Breast Reconstruction After Radiation?
- Asked by hhwt2e in Windsor, Ontario, Canada
- 4 years ago
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.
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.
Web reference: http://www.breastreconstructionhouston.com
Breast Reconstruction after radiation and what to do to decrease complications
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
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Breast Reconstruction Photos
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,
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.
Web reference: http://www.drpaulgill.com
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.
Breast reconstruction after radiation
Mastectomies are performed to remove all of the breast tissue, including your tumor. Lumpectomies remove only the tumor and a small amount of surrounding normal breast tissue. Lumpectomies are always followed by radiation to eradicate any residual cancer cells. The surgical oncologist often recommends one of these two options to the patient, but sometimes either option is available.
After mastectomy, breast reconstruction may be performed in multiple steps, encompassing 3-4 procedures over approximately one year. The stages consist of:
- Building the breast mound to give the shape of the breast on your chest.
- Revising the reconstructed breast for improved contour and procedures to improve symmetry between your breasts.
- Building the papule of the nipple
- Tattooing the areola
There are two ways to build the breast mound: implant-based and tissue-based. For breast reconstruction using implants, an adjustable tissue expander is placed beneath the skin of the breast and periodically, over several weeks to months, a saline solution is injected to slowly stretch the overlaying skin. These injections of saline are performed in the office and typically cause minimal discomfort, similar to a sore muscle, that resolves over 1-2 days. After the ideal breast size is achieved, a more permanent breast implant, filled with saline or silicone gel, is inserted in place of the tissue expander to give a softer and more natural-appearing result. The procedure to exchange your tissue expander for a permanent implant is typically performed as an outpatient and has a healing time of approximately one week. Implant-based breast reconstruction is not a good option for patients who have been treated with radiation because of poor cosmetic outcomes and a high likelihood of healing problems.
The other technique for breast reconstruction is to use the patient's own tissue to recreate the shape of a breast. You may see this technique referred to as "flap reconstruction," autologous reconstruction, or "free flap reconstruction." Specific names that you may see are those referring to use of tissue from the abdomen: Transverse Rectus Abdominus Myocutaneous flaps (TRAM), free TRAM, muscle-sparing TRAM, Deep Inferior Epigastric Perforator flaps (DIEP) and others.
With autologous tissue reconstruction, skin, fat and sometime muscle from the abdomen, thighs or other parts of the body are utilized to reconstruct the breast mound. This healthy tissue replaces tissue that is lost with a mastectomy and can help the body to heal, even after damage caused by radiation. The most commonly used tissue for autologous reconstruction is the skin and fat from the abdomen, as this best replicates the breast tissue that has been lost. This procedure tightens the abdomen where tissue is removed and results in a long scar, extending from hipbone to hipbone.
There are numerous variations on the technique that is used to move the abdominal tissue to the chest for breast reconstruction. Some surgeons rotate the belly tissue to the chest, leaving an attachment at the ribcage, a procedure called a "pedicled TRAM." Surgeons at Plastic Surgery Northwest use a newer procedure, known as the "free TRAM" where the tissue is completely separated from the body before it is moved to the chest, regaining it's blood flow when small blood vessels from the abdominal tissue are sewn to blood vessels in the chest. This technique is known as the free TRAM, the muscle-sparing TRAM, or the DIEP flap, depending on the amount of abdominal muscle that is moved with the skin and fat.
Sometimes a woman may not be able to use her abdominal tissue for their breast reconstruction due to prior surgery, a paucity of abdominal fat, or other factors. These patients may be able to use inner thigh, buttock, or other tissue to replace the lost breast tissue. Tissue based breast reconstruction operations are much longer than operations to place implants for breast reconstruction and have a lengthy recovery time of 1-3 months. However, your own tissue yields the most natural appearance and a result that can endure for decades.
Lumpectomy, the removal of a tumor with a small amount of surrounding breast tissue, is the other form of surgical breast cancer treatment. This is sometimes called "breast conserving therapy." After lumpectomy, the breast is treated with radiation to eliminate residual cancer cells. Although treatment with lumpectomy and radiation does not remove all breast tissue, this treatment may result in changes to the breast appearance. These changes are most noticeable in women with smaller breasts or larger tumors and may result in significant distortion of the breast. Unfortunately, radiation therapy changes the breast's ability to heal after future surgery and can limit the reconstructive options available if a patient has a poor aesthetic outcome. Reconstruction after lumpectomy and radiation typically involves bringing in tissue from a non-radiated areas.
Radiation and Breast Reconstruction
Radiation can cause multiple problems in reconstruction of a breast after mastectomy. The skin is often firm and lack flexibility to be expanded and may result in problems with infection, displacement and extrusion of the expander or the breast implant that replaces it.
For these and other reasons, I feel that flap reconstructions, using your own tissues are superior. These techniques for breast reconstruction include TRAM flaps and free flaps, DIEP flaps among others.
These procedures bring healthy tissue to the areas treated by radiation, and often are performed at the time of mastectomy, and can tolerate the radiation therapy that is given afterward.
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.