What breast reconstruction options are best suited for radiation patients. complications? Is back tissue a good option to consider? Why?
Options for Breast Reconstruction for Those Who Had Radiation?
Doctor Answers (8)
Breast reconstruction after radiation
I prefer to use your own tissue after radiation.
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+
Breast Reconstruction After Radiation
I always recommend transfer of non- irradiated tissue for reconstruction after radiation. The back tissue may be one option depending on the situation, but I prefer the lower abdominal tissue.
Breast Reconstruction After Radiation Therapy
Breast reconstruction for patients who are going to have or who have had radiation therapy is best accomplished with flap breast reconstruction techniques that utilize only your own skin, fat, and muscle tissues.
These all natural tissue breast reconstructions eliminate the potential complications of breast implant infection, breast implant capsule contractures, breast implant exposure.
While not for everyone, flap breast reconstructions such as TRAM flaps, or DIEP flaps offer reconstructions with tissues that have their own circulation that is resistant to infection, is healthy tissue that brings additional blood supply to the breast reconstruction area.
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Post Radiation Breast Reconstruction Options
There is some controvery on how to approach breast reconstruction after radiation therapy (XRT). Radiation therapy is excellent in helping you reduce your risk for recurrence. As I tell my patients, radiation is excellent at killing microscopic cancer cells. However, radiation does "fry" the non cancer normal tissue as well. Radiated tissue will never be the same.
Although some notable studies have shown acceptable results with implant-based reconstruction in patients who required XRT, I tend to subscribe to the perspective that implants and radiation don't mix well in the long run. Why? Because we know that radiation therapy significantly increase the risks for capsular contracture (a vigorous scar tissue response). In my breast reconstruction practice, I generally recommend some form of autologous (using your own tissue) reconstruction after XRT. - such as DIEP, SIEA, or TRAM flap. The reason why I recommend autoloogus reconstruction following radiation is that the new tissue that is brought to the radiated site, I believe, brings new non-radiated soft tissue, new blood supply, and perhaps new healing potential to a radiated chest wall. Furthermore, a tissue-only reconstruction (such as the DIEP flap) may not require a foreign body implant. Hence this eliminates any risk for foreign body (implant) scar tissue (post radiation capsular contracture). I believe a tissue-only reconstruction breast following radiation therapy will give my patient the best long lasting result.
Radiation definitely complicated breast reconstruction. But in experienced hands, you definitely have options following radiation therapy. I hope this helps. Best of luck.
Web reference: http://www.breastreconstructionhouston.com
Breast Reconstruction after Radiation
Due to the high incidence of capsular contracture with breast implants in those who have undergone radiation, I do not recommend their use in these patients. Although the latissimus dorsi (LD) flap involves a quicker recovery than other traditional tissue flaps, it often requires a small implant to provide projection and an aesthetically pleasing breast mound. Therefore in radiated patients, I prefer the LD flap as a backup procedure in the event that a patient is not a candidate for tissue only reconstruction.
Our preferred method of tissue only reconstruction in the radiated patient is a DIEP flap. The abdominal skin and soft tissue is very close in consistency to natural breast tissue and can be shaped to restore much of the normal anatomic boundaries of the breast. Secondly, the abdominal skin is used to replace the radiated chest wall skin, providing a smooth soft natural appearing breast mound.
Web reference: http://www.drpaulgill.com
Your best option is autologous breast reconstruction.
Patient with radiation have higher risk of capsular contracture. Using DIEP flap from the abdomen without the use of the abdominal muscle is a good option if you have fatty tissue over the lower abdomen.
Radiated tissue does not do well with implants. Implant failure is very high in radiated tissue.
The back muscle and skin (Latismus Dorsi Myocutaneous flap) will bring with it a health muscle with good blood supply and can use an implant undr that muscle.
Othe option is the excess skin and fat in the lower abdomen, TRAM Flap, if there is enough fat you will not need an implant.
Other options are the Free Flaps, taken from the abdomen, or the buttocks
Breast reconstruction after radiation
If you have some extra tissue in the lower abdomen, this is the best option for breast reconstruction (TRAM, DIEP flaps) after radiation because it can be shaped into a soft natural looking breast. The radiation makes it extremely difficult for implants to work without dense scar tissues forming around them. Please go to a plastic surgeon who can offer you ALL options including microsurgical flaps (TRAM, DIEP etc) so the best option can be selected for you. The back (latissimus dorsi flap) is another non-radiated source of tissue but usually requires an implant.
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.
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