I Am a 55 Yrs Old. Double Mastectomy with Radiation on Left Side.

some residual soft skin on left. Height 177cm. Weight 115kg. Had hysterectomy.do not want a flap procedure. can expansion be considered? thank you

Doctor Answers (7)

I am 55 yrs old - double mastectomy with radiation on left side

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Hello!  Thank you for your question.  After radiation, you have an increased rate of complications including wound problems, infections, thinning of the tissue, and decreased vascularity to the skin/tissue of the area.  The best method to reconstruct a breast following radiation therapy is with a flap.  The flap, which is skin, fat, and sometimes muscle, will serve to bring in healthy, well-vascularized tissue to the chest/breast area that will significantly ameliorate the radiation issues compounding the problem.  Microsurgical perforator flaps (such as the DIEP flap and SGAP/IGAP flap) are the newest and most-innovative procedures in breast reconstruction today.  As these are muscle-sparing flaps, the pain, morbidity, and complications such as those above, of these procedures are much less.  They are highly-complex procedures that few plastic surgeons performed and consult with one who is well-versed, trained, and skilled in these procedures if you are interested.  

There are many options to breast reconstruction including implant-based and flap-based procedures.  The complication rate with implants following radiation is reported as high as 60-70% in some studies.  Flap reconstruction is usually recommended, but there are several centers who perform implants following radiation with great success and results.  I typically prefer flaps, such as the DIEP flap.  Other flaps are the conventional TRAM, latissimus flap, SGAP/IGAP, and, TUG.

You are a candidate for other procedures, if you are willing to continue with your journey for a reconstructed breast.  Flaps such as those above, including others, are available.  The decision to continue with this will be your decision and what you are willing to go through.  There are risks and benefits with everything that we do in Surgery - discuss the various options with a board certified plastic surgeon who will educate you on all of the options and help you to decided if breast reconstruction or which procedure will be best for you.  Hope that this helps and best wishes!


Scottsdale Plastic Surgeon
5.0 out of 5 stars 11 reviews

Breast Reconstruction after radiation

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Radiation affects the healing potential of tissue and can therefore increase the risk of post-operative complications especially with implant-based reconstruction. That said, it is still possible to successfully perform implant-based reconstruction in the setting of radiation. A more customized plan can be made based on your consultation. I wish you luck.

Asaad H. Samra, MD
New Jersey Plastic Surgeon
5.0 out of 5 stars 23 reviews

Post-radiation expander reconstuction may work

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Radiation damages the skin and makes it less pliable and less resistant to infection.  However, not every breast is similarly affected.  If you do not want a flap, try an expander reconstruction. You may have to compromise the "perfection" or softness of the result, but you will gain in simplicity. 

Get the advice of a good surgeon whom you like.

Mark B. Constantian, MD, FACS
Nashua Plastic Surgeon
5.0 out of 5 stars 20 reviews

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Tissue expander breast reconstruction after radiation usually works.

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Hi.

We do this frequently, and with low complication rate.  The condition of your soft tissues (skin and muscle) is important, and you need to find a really experienced plastic surgeon.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Radiation and tissue expanders

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Although placing expanders after radiation can be performed. It all depends upon the quality of the tissues. You have to also understand that the risks for infection and wound complications are higher with the radiated tissue.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 16 reviews

Breast reconstruction after radiation

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I agree with Dr. Jenson, you have a higher liklihood of complications on the radiated side with expander/implant reconstruction alone. Your best bet is a latissimus flap over expander/implant. This places healthy ,well- vascularized tissue over the implant and takes some of the strain off of the radiated mastectomy skin.

All my best,

Daniel A.  Medalie, MD

Daniel A. Medalie, MD
Cleveland Plastic Surgeon
5.0 out of 5 stars 10 reviews

Radiation and breast reconstruction

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Once you've had radiation the tissues do not heal as well after surgery. With expansion there is a very high complication rate in radiated tissue, primarily infection and extrusion of the implant. Your best bet would be a lattisimus flap from the back for the irradiated side and expansion on the non-irradiated side.

Robert M. Jensen, MD
Medford Plastic Surgeon
4.5 out of 5 stars 20 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.