V Leiden by giving them blood thinners.
Factors Increasing the Potential of Wound Healing in Breast Reconstruction
Dr. C names three factors often considered to be some of the biggest factors in wound healing and management. They are:
- Diabetes
- Not having a favorable BMI (Body Mass Index)
- Smoking
He points out the most difficult trifecta in breast reconstruction wound management is a smoker who is overweight and diabetic. However, another factor not always considered is the nutrition of the patient who may not have any other of the above listed comorbidities. Dr. C points out it is important to recognize the nutritional status of the patient. I like his comment, “Nutrition has to be really tuned up before and after major surgery.”
The risk of wound healing is always a risk in surgery, no matter the health of the patient. Even patients with optimal health and no medical comorbidities can develop wounds that will need to be managed after surgery. Wounds generally occur in the first couple of weeks of the healing process but can happen beyond that time. This might include a superficial suture a patient isn’t tolerating well. Patients with prior radiation who have implant-based reconstruction have a potential of latent wound issues.
A Personal Note from a Patient Advocate on Wounds
There are some thoughtful smiles from both Dr. C and I in the video when I use the word “risk analysis”. Let me explain. I speak to thousands of women and men through social media about wounds and wound management. Not all wounds are created equal nor are patients’ perspective of what a critical wound and manageable wound are. Patients who are healing from surgery don’t like to see any hiccups in their recovery. I mention, “A small wound might be perceived as a large wound to a patient.” As a surgeon, Dr. C knew exactly what I was talking about when he smiles and responds with, “Perception is everything.”
I don’t allow photos of wound healing on my closed Facebook group site. Why? I simply feel these photos should be shared with their plastic surgeons’ office via email or in person to make the best assessment of care. It is part of the responsibility I assume and accept as a patient advocate when carefully monitoring my Facebook page.
This is a topic I believe should be discussed at your initial plastic surgery consult so you are aware of how wound healing and management will be handle if it occurs after your breast reconstruction surgery. Many patients travel to find their “just right” plastic surgeon. Under these circumstances, I encourage them to find a wound care center in the area they live in. Put this in place before surgery. Hopefully it will not be needed but planning ahead will make breast reconstruction wounds and management easier when you return home from your surgery.