Failed Breast Reconstruction Procedure Leads to Paralysis and Scarring

This case takes place in Tennessee and involves a 71-year-old female patient who experienced complications following a TRAM flap procedure. The patient, who is obese and previously had a mastectomy, consulted with the defending doctor for new breast reconstruction. The surgeon immediately opted for the TRAM flap procedure. It was performed with complications; the patient lost use of her right arm, has issues breathing and suffered tremendous scarring. The plaintiff filed suit and hired a plastic surgery expert witness to review the records to determine if the surgery was contraindicated due to the fact that she was greater than 70 years old and she had artery disease.

Question(s) For Expert Witness

1. Do you have experience with this type of patient?

2. Do you perform the procedure in question?

3. What alternative procedure could have been done?

4. What makes a poor candidate for this procedure?

Expert Witness Response E-008659

I have had experience with this type of patient and do perform the procedure in question. There are many other options other than this surgery, such as tissue expanders and/or implants, latissimus flaps, and regional flaps. Someone of advanced age is not an absolute contraindication for TRAM flap, and I have done this procedure for patients in their 70s. But 75 is older than anyone I have done. I would strongly recommend another procedure in this case due to the impact on the abdominal wall strength. The older patient who has a TRAM flap is at increased risk for many types of complications including DVT/PE, hernia, and UTI. If the patient had any other risk factors for wound healing, like diabetes, lupus, arterial disease, history of blood clots, etc., then I would absolutely not proceed. This would fall below the standard of care in terms of surgical judgment and patient selection.