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Over the Muscle Implant Placement After Radiation Therapy?

I have had a bilateral mastectomy. I have under the muscle silicone implants. I had radiation treatment on the right breast and the implant is uncomfortable when using my arm and my muscle is very tight. Is it best to have my implants placed over the muscle? I had gone through the expander process before the implants.

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17 Doctor Answers | Asked by Jenny41 in canada

Doctor Answers (17)
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Radiation and implants

I recommend not placing implants under any tissue that is radiated. There is a higher chance of implant contracture, infection and poor wound healing overall. As has been mentioned in other posts, I would consider using your own tissue from a site that is not been radiated to reconstruct your breast. An example would be a DIEP flap.

Breast reconstruction and radiation

In general, there is a higher chance of scar tissue forming around breast implants following radiation therapy. Other techniques for reconstruction (flaps) may be helpful. Tissue from the abdomen (diep flap), thigh (tug flap), buttocks (sgap), or back (latissimus or tap flap) may be used to reconstruct the breast.

Implants After Radiation...

When radiation is used in the treatment of breast cancer, non-cancerous tissues in the path of the radiation are also affected. Radiation therapy can mean a significant loss of skin elasticity, which can profoundly affect the aesthetic results of breast reconstruction. And because the body’s wound-healing mechanisms are altered by exposure to radiation, complications from all types of reconstructive breast surgery occur at a higher rate. Radiation is especially problematic for... more

Tightness of implants

After radiation you may have sustained a tight capsule. You may need alternative reconstruction to keep the implant protected and soften the pocket.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Breast implant suggestions

Hello, You might be better served by taking the implants out. The tissues around the implants frequently respond to radiation therapy by becoming very prone to scar formation (encapsulation) and this can be painful. Implant removal (although not pretty) usually relieves this pain. An alternative reconstruction can be planned using your own tissues. These are still a bit more problematic after radiation therapy but are more likely to be successful.

Your own tissues or new pocket reconstruction

Radiation increases the chance of having capsule contracture and a tight deformed breast. The classic teaching is to switch from an implant to an autologous reconstruction (your own tissues from the back or the tummy). However, practically this is not always feasible or practical. Another option would be to perfrom a total capsulectomy (removal of all the internal scars), exchange the implant and use alloderm to create a new pocket. A muscle flap from the back could be used as well if... more

Implants should stay under the muscle following radiation

Dear Jenny: It appears that what you are experiencing is something called a capsular contracture. This is a condition in which the scar tissue, that normally forms around a breast implant, becomes hard causing pain or possibly distortion of the breast. Attempting to change the location of the implant will increse the possibility of wound breakdown leading to infection and possibly implant extrusion, which will result in the need for implant removal. If the condition is not tolerable or... more

Post radiation implant switch from unders to overs?

I would strongly advise that you refrain from changing the position of your implants. You will be at an exceptionally high rate of capsular contracture, visibility and infection or wound breakdown

Otto Joseph Placik, MD

32 reviews

Chicago Plastic Surgeon

Not an option

Jenny from Canada, Implant placement above the muscle is not an option in breast reconstruction with or without radiation. The symptoms that you describe are an unfortunate side effect of radiation therapy. A discussion with your board certified plastic surgeon will shed some light on the options to ease your discomfort. Good luck!

In breast reconstruction the implants must go under the muscle

In breast reconstructions, especially with radiation, the implants must go under the muscle. You need to have adequate soft tissue coverage to protect the implant. Breast reconstruction is completely different than cosmetic breast augmentation. Additionally, radiation significantly affects the quality of the tissue covering the implants.

Over the muscle placement would make things worse

The failure rate for implant reconstruction in a radiated breast is at least 50%. Hopefully, this was discussed with you during your course of treatment. Changing the pocket for the implant, above the muscle will increase the contracture rate and others as well. Conversion to a natural tissue reconstruction may be the best option if a capsolotomy/capsulectomy (procedures to loosen up the capsule) is attempted and fails.

Options for submuscular contracture after radiation...

Unfortunately it is not uncommon for tightening and discomfort to occur with implant reconstruction after mastectomy but even more so with radiation therapy. Statistics show that this problem is even more severe with implants over the muscle. If your problem is severe and disabling you shuold see your plastic surgeon and possibly discuss a latissimus flap to effectively "expand" the surface area of the muscle coverage. If your skin is tight as well, the latissimus can also be used... more

Robin T.W. Yuan, MD

4 reviews

Beverly Hills Plastic Surgeon

Never above the muscle

Never in breast reconstruction should the implants be placed above the muscle. A patient who has been radiated will virtually always have problems with implant reconstructions especially from capsular contracture. Replacing the implant wont' help even if you stay below the muscle. You need to go to a seasoned plastic surgeon who can do microsurgery and discuss options in your case for replacing the implant with a reconstruction using your own tissue. This is the best way to go after... more

Putting the implants over the muscle is ABSOLUTELY not an option.

Hi! You are in a difficult situation which is not uncommon. But I am afraid you only have 3 choices: 1) Tolerate the discomfort. It may get better. 2) Have the implants removed and abandon reconstruction. I don't recommend this. 3) Have the implants removed and get reconstruction with your own tissues, preferably from the abdomen.

My strong opinion on this is...

First, I admit that my bias is strongly toward under the muscle for implants. That said, you have had a mastectomy, and there is NO breast tissue to cover the implant. I would estimate that if you could find someone to put the implant under the SKIN, you would have ~100% chance of a complication. In your curent situation, you are likely experiencing a contracture. You will always be at some increased risk for contracture due to the radiation and mastectomy. As I see it, you have... more

Leave them where they are.

Radiation damages skin. You need the muscle between the implant and your skin. Do not move the implants, you will endanger the result and may not be able to ratain the implant. The discomfort usually gets better over time.

Radiation therapy can increase your chance of capsular contracture

It sounds like you may be having some problems due to the fact that you had radiation therapy. Radiation therapy can lead to fibrosis of the tissue (muscle, skin) which can make the tissues feel stiff and tight. It can also increase the chance that capsular contracture develops around a breast implant. I would suggest that you talk to your plastic surgeon and discuss the options. A capsulectomy (removal of the scar tissue around the implant) and replacement with a textured implant may be... more