I had a lumpectomy and re-excision on one breast about 8 weeks ago. I am currently having chemotherapy and am scheduled to begin radiation in April. The area around the incision is flatter than before, and I am concerned that after radiation the area will become even flatter and be cosmetically unacceptable. Assuming that my post-chemotherapy mammogram is fine, is it possible to have plastic surgery to correct the depression before radiation? I know that after radiation, it may be too late.
Can I Have Plastic Surgery to Fix a Lumpectomy Depression Before Having Radiation?
Doctor Answers (10)
It is best to wait until after radiation to correct post-lumpectomy deformity.
1) I understand your thinking. The good new is that the flat area can be corrected, either with fat injections, or with a local flap. But this reconstruction should be done several months after radiation is over. If you do it before, the radiation usually causes atrophy and hardness of the reconstructed tissue.
2) It is also true that doing reconstruction on a radiated breast is more difficult, but in your situation, it is by far the lesser of the two evils. Good luck.
Radiation and breast deformity
You should really wait to undergo any form of breast reconstruction until you have recovered fromthe radiation treatment. This may take a year or more for the skin to settle down.
You need to wait 3-6 months after radiation tx before doing corrective surgery
Your breast tissue will change after radiation and depression will get worse. If the treatment done before radiation, the radiation will damage the tissue and cause complication. You will need in person consultation with aboard certified plastic surgeon before you start radiation. If you are candidate for implant reconstruction, you should get tissue expander before starting radiation to prevent scaring down. If you are candidate for fat grafting or flap breast reconstruction,you should wait 3-6 months after radiation treatment. The reason for the delay is that radiation will damage the flap or fat grafting.
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Lumpectomy deformity timing with Radiation.
It is certainly possible to have a breast deformity after lumpectomy, even though it is considered breast conservation surgery. There are a variety of plastic surgery reconstructive procedures that may be of help including transfer of tissues used in postmastectomy breast reconstruction as well as fat grafting. In many cases, however, it would be preferable to have radiation first and see how the tissues respond to the radiation and then tailor the reconstructive procedures to the resulting deformity after the initial lumpectomy and radiation therapy.
Post lumpectomy deformity
Fixing post lumpectomy depressions or deformities usually involves bringing in tissue from another part of the body either via fat grafting or a tissue flap. Most plastic surgeons, myself included, would prefer to wait until after your radiation therapy is complete in order to do a more accurate assessment of your deformity and what will be needed to correct it. Hope this helps!
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+
Fat grafting to the lumpectomy site is one option. A second option could be a lift or reduction depending on the size of the breast to start.
Breast reconstruction for lumpectomy defect
Although breast reconstruction can be performed prior to radiation, you should wait till radiation is completed. Performing breast reconstruction will delay your radiation. In addition, your breast (shape and size) will change after radiation. Usually I wait a minimum of 3-6 months to see the post-radiation change to the breast.
Web reference: http://www.drkimplasticsurgery.com
Correction of lumpectomy defects
There are real pros and cons to correcting lumpectomy defects prior to surgery. One of the main problems of reconstruction or breast surgery prior to radiation is that it can delay therapy aimed at abolishing any remaining potential cancer cells. Now that you are already 8 weeks post lumpectomy, reconstruction at this point will delay therapy even longer. Therefore in your situation, I would recommend completing your radiation and waiting until your surgeon recommends that you are ready for a delayed reconstruction.
Oncoplastic reconstruction before
Yes, oncoplastic breast surgery can be and should be performed prior to radiation therapy. Once the radiation is done, it can be very difficult to correct. Discuss with your doctors to see if you have a window of opportunity between chemo and radiation therapy to get oncoplasty. Bear in mind, however, than any complications that you may have can delay your radiation treatments and compromise the effective treatment of your breast cancer.
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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