I have undergone the first stage of breast reconstruction after a double mastectomy. I will be getting the expanders removed in 2 weeks with implants replacing them. I am hoping for a full C. The doc said he will be putting 415 cc's. Is this a full C? I am 5'2" weigh 135lbs. Also, following the surgery I will have 5 weeks of radiation on the left breast. I would like to know everything I need to know to offer me the best results for the radiated side.
Breast Reconstruction After Radiation?
Doctor Answers (17)
Radiation and Breast Reconstruction
You ask an excellent question. There is some controvery on how to approach breast reconstruction when radiation therapy (XRT) is required. Radiation therapy is excellent in helping you reduce your risk for recurrence. This is the most important thing. As I tell my patients, radiation is excellent at killing microscopic cancer cells. However, radiation does "fry" the non cancer normal tissue as well. Radiated tissue will never be the same.
Although some notable studies have shown acceptable results with implant-based reconstruction in patients who required XRT, I tend to subscribe to the perspective that implants and radiation don't mix well in the long run. Why? Because we know that radiation therapy significantly increase the risks for capsular contracture (a vigorous scar tissue response). Given your specific situation, you currently have tissue expanders. It is not wrong to proceed with your implant exchange prior to XRT. However, in my breast reconstruction practice, I generally will clear a patient with a temporary tissue expander to proceed with radiation therapy (XRT). Then I allow approximately six months to pass after XRT to allow for the radiation effects (inflammation/skin burn) to cool off. At this time, I recommend delayed definitive autologous (tissue) reconstruction with excess abdominal tissue (DIEP flap) or back tissue (latissimus flap). The reason why I recommend autoloogus reconstruction following radiation is that the new tissue that is brought to the radiated site, I believe, brings new non-radiated soft tissue, new blood supply, and perhaps new healing potential to a radiated chest wall. Furthermore, a tissue-only reconstruction (DIEP flap) may not require a foreign body implant. Hence this eliminates any risk for foreign body (implant) scar tissue (post radiation capsular contracture). I believe a tissue-only reconstruction breast following radiation therapy will give my patient the best long lasting result.
Radiation definitely complicated breast reconstruction. But in experienced hands, you definitely have options following radiation therapy.
I hope this helps.
Breast reconstruction following mastectomy with post-mastectomy radiation can present a challenge. In general, plastic surgeons prefer to use a woman's own tissue when reconstructing a radiated breast. In this case, the tummy (or abdominal donor site) may be a good option. Using advanced microsurgical techniques referred to as the DIEP flap (deep inferior epigastric artery flap) extra skin and fatty tissue from the lower abdomen can be transferred to the breast. If there is insufficient tissue in the lower abdomen (ie too skinny), other options may include the inner thigh or buttock
Breast Reconstruction after radiation and what to do to decrease complications
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Radiating the implant pocket causes contracture
The management of breast cancer with radiation causes a lot of concerns when an implant is in the field of radiation. There is a high risk of capsular contracture in implants that have been radiated or are in an area that has been radiated. It sounds like your implant size is appropriate but the radiation may give you some problems.
415 cc breast implants should be about a C cup
Given your size 415cc implants should end up with you being a C cup. This will depend a bit upon how thick your mastectomy flaps are. Also the fact that you will require radiation could effect your final result. Patients that get radiation have a higher incidence of capsular contracture or firmness around there implants. This sometimes can require further surgery to adjust the implant pocket.
Your surgeon will be an excellent source of information in this regard.
Good luck with your upcoming surgery,
Breast Reconstruction After Radiation?
After radiation, you have a slightly 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, if you have failure of your implant-based breast reconstruction. 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. 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. Best wishes for a great outcome!
Radiation will cause changes!
Three basic forms of breast reconstruction exist. You can use your own tissue, implants or a combination of the previous two techniques. Your own tissue can be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting. Implants can be done in one stage or two stage. Two stage reconstructions are started by placing expanders at the time of mastectomy. Once they expanders are placed they are able to be inflated as determined by wound healing. The final time consists of combining any of the above techniques.
If you are interested in being seen in Austin please give us a call. I know this is a difficult time for you. The majority of my practice is devoted to reconstruction for women with breast cancer or who are BRCA+
Radiation after Mastectomy
Thank you for your question. Breast reconstruction after radiation is a frequently debated topic. The textbook answer is to utilize one's own tissue to permanently reconstruct a breast after radiation.
This is the philosophy that I employ in my practice, as i have seen first hand how much radiation can damage an implant reconstruction.
My preferred method of tissue reconstruction is a DIEP flap because the flap can be quickly harvested compared to the buttock or thigh tissue, and it allows for the benefits of a tummy tuck without loss of muscle function.
I would consult with a few board certified plastic surgeons with expertise in breast cancer reconstruction, prior to making your final decision.
I wish you a safe recovery.
Breast recon after radiation.
Radiation will change the quality of the skin and increase you chances of capsular contracture. You will likely have some asymmetry but is can be fixed.
Breast Reconstruction After Radiation
Unfortunately, Radiation therapy and implants don't work well together, although some reports out of Memorial/Sloan-Kettering show that radiation once the implants are in place is better tolerated than if one receives radiation to the tissue expander and then trys to put in the implants. I don't think there is anything you can do personally to guarantee a good result. Your radiation therapist will give you instructions on how to care for your skin during the therapy and I believe that will help.
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.