S/P Stem cell transplant 2003. looking to have breat augmentation. Still have cGVHD and am on 5 mg prednisone and 1 mg sirolimus. Can my history complicate breast augmentation beyond the usual risks?
Can Graft Versus Host Disease Complicated Breast Augmentation Surgery?
Doctor Answers 9
Breast Augmentation and Graft versus Host Disease
Yes, your history can complicate breast augmentation beyond the usual risks. Prednisone and immunosuppressant drugs always adversely affect normal wound healing, and increase the risks of infection which could lead to multiple other complications including removal of the implants themselves.
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Don't do it!
In a word, "Yes." Normal healing depends upon the body's inflammatory response and the drugs which you are on will not allow for a normal inflammatory response. I would discuss this issue with your oncologist. I suspect that he/she Will recommend against the breast augmentation as well.
Breast Augmentation vs GraftvsHost Disease
I would be very hesitant to perform breast augmentation under these circumstances. Your risk for complications would be significantly increased, especially for wound healing problems and infection. I would think the risks of breast surgery outweigh the benefits.
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Breast implants and immune compromise
If you currently have graft vs. host disease you should not have any elective cosmetic procedure much less have implants placed to make your breasts bigger. Between the prednisone and the graft trying to destroy your own native tissue the risk for infection and wound problems is sky high. Everything needs to settle down for at least a few months before you could undergo any elective cosmetic surgery. If you develop any infection due to immune system compromise you should not have any elective cosmetic placement of any type of implant -face, breast etc. because the risk of implant infection would be very high.
Immunosuppression and breast implant augmentation surgery
Steroids are immunosuppressants and may effect immunomodulators which can result in an increased risk of wound healing problems and infection.
Breast Augmentation and GVHD?
Very good question. Unfortunately, there is very little information in the medical literature to answer your question. And while breast implants are considered to be inert, the biggest issue you may encounter is delayed healing due to your use of prednisone.
Your best best would be to speak with a Board Certified Plastic Surgeon in your area. Discuss your goals as well as concerns and see if he/she feels that you would be a good candidate.
I hope that helps!
Transplant patients and breast implants
While there are no any studies looking specifically at transplant patients who have breast implants, from what we know about medical implants in general, they seem to be well tolerated. The biggest issue may be healing problems if you are on high doses of immun-suppressing medications. This can be discussed with your transplant doctor to make sure you are on an appropriate dose before surgery. As for GVHD, it is unlikely that this would result from a breast implant. From the best data we have, the immune related disorders that were thought to have been linked to silicone gel implants in the early 1990's have not been shown to exist. If you are really concerned about it, then consider using saline implants. They have a silicone shell but do not have the silicone gel which was the center of the controversy.
Breast Augmentation and Graft versus Host Disease
Thanks for the question.
While a breast implant is in theory "inert" and shouldn't elicit an atypical immune response, given your history of immunosuppression and corticosteroid use, you are at higher risk for infection than the typical patient population. You must be cleared by your managing physician before considering an elective cosmetic procedure such as a breast augmentation.
Glenn Vallecillos, M.D., F.A.C.S.
Breast implants do NOT elicit an immune response as a foreign organ
Regarding: "Can Graft Versus Host Disease Complicated Breast Augmentation Surgery?
S/P Stem cell transplant 2003. looking to have breat augmentation. Still have cGVHD and am on 5 mg prednisone and 1 mg sirolimus. Can my history complicate breast augmentation beyond the usual risks?"
For the benefit of the non-medical readers, when a graft or organ is taken from one human and placed in another, the recipient's immune system immediately is able to detect the graft is "foreign" and begins to mount a complex immune campaign which results in rejection of the graft. For this reason, graft survival depends on using certain drugs to weaken and blunt the immune system of the grafted individual. Such immune suppression drugs increase the rate of infection and potentially even cancer rates in the grafted / transplanted person. In certain number of these cases, as the immunity is weakened cells IN the graft which ALSO recognize they are surrounded by a foreign tissue actually attack the individual in what is termed a Graft VS Host Disease. This is seen more commonly with bone marrow type transfers than heart or kidney transplantation.
The breast implants do NOT elicit an immune response as a foreign organ and are not attacked either by your immune system or the graft. However, a decreased immunity is associated with a higher infection rate and MAY be associated with a higher capsular contracture rate.
You MUST clear your cosmetic surgery with your hematologist.
Dr. Peter Aldea