I had a right breast mastectomy, chemo, and radiation for breast cancer that included lymph node involvement. I am considering a DEIP for reconstruction, but would like to know if there is a typical waiting period after the radiation, and what types of complications are likely?
DIEP After Radiation?
Doctor Answers (8)
DIEP after radiation?
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. Typical complication discussed for the DIEP flap include: bleeding, infection, flap failure, fat necrosis, symmetry issues, abdominal bulge, etc. Discuss the various complications, all rare, as well as success rate with your surgeon. 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!
Is DIEP flap a good choice after radiation?
How long after radiation can I get a flap for breast recon?
At least 4 months after the complete of radiation is a good rule of thumb. 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
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DIEP after Radiation therapy
The minimum you need to wait after radiation is 5-6 weeks, but most people wait at least six months to try and let the skin heal as much as possible. The complications are most certainly higher after XRT, but it often depends on other factors such as your weight and other health issues.
DIEP after radiation
I typically wait until the acute changes in the skin have resolved, usually 4-6 months. The shape of the reconstructed breast is often different from the opposite breast after radiation. In addition, most patients will need some skin replaced with the flap, which can affect the appearance of the breast. The radiated skin is often more swollen and firm to touch. Wound healing complications in the breast are more common after radiation.
You can have a DIEP flap after radiation and chemotherapy.
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 and DIEP flaps
Radiation may impact the vessels that are used when restoring blood supply to the DIEP flap in the chest. There is no specific time that will make it perfect. usually you want any skin changes to subside. However, the vessels may not be good and one may not find out until the exploration of them.
Post Radiation Breast Reconstruction
I generally recommend autologous (using your own tissue) reconstruction after radiation therapy. A DIEP flap is an excellent procedure. I generally recommend waiting about 6 months after radiation to consider DIEP flap reconstruction. If the radiation changes (redness or firmness of skin) persist at 6months, it is wise to wait longer - up to 12 months. Please visit with a board certified plastic surgeon experienced with DIEP flap reconstruction to learn more about your options.
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.