Pseudobursa after breast reconstruction and TRAM/DIEP
Dear Dr Repta- You seem to be the only doctor on the net who understands the pseudobursa problem and how to fix it.I had a removal of implants and a pedicle tram flap in July, 2015. (DIEP flap was not done because circulatory system compromised in chest from mantle radiation 30 yrs ago). My umbilicus never completely healed; it always seemed to be “leaking”. In Dec of 2015 infection happened, sent me to the hospital,i was on IV antibiotics for 3 weeks. A large horizontal seroma all along the incision scar was drained. It is now Feb, and belly button is still “leaking” and not healed. The other problem is right below belly button, slightly to the right, above horizontal scar, the large seroma that was seen in hospital ultrasound is now hard and extremely painful. There is a definite ugly bulge and i feel like i’m 5 months pregnant. It sounds like a pseudobursa. My question is: can this be surgically removed even though this isn’t from a tummy tuck but a pedicle tram flap that involved tunneling the muscle/blood vessels up to my chest and putting in mesh? I’m so tired of feeling sick. I would really appreciate your thoughts. Thank you!
A: Hello Anonymous,
I am sorry to hear about your breast reconstruction healing issues following TRAM flap. From what you have described it does sound like you have a pseudobursa. There are many factors that may have contributed to this but I suspect that a combination of permanent sutures and the mesh are either part of the cause or at least involved in the pseudobursa formation. Although I do not have all of the details of your history and physical exam I cannot imagine what full correction would not be possible. Full and complete correction would likely involve revision of the “tummy tuck” portion of the TRAM flap procedure where the abdominal soft tissue is elevated and the pseudo-bursa removed. Additional contouring of the abdomen at that time may also be possible. Depending on the insurance that you have, I may be able to have this covered under your insurance as part of complications related to your breast reconstruction TRAM flap procedure. Feel free to contact my office, 855 Dr Repta (377 3782) or via Scottsdaletummytuck.com to arrange a phone consultation with photos. We could then go from there.
All the best,
Dr. Remus Repta