Is it possible to have Breast reconstruction after a lumpectomy and radiation?
Breast Reconstruction After Lumpectomy and Radiation?
Doctor Answers (14)
Breast reconstruction after lumpectomy and radiation.
Just to add to what has already been said. My algorithm for tackling a lumpectomy defect is to ask if you are happy with the volume of breast that you are left with or not.
If you are happy with the volume of breast that you have left, you may need to have the breast reshaped which can often be done in the form of an uplift. You may need a balancing uplift/reduction on the other side.
If you are not happy with the volume, then you need to have volume added. This can either be in the form of fat transfer or a latissimus dorsi flap.
Yes breast reconstruction is possible after lumpectomy & radiation
Yes, it is possible to have breast reconstruction after lumpectomy and radiation. However, it tends to have a higher rate of complications due to the compromised blood supply and wound healing. This is especially true when reconstruction is acheived with implants. It is more likely that you will benefit from the use of vascualrized tissue in breast reconstruction.
Absolutely Possible. See the Plastic Surgeon before the tumor surgery.
There are many things that can be done to reconstruct a breast after lumpectomy and radiation. Options include use of a small implant, use of a small local flap, a mastopexy (uplift) type operation to reshape the breast and standard, more invasive types of procedures. No matter what is done, the best plan is to see a Plastic Surgeon before the initial procedure. He/she can work with the general surgeon and plan the procedure so that a minimal defect will be left. In people with a reasonable sized breast, this may involve using a reduction incision and removing the tumor as one would remove the tissue in a breast reduction, thus resulting in a normal appearing breast that was easier to obtain than after an initial procedure with an incision in an inconvenient location.
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Yes you can have a breast reconstruction after lumpectomy!
Fat grafting is a valuable tool in breast surgery. This technique has gained more popularity over the past 7 years. There are many techniques used to harvest the fat, process the fat and then re-inject the fat. Conventional suction lipectomy is performed with a small diameter cannula, processed by separating the liquid and fibrous tissue from the fat, and then placed into syringes for re-injection or through a closed system.
Lumpectomy and radiation
Implants should never be used alone in a radiated breast unless it is combined with another flap for coverage. To get more volume in a radiated field you need to use your own tissue. A TRAM flap is just one tool used in breast reconstruction. It sacrifices your stomach muscle but provides fat on a leash to your breast.. Another is a DIEP flap which also uses your belly tissue but does not sacrifice your stomach muscles. It essentially uses the same tissue that would be discarded in a tummy tuck but relocates the tissue to create a breast. A third option is the Latisimus flap (back muscle); its best use is along with an implant. These "autologous" tissue (your own tissue) can be used in any breast reconstruction. Women prefer it because it is their own tissue. It is also an excellent option for someone who has had radiation. You should consult with a plastic surgeon who offers all three of these methods as well as the implants, so that you have the best choice of options
Breast Reconstruction After Lumpectomy and Radiation
Absolutely! Sometimes at the time of lumpectomy, a plastic surgeon can be there with the breast surgeon to reshape the breast immediately. You may want to coordinate your care with both surgeons if you haven’t had your lumpectomy yet. Even if that wasn’t the case, reconstruction to a breast treated with lumpectomy and radiation is possible later on. Radiation often changes the skin, or the breast is just smaller after lumpectomy. Fat grafting from elsewhere in your body can be a wonderful way to enhance the size of the breast and to reverse the skin changes. In other cases, a small implant may be helpful. Every lumpectomy and radiation situation is unique, but most problems can be improved with reconstruction. Good luck.
Breast reconstruction is possible after lumpectomy and radiotherapy
Increasingly, the goal of breast surgeons is to preserve as much breast tissue as possible by only removing the cancer (lumpectomy) and the treating the remaining breast tissue with radiotherapy. This has been shown to have the same cancer control rate as having a mastectomy.
Sometimes the cosmetic results from this "breast conservation" surgery are excellent - but sometimes they are not. Lumpectomy reconstruction after radiotherapy in my practice generally involves replacing the portion of the breast which has been removed with a "flap" of tissue from the back (a latissimus dorsi flap). If a large amount of skin has been removed and the position of the nipple has been affected by the lumpectomy, skin from the back will the taken from the back as part of the flap and used to replace the skin that was removed in the cancer treatment.
Some patients, in addition to reconstructing the lumpectomy defect, also want their breasts to be larger. The latissimus dorsi flap can be used to cover a breast implant of tissue expander, while the unoperated breast undergoes a standard breast augmentation.
A newer technique is to reconstruct the lumpectomy defect is with fat grafting (performing liposuction elsewhere, separating out and then re-injectig the fat into your breast fill the hole) - but I don't think the jury is in on the safety of this technique in patients who have previously had breast cancer (although I know some of my colleagues will disagree!)
I hope this helps.
Oncoplastic techniques for breast reconstruction
Breast conservation (lumpectomy with radiation) is a common treatment for breast cancer. However, in some women (even up to 30%), lumpectomy results in a significant cosmetic deformity. While it is possible to perform reconstruction on the breast, the risk of surgical complications is higher (due to the effects of radiation). In general, autogenous techniques (ie flaps: tissue transfered from one's own body) is used to perform the reconstruction. In addition, surgery can be performed on the other breast (ie lift or reduction) to help improve symmetry.
It is important to have the plastic surgeon involoved in the preoperative planning. Newer surgical techniques (often referred to as oncoplastic surgery) allow the plastic surgeon to reposition the tissue of the breast at the time of lumpectomy (or shortly thereafter) to help reduce the chance of cosmetic deformities
Yes, it is possible.
Depending on the location and size of your lumpectomy, you can either have implant reconstruction, local rearrangement, or regional flap (such as latissimus dorsi flap). Normally, you need to wait at least 6 months from the end of your radiation. You want your breast to become soft from the radiation and to have swelling subside. Given that you had radiation, you are at higher risk to develop capsular contracture of implant. You may also need a balancing procedure of your contralateral breast. Please discuss all your options with your plastic surgeon.
Dissatisfied with post radiation breast conservation?
Lumpectomy and XRT is a good method for breast conservation in select types of breast cancer, however once the disease is controlled, the challenges begin. Radiation affects all components of the breast, starting with the skin, the tumor bed and surrounding breast tissue. Radiation is intended to kill microscopic foci of breast cancer, however it can also cause shrinkage of the remaining breast tissue, so that the affected breast becomes "static", while the opposite side continues to age, droop, enlarge. So the problem is asymmetry, which can be corrected by reshaping the cancer side or both breasts by augmentation, lift, reduction, etc.
The big "caveat" or warning is that the affected breast will usually experience delays in wound healing, be more prone to infection and have the asymmetry recur. Not to discourage you, but external beam radiation therapy can make any reconstructive surgeon humble. Stay tuned, for the development of IORT (intraoperative radiation therapy) for tumors which conform to a specific size and single focus. Things are changing, hopefully for the better. Good luck.
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.
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