I'm 1 mo post-op of double "M". My left side had prior lumpectomy and radiation. My skin is having trouble healing in the incision site on my left side. Their is no infection, but some necrosis on the horizontal incision edges top and bottom. I have been undergoing hyperbaric oxygen therapy for the past three weeks. There isn't much improvement. The top of my left breast is becoming indented, like a shelf. If I have the incision site trimmed and resown, will the new incision heal any better? What would be recommended for the chance of best results?
Problems Healing After Double Mastectomy
Doctor Answers 3
Healing After Radiation and Mastectomy
Radiation devices are commonly used in Medicine for multiple indications, like Keloid Scar and Cancer treatments, it is also used in other industries for sterilization, agriculture and research.
Despite advances in radiation safety and more 3-dimentional approaches to the treatment of medical conditions, the radiation injury still occurs. Most common areas of local involvement are soft tissues after breast cancer or other soft tissue cancer treatments, and bone.
The radiation injury can be acute or chronic. Acute injury comes from high dose exposure and can be associated with other injuries, like thermal burns and systemic complications, like injury to internal organs. Chronic radiation damage is a long term complication of radiation exposure.
The typical long term radiation damage comes from 3H’s: Hypoxia, Hypovascularity, Hypocellularity. During radiation exposure the water is broken down into H+ and OH- ions and they produce extensive damage to cells and DNA. As the result, the damage to internal lining of the blood vessels decreases the number of working blood vessels (hypovascularity). Less blood vessels means less blood and less oxygen to the tissues (hypoxia). Less oxygen means some cells are unable to survive (hypocellularity).
Unfortunately, there is no 100% reliable treatment to fully reverse the damaging effects of radiation, however, Hyperbaric Oxygen Treatments along with Vitamin protocols may be able to create visible improvement in tissue quality and its ability to heal.
During hyperbaric oxygen treatments partial pressures of oxygen increase dramatically inside of the tissues stimulating formation of new blood vessels. This process starts after 14 treatments and continues on. It is believed that the process plateaus after 25 and 30 treatments. The patient's who has significant amount of radiation, upwards of 60 or 80 treatments may be necessary to establish adequate blood supply in order to heal. It is important to remember that the effect of hyperbaric oxygen therapy is cumulative.
Other options include having flap surgery. Having hyperbaric oxygen therapy treatments prior to flap surgery can also facilitate healing process.
At our office we also have a freestanding hyperbaric oxygen therapy facility. I see every day how challenging it can be to continue with multiple treatments. The good news is that they work.
Your most welcome to visit our website. Under the category of Reno Hyperbaric Center you can find a lot of answers about the effects of radiation and available treatment modalities.
I wish you well in your healing process.
Boris Volshteyn M.D., M.S.
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Poor wound healing following radiation therapy
Unfortunately the only other alternative to hyperbaric oxygen is a muscle flap which is probably over treatment at this point in time.
Helaing is sometimes difficult after radiation
Sounds like you are having trouble healing after radiation. This is normal but unfortunate. If there is not too much necrosis then trimming the necrotic area and reclosing may help speed the healing process. As long as there is no tissue expander or implant under the incision, eventually you will heal.