i am 35 years old had lumpectomy and radiotherapy 10 years ago. 2 kids later. now would like implants. is it possible that my 'ok' breasts could end up looking worse? seen specialist, they say 50/50. would just like an honest opionion. please help
Implants After Breast Cancer and Lumpectomy
Doctor Answers 18
IMPLANTS AFTER LUMPECTOMY
Be well and good luck!
Implants after breast cancer and lumpectomy
No implants after radiation
Radiation predisposes you to many issues, the least of which is poor healing because of the decrease in blood flow. That combined with a foreign object like an implant spells disaster. I would advise you strongly against that route.
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Implants and the irradiated partial mastectomy defect: not good bedfellows
I would proceed cautiously with implant placement following radiation. For the patient with minimal asymmetry following partial mastectomy and radiaiton, it might be better to avoid implant reconstruction altogether. Some of the concerns include:
1. Reduced compliance of the pectoralis muscle and overlying breast. This results in a firmer breast, even without capsular contracture.
2. A tendency of the radiated breast to be less mobile, and therefore less ptotic than the contralateral breast. As a result, the other breast will tend to age at a different rate and is more likely to require a mastopexy, or lift.
3. Failure of the implant to address the lumpectomy defect itself. This may require improvement using a separate technique.
4. Potential for capsular contracture, wound infection and wound dehiscence.
5. Placement of an implant may unmask an asymmetry that is less obvious without an implant.
6. Potential interference with mammography.
That being said, there are many patients who have completed reconstruction in this setting with excellent results.
Breast implants following radiation
Breast implants can be a challenge following radiation therapy. Radiation therapy may limit the pliability of the skin and pectoralis muscle. In addition, the rate of scar tissue (known as capsular contracture) is increased in women who have undergone radiation therapy
Implants Radiation, a Bad Combination
Breast reconstruction with implants after radiation is fraught with problems including capsule contractures resulting in firm deformed breast mounds, infection, extrusion of the implants. Sometimes implants can't be placed because the mastectomy pocket may require an expander to enlarge the space to fit an implant.
For these and other reasons, I feel that flap Reconstruction, such as TRAM Flaps, free flaps, or DIEP Flaps using the patient's own tissues is a better option as these techniques bring healthy tissues to the area and tolerate radiation better than implants do.
For more information see nybreastreconstruction.com
Implants After Lumpectomy and Radiation
I generally do not recommend placement of implants after radiation because of an increased risk of scar tissue formation around you implant (also known as capsular contracture). However, if I meet a patient who understands this increased risk, I may consider placement of an implant if I think it can meet the patient's goals for reconstruction. However, if a patient opts for an implant after lumpectomy and reconstruction, she must understand the following:
1. the implant may not completely eliminate the deformity from the lumpectomy defect 2. there will be an increased risk of scar tissue around the implant 3. there will always be some breast asymmetry as the radiated breast will almost always sit higher than the non radiated breast. this is a sequelae of radiation therapy. this asymmetry may get worse over time 4. if a problematic scar manifests, the implant may need to be removed.
In general, once tissue has been radiated, it will never be the same. This is one of the down sides of breast conservation therapy. Please visit with a American Society of Plastic Surgeons member surgeon to review your options
Breast Implants after Radiation
We have achieved many successful and lovely reconstructions and augmentations for women after breast cancer treatment that included radiation.
There can be no question, however, that patients like yourself will experience more complications, and will generally need more maintenance procedures over time, so be sure you are comfortable taking this on before you commit.
Depends on what your final goal
Pictures would be very helpful with your question. There is alway a potential for the outcome to be less than pleasing. Usually, women who have had lumpectomy have some kind of contour deficiency of that breast that involves the use of your own tissue to improve the contour.
If you have small breast and desire an increase in size then breast augmentation would help. The implants should be placed under the muscle not to obscure your mammograms. Even after implants you may still may have a contour deformity that needs to be addressed.
BETTER is the Enemy of GOOD - Augmenting "OK" Radiated Breasts
To answer your question directly - Even if you did NOT have a history of breast cancer, lumpectomy and radiation - EVERY operation has associated complications and it is ALWAYS possible for "OK" breasts to look worse after a breast augmentation. The risk is much higher in radiated breasts. Radiation causes intense scarring through the breasts with a decrease in effective blood flow. The result are stiffer breasts which heal poorly after surgery, have a higher rate of infection and a very high rate of scarring around the implant (IE capsular contracture).
In addition, your odds of having recurrent breast cancer is higher than if you had no such history. Breast implants may interfere with some methods of breast cancer diagnosis. Are you sure that you want to add this risk?
You need to judge if having "OK" breasts now - are worth the added risk.