Hormone therapy and wounds

Ask our Nurses your questions
1

Hi.
Ive had a diep flap breast reconstruction and reduction November 2024.
Long story short, one of the wounds still hasn’t healed. I also have Lupus and take the main drugs Prednisolone and Hydroxichloriquine.
3 years ago, I had a mastectomy. That healed quickly, no issues and was taking my Lupus drugs throughout. The only thing different with this operation is im now put through menopause and taking Letrozole and Clonidine.
My surgeon keeps trying to put the blame on Lupus, but I don’t think that’s the reason as outlined.
Could the poor healing have something to do with the hormone therapy and menopause?
I receive emails from BCN of topical breast cancer journeys and most of the women who have/had surgery are either younger; not menopausal/hormone therapy or older so past all of that and have successful surgeries.

Could there be a connection here?

Hope you can help.

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Hi I’m 64 and had a DIEP 18 mths ago , also on Letrozole . Wounds are slower to heal if you are on steroids . You don’t say where your wound is or how long it’s taking to heal, or what they are using on it . Feel free to private message me or show photos . Otherwise consider the following : Ask to be referred to the specialist wound team ( Tissue Viability nurse specialist) . Eat a well balanced diet with high protein ( Aldi sell high protein yoghurts etc) . Plenty of vitamin C x

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Hi.
Wound is on my breast and it hasn’t healed since 30th November 2024, so its 6 months now.
I understand about steroids, as ive been taking them for 18yrs now BUT im on less now, than when i had my mastectomy (i was taking steroids for my Lupus + steroids for chemotherapy) and my mastectomy breast healed up within 4-6weeks.
That’s why i think there’s something else going on here.
To be honest, my surgeon is exacerbated at what to do next. They use urgatol, silver nitrate and gauze now. Earlier it was iodine, a type of pump can’t remember the name, gel type dressing.
Im just also concerned that my skin around the area is very thin and vulnerable with the constant dressings and treatments etc…my Lupus started in my skin, so I have to be very careful regarding this.
I wish I could get a 2nd opinion or be referred to someone who might be able to deal with this, but the hospital don’t want you to be "stepping on someone elses shoes ’ so to speak.
I have changed my diet. We eat plenty of protein with every meal and I’ve halved all my carbs.
Just very frustrating and painful at times.

4

I’m sure you’re at your wits end with this but after 6 months I think treading on toes or not , ask to be referred to the tissue viability team …. Does the wound look infected ? Is the wound bed dark red?

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5

Its more pinky red. It bleeds at times, so the nurses say its still healthy blood flow. No infection.
Im seeing them on Tuesday, so I will ask if there is such a department at my hospital. My surgeon has never mentioned such, but then he would have to internally admitt defeat, so maybe that’s why he just keeps saying a couple of weeks more.
Just over a month ago, I had local anaesthetic surgery to sew up the wound with potential skin graft. The surgery failed and now I have visible stitches which should have dissolved. Fortunately, he didn’t do a skin graft, as that would’ve failed.
Plan for Tuesday is to get this surgical thread out and ask about a tissue viability team.

Thanks for this avenue. As I said, never heard if it.

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6

Sorry if I sound odd , I have a background in wounds ( a few years ago) , but if a wound bed is dark red , bleeds on contact and is friable and fragile , it could indicate a deep tissue infection …… this does not present as a typical infection ie hot , red smelly but fails to heal and does not always show on a wound swab , which I presume they have taken . Have you had a course of Flucloxacillin ?? Most hospitals have a tissue viability team . I hope that you get it sorted x

7

I had some antibiotics a few months ago when I got an infection. They have done 2 swabs in the past months, but nothing has comeback. I will investigate further. The staff there seem very blaze about it and just putting it down to steroids. Then again, its not them suffering with a wound.
Thanks for your help. Can’t spend summer like this as winter.

8

Yes , I think you need it to be investigated as it’s gone on so long , I’m sure it’s getting you down . Tell them you want to go on holiday and go swimming and you can’t because of this wound ! Please ask them on Tues , please let me know how you get on x

9

Funny enough, I went on holiday for my 50th in April. Was assured it would be all better by then!!

Will let you know how this pans out.

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10

I has the tiniest dot of an infection that refused to heal where they tied off on the last stitch of my lumpectomy wound. Tried antibiotics which did nothing and just made me feel ill. If its chronic- as its been months, then healing needs stimulating. Might be worth asking the TVN’s if negative pressure wound therapy is possible, as if it is, it works a treat, but is not suitable for all wounds so needs to be assessed. Failing that, IV antibiotics might be required. Getting a TVN assessment is your best bet.

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11

Dear concerned75,

Sorry to read you are feeling uncomfortable, you need to speak with your team, asking them for some clarification as to why they are blaming this on Lupus, also you are entitled to a second opinion with another consultant.

You could call the breast cancer nurses on this site, who are extremely kind and knowledgeable. I feel sure they will point you in the right direction.

Please come back and let us know how your getting on.

Wishing you well, much love Tili :rainbow::pray::rainbow::pray:

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12

Hi Concerned75,

Thank you for your post.

It sounds like a difficult time for you, and you may find it helpful to give us a call on our helpline to talk this through. The helpline team have time to listen, talk things through and signpost you to additional support and information if necessary.

Delayed wound healing can occur for people who have breast reconstruction surgery. The time it takes for the wound to heal varies for each individual and as you mentioned can depend on other factors such as pre-existing medical conditions and medications, such as prednisolone. Although you mention that this hasn’t changed, breast reconstruction has a higher risk of complications, such as slow healing than a mastectomy alone.

Hormone therapy like Letrozole or being menopausal is not known to cause poor healing.

As @edna, @tili and the others have mentioned it would be a good idea to speak to your breast nurse (if you have one) or your surgeon about your concerns. You can ask to be referred to the tissue viability team as mentioned, and you can ask for a second opinion from your GP for assessment with another team if you feel this will be of benefit for you. Do let them know how this is making you feel, so they can support you.

You may find it of benefit to speak with the team you are under for Lupus to help clarify if this could be a cause of delayed wound healing.

We offer a range of free supportive services for anyone who has had a diagnosis of breast cancer which you may be interested in. They include face to face and online courses and events.

As mentioned do call our helpline if you would like to talk this through or have any further questions. Your call will be confidential, and the number is free from UK landlines and all mobile networks.

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Best wishes

Sonia

Breast Care Nurse

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