Q: I recently had a double mastectomy and immediately had reconstruction. This followed by two more surgeries to remove the expander on one side. I developed a massive infection. I received three different antibiotics and a unit of blood. My hgb dropped to 6. I still have one expander in with no problems. I need to decide whether to have that expander removed or not. Can you advise me on what to do? Thanks!

A: Hi, I'm sorry you are having a rough time with your reconstruction. We primarily reconstruct patients using only their own natural tissue. Usually this comes from the abdomen (DIEP flap), but can come from the buttock (sGAP flap) or posterior thigh (PAP flap). We have successfully reconstructed many, many patients with their own tissue who initially experienced problems such as you describe. Fortunately, your own tissue is much less likely to get infected than an implant (or expander), and leaves you with a far more natural-feeling result. If you decide to have a DIEP flap, it may be best to have the other expander removed first, as we usually obtain an MRI angiogram prior to surgery, and most expanders are not MRI-compatible. If you wish, I would be very happy to chat with you about your situation by phone. Just let us know how we can help. Richard M. Kline, Jr., MD