Expanders After Mastectomy

I asked a question earlier this week about Radiation and Implants but what I failed to mention is after my Mastectomy expanders were immediately put in and have been expanded since July 2010...I did have radiation on the right side with the expander in. Since it has been slowly expanded over the months even after radiation and my skin is stretched would it still not be a good idea to go with implants?

 

original question: I was diagnosed with breast cancer in May 2010 at the age of 33. I since have undergone a bi-lateral mastectomy...chemo and radiation. I am scheduled to begin reconstruction in Sept 2011. Due to the radiation on my right side would it be safer to do a DIEP procedure which is what my surgeon wants to do or can I just go with implants which is what I would like to do? Ive been checking up on it and have found alot of sights which say not to put implants in radiated skin

Doctor Answers (11)

Implant reconstruction after radiotherapy

+2

As you have had expanders for almost a year and have not mentioned any problems, I think it will be very reasonable to have the expanders changed for permanent implants. There are number of known problems that can happen with implants under radiotherpied skin - but they are equally applicable to expanders as well.

After all, if you had any major problems with implants in future, there will still be an option for a flap reconstruction. Also, to be fair to your surgeon, DIEP is meant to be the preferred option in radiotherpied area. But having expanders for a year since mastectomy somewhat changes the equation.


Birmingham Plastic Surgeon
5.0 out of 5 stars 5 reviews

Expanders after mastectomy

+1
Hello!  Thank you for your question.   It is reasonable to continue with your reconstruction, since you already have your tissue expanders in place.  This is a common thing to do and can produce excellent results still.  If, after radiation, you experience problems - you have an 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.  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.  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.  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!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 11 reviews

Breast reconstruction after radiation with expanders.

+1

There is no right or wrong answers to how to reconstruct the breast after having radiation.  As long as you are well informed, you understand the pluses and minuses of having implants vs. your own tissue as a flap, and you have discussed these options in depth with your plastic surgeon then you have to proceed with what you feel is right for you.  Both methods have their benefits and risks.  The fact that an expander has been placed and has worked without problems is promising but not a guarantee.   Ultimately, your surgeon whoever it is, can only make a recommendation.  You are the one who must make the decision and accept the risks of that decision.

Adam Hamawy, MD
Princeton Plastic Surgeon
5.0 out of 5 stars 13 reviews

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Expanders After Mastectomy

+1

Congratulations on achieving a nice expansion in the face of radiation therapy. Sure you can use implants vs a micro flap, it is a decision between you and your chosen PS. Weigh all the options. Best of luck. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
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Radiotherapy and breast reconstruction

+1

Having had radiation after expansion means you were not expanding irradiated tissues which is good.  However, your tissues are now irradiated.  So the positive thing is that your skin and muscle may not be as thinned out as they would have been if you tried to expand a previously irradiated chest.   However, your next surgery will now be in irradiated tissues that have a poor healing potential.  Thus your risk of wound healing problems is still increased relative to non-irradiated patients.  There are pluses and minuses to all surgical options.  Have a thorough discussion with your plastic surgeon, and also have a discussion about his/her back up plans if the surgery fails.

Sincerely,

Martin Jugenburg, MD

Martin Jugenburg, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 128 reviews

Breast reconstruction after radiation

+1

If you have expanders in and have had radiation, reconstruction can certainly be done, but it definitely has higher risks of complications.

Steven Wallach, MD
Manhattan Plastic Surgeon
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Safety of Placing Breast Implants after Radiated Tissue Expanders After Mastectomy

+1

There are no absolutes in Surgery. Whenever a seasoned surgeon hears "always", "never" etc in a clinical presentation, our built-in BS-Pinocchio alarms developed and charged by years of surgical experience and training begin sounding off. We all know that Medicine is an art where based on the set of factors presented to us, using certain treatments would be associated with certain results AND complications.

Radiation is very good at keeping cancer from recurring locally. But it is very punishing to the local chest tissues by causing scarring, loss of much of the blood supply and of the normal stretchiness of the skin making expansion hard. Incisions into radiated skin have a hard time healing as well.

In your case, it sounds as if the skin has been successfully expanded. The next step is placing in a substitute breast volume. Traditionally, this has been done as a combination breast implants with the Latissimus muscle for coverage and added volume. This option is open to you with the understanding that when the implant(s) leak you will need further surgery. If the implants get infected, they will need to be removed sooner. The advantage of the DIEP flap is that if it is successful, it will be a one time operation which brings in fresh, healthy flesh to the area which will feel like a normal breast. It IS a bigger operation but the potential yield is much better. On the other hand, all things being equal, it could be done if your implants become infected or when they leak in the future. The only variable is finding a surgeon who does this operation frequently.

Good Luck.

Dr. Peter A Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 58 reviews

Breast reconstruction with implants after radiation is safe.

+1

Hi.

It is not quite as safe as without radiation, but we do it often with very rare problems.  And there are plenty of complications with flaps.  So, assuming your tissues look healthy, go with implants if that is what you want.  It is a lot less surgery.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Radiation and breast implants

+1

Breast reconstruction after radiation is not an all or none issue. It is a statistical problem. SInce tyou already have expanders in, your genral options are replace with an implant (your surgeon can review risks of capsular contructure using saline or silicone implants), autogenous reconstruction with the various flap options, or a combination using implants and a latissimus flap. Each patient's treatment must be individualized taking into all the considerations of past history, past anatomy, present anatomy, risk tolerance,and goals.

Robin T. W. Yuan, M.D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 7 reviews

Breast reconstruction with expanders if having radiation?

+1

Yvonne, this additional history is very important. Immediate breast reconstruction with tissue expanders is safe. Sometimes the patient may require radiation after the mastectomy and reconstruction. This does increase the risk of complications with the expander, but many patients do well. If you have done well with the expanders and are happy with the result and expansion so far, you can simply have an expander exchange for a permanent silicone implant. The risk of infection or wound healing problems is elevated, but if this occurs, you can always reconsider a flap reconstruction (DIEP, TRAM, or latissimus dorsi).

Frank Agullo, MD
El Paso Plastic Surgeon
5.0 out of 5 stars 28 reviews

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.