What happened, in summary

A young woman had previously been treated for a 9 mm, grade 1 hormone receptor-positive invasive ductal carcinoma in the right breast. Treatment included breast-conserving surgery and 6 weeks of radiation. She could not tolerate adjuvant hormone therapy.

Five years later, a new 6 mm grade 1 hormone receptor-positive invasive ductal carcinoma was found in the left breast. She chose bilateral skin-sparing mastectomies with immediate implant reconstruction.

The left-breast wound did not heal normally. Six weeks after surgery, tissue at the T-shaped meeting point of the incisions had died, and the implant mesh became exposed. She had resumed smoking during recovery, which likely increased the risk of poor healing. Simple removal of unhealthy tissue and direct closure were not considered sufficient.

Surgeons created a Limberg flap by moving a diamond-shaped section of skin and tissue from the upper abdomen into the defect. This allowed the implant to remain in place. Negative-pressure wound therapy was applied over the repair. The drain and first dressing were removed on day 5, and the flap was healing well. A second dressing was removed on day 12.

She stopped smoking, and the wound was fully healed by 2 months. She later continued tamoxifen and routine cancer follow-up. The successful reconstruction allowed the implant to remain in place while she continued cancer follow-up.

Preserving the implant avoided another major reconstructive procedure. Smoking cessation and close wound review were important parts of the successful healing process. Tamoxifen and routine follow-up continued after wound recovery.