Implant Reconstruction gone wrong

Hi. I had a mastectomy with immediate silicone implant reconstruction on my left breast in September 2012 - fortunately no need for radiotherapy or chemotherapy. A few weeks after surgery my skin (in the area where the nipple had been) became necrotic - black and hard, and was discharging. I went back to the consultant many times, who just monitored it and kept telling me to put on dry dressings. The black skin eventually healed, except for a small hole in the middle, and has been discharging all the time. I have had to change the dressings and my bra several times a day and at night. I suspect that the skin died because it was too thin, being pulled too tight over the implant, but despite going back to the surgeon many times he has allowed this to continue. I have now developed another “hole” in the scar line under the breast, which is also discharging. I saw the cosmetic nurse this week who said she can see the implant, so it will have to be replaced, but my surgeon is away until the end of next week. The “hole” in the middle is now very large and getting larger every day, and discharging more and more, and I can clearly see the implant. I am now resigned to having to have the implant removed, having a flat breast for a while whilst it heals up, and then having a new implant inserted. I am less than happy with this, due to the fact that I will not want to be without an implant and do not want to have a flat breast, even for a short time (I would not have opted for the reconstruction if I did), and now face further surgery, pain and healing, and more time off work, just when I have got my life back on track and am feeling fit and well again. I feel that my surgeon should have spotted the signs long ago - possibly at the time that the skin became necrotic, and not allowed this to get to this stage and for me to have suffered for so many months. I am even wondering if I have a right to claim for medical negligence, and if so, how to go about this - should I wait until the treatment is complete, or start something now. I would like this surgeon to finish what he started - he is highly respected, but does not seem to have done a very good job with me. I have been very positive throughout since I was diagnosed, and never let it get me down, but this is now testing me and I am beginning to feel quite down about it.

Hello Positive-thinker

Welcome to the forums, this must be a very difficult time for you but you have come to the right place for support from our experienced users who I’m sure will be along to support you soon.

In the meantime maybe you would like to talk things through with a member of our helpline staff who are there to offer emotional support as well as practical information. The free phone number is 0808 800 6000 and the lines are open Monday to Friday 9.00 to 5.00 and Saturday 10.00 to 2.00.

Best wishes

June, moderator

Hi Positive thinker
I could have written this post myself two years ago and i can tell you , i did make a claim for clinical negligence (how far i get, is another matter)
I had tissue expander recon back in 2009/2010. My skin by the nipple area had also thinned out, so much so, that it broke through and the implant began to extrude, leaking fluid.
I only knew what was happening, when i was referred to a proper PS at a different hospital, ironically for a nipple recon!. My BS at the time, was unaware of what was happening, until the day he got me in theatre and was about to proceed with a nipple recon!
When i saw the new PS, he predicted what was about to happen, but the old BS dismissed it, saying that if it did break , he would stitch me back up and that new PS was criticising his work!
It would be interesting to know where your mx scar is PT? Mine was a huge hockey shaped scar situated on the outer rim of my chest, which was pushing against the thinned out skin and the implant (despite BS stating on the notes it was an 'oblique incision!)
The long and the short of it is, that i had to have the LD flap, as a matter of urgency, due to the need for new soft tissue and skin to replace the damaged area. I could only have the implant inserted some months later, due to infection and inflammation.
BE WARNED: Going down the medical negligence route is a long and stressful process. I instructed a solicitor to investigate nearly two years ago and i still don’t know whether i have a case to answer. Breach of duty needs to be proved before a case can proceed and it all takes an inordinate amount of time.
Begin with a letter of complaint to the hospital and take it from there. You may also wish to consider contacting PALS?
Don’t worry that your surgeon is well respected and highly regarded PT. Mine was also but this does not stop me trying to get him on failing to involved a PS in my care, not monitoring me properly, positioning an implant incorrectly, trying to do a nipple recon when there was no chance, poor symmetry on the good side (needed 3 attempts to gain symmetry) and lying on the notes!,
I hope all works out for you…
PM me if you want to get in touch.
Naz x

Hello Positive Thinker,
Poor you. I really feel for you and hope you can hang on in there.
I had an implant reconstruction which failed- my experience is very complicated: I had bilateral mastecomies 2 years after a first diagnosis of breast cancer. I had implants and strattice. My left breast had been treated by rads and I was warned that the nipple might not survive the op as the small vessels might have been damaged by the rads. It went black but miraculously seemed to heal up. About 3 months after the op. I noticed I had swelling and inflammation and kept going back for the implant (expander) to be deflated as it was so sore. By now, I was on chemo again (long story). The skin at the scar started to degrade and go black and my surgeon told me we would have to remove implant but he did not want to do this while I was on chemo. In the end, he did have to remove it, it was an emergency op. I carried dressing around with me and he told me if the tissue broke down before the op (by this point planned to co-incide with when my bloods were good) to go straight to A and E for immiediate surgery. I know my situation was different because I was on chemo but I am surprised its considered acceptable to just leave it. It must be an infection risk? I would ring BCC for some advice as I do not have any medical expertise.
I was devestated when the reconstruction failed, and I ended up having what I considered a mastectomy- ie all skin and tissue removed. I can understand your reaction. Its strange that when I read your post, I could see your reaction is completely understandable, but I gave myself such a hard time.
I wonder if your surgeon was hoping the tissue would heal-it can take a long time. For what its worth, even though I saw my surgeon pretty regularly (weekly!!) for about 2 months, it made no difference to the final outcome. I did at least know that this was what we were trying to do was save my remaining breast tissue and skin so at least when it had to be removed I knew that it was the last resort and we had tried.
This is all very long and involved. I hope it helps - a bit! At the time, I could not find anyone else who had been through this experience though I now know it does happen and is a risk.
PM me if I can be of any help or you have a specific question.
Rattles x

Hi Naz and Rattles. Thanks so much for getting in touch. It is amazing that you have both been through something similar to me, so there must be others out there. I do think that my surgeon was sending me away each time with a bag-ful of dressings, hoping that it would heal, but I kept mentioning that it did not look like a normal wound which would heal, as I normally heal fairly quickly. This just continued to ooze and stay open for months on end. At one time it did seem as though it had healed, but it became swollen and burst through again, and now the hole is very large. I am going to see the breast surgeon tomorrow, as the plastic surgeon is away on holiday and I am desperate and concerned about infection getting in. I really do feel that if something had been done sooner rather than just taking the “wait and see” tactic, it may not have been so drastic as it is now likely to be. One of you mentioned that the implant had been poorly positioned - I had never felt comfortable since I had it done, and always felt that it was pressing on my breastbone and making me feel breathless and never comfortable at night. However, in the last week since it has been discharging so much, it is now relieved and not pressing on the breastbone any more, and the implant feels less firm, so presumably something is leaking out which has relieved the pressure! I have been in touch with a medical negligence solicitor but they are not sure if it is medical negligence or not. Also, my medical insurance company have said they will not pay for a “revision”, but I have tried to explain to them that it is not a revision but a medical emergency situation, so they need a report from my surgeon to explain, but cannot guarantee they will pay. It does not seem right that I have to pay again for something that has gone wrong that perhaps could have been resolved some months ago. How are you both now? Hopefully good, and happy with your reconstructions now.

Sorry to hear of your troubles.
my recon experience has some similarities with what you’re going through. I had bilateral nipple-sparing mastectomies with strattice direct to implant recon in December 2012. Both nipples turned black but my surgeon was confident that it was just superficial scabbing and time was all they needed. The left one healed slowly but well and looked good six weeks later, but the right was definitely taking its time. The scab started coming off in late feb and it looked a bit dodgy underneath so I took myself off to hospital to be told that the implant had extruded and I was being admitted for emergency surgery to remove it. I was devastated.
The implant was removed and I was flat on that side for six weeks, then three weeks ago had another surgery to place an expander. they will slowly expand this and eventually replace it with a permanent implant in a few months time. Although it was initially very upsetting, i adapted to lopsidedness pretty quickly and the time i had to wait before getting the expander flew by.
initially I wondered if my surgeon could have identified that the scabbing on the right side was not superficial and done something sooner to avoid the stress and trauma of what actually happened but I think ( having done lots of reading and thinking about this) that once the skin has died there is nothing that can be done except hope for the best, especially with a direct to implant recon, which I think you had too? They could have removed the implant sooner but i expect they will have been hoping the necrosis was superficial - it often is and can take a long time to heal.
What does concern me though is that no one seems to be treating this like the emergency it is. when an implant is visible there is a very high infection risk and they need to get it out and get you on antibiotics ASAP. I hope your surgeon takes it seriously tomorrow and gets you admitted to hospital.
It is hellish when it’s happening, especially the stage you’re at with all the uncertainty and my heart goes out to you but you will get through it and it will be ok! At the time it felt like my worst nightmare coming true but i surprised myself in coping with it really well and just getting on with my life and trusting my surgeons to put me right again. And they are and I will hopefully have a matching pair again come September.
all the best

I saw my BS on Tuesday and he thought that the implant has gone so badly wrong that it has to come out, so I am going in for surgery with my PS tomorrow (as soon as he returns from his holiday) to remove the implant. I will have to wait a few weeks or months for it to heal up, but I am undecided about what to do next - do I just leave it flat (probably not as I like to have some sort of cleavage and could not be bothered with prothesis etc). However, I am unsure whether to try another implant, or whether to have something more drastic such as a DIEP. I would like to hear from anyone who has had to have an implant removed, and what they decided to do next. I am a private patient but my insurance company will not pay for any “revision” as they call it, so whatever I decide to do I will have to pay for it, which could affect my decision somewhat, depending on the cost of the various procedures.

Hi Positive thinker
I had problems with my LD flap and had it removed I then went through the DIEP route and have posted a few threads

Diep date 27th June -encouragement needed please

I have had some lovely comments from some great ladies and this helped me so much especially with my final phase to have the DIEP, I now have a nipple and am going to have it tattooed in July.
My breast was oozing etc whilst I had the implant and at time I thought I was on my last legs, in the end I think I had blood poisoning!! my fault I think because I always said I felt fine etc until I could take no more pain
It is a hard place to be but I think I appreciate what I have
If you want to PM me that’s fine