47 Yr old. Had breast cancer, chemo & rads (whole left breast) in 2007. Had bad mammograms at every 6 month f/up so I opted for bi-lateral MX. After each surgery my rads side gets necrosis. On 5/21/13 got implants & not healing left side - area size of a dime. New surgeon suggests I have the implant removed, cut out the "bad" area, TE back in & acellular dermal matrix to help. Is this common procdure, what is % you think for success? Abort the whole process? I have pockets?
Had Rads in 2007 & I Don't Have a Radiation Ulcer. Am Currently Going Through Breast Reconstr & Having Issues with Healing.
Doctor Answers (7)
Radiation and healing problems
How patient are you with set backs? If you're willing to accept the risks, keep forging ahead. But you are facing an uphill battle. Is there a reason you cannot use your tummy tissue instead? It could be a better choice at this juncture, especially when you consider how firm your reconstructed breast will be.
Radiation injury and tissue
Radiation is the gift that keeps on giving. It may always have a decreased capacity to heal without bringing in healthy tissue.
Improving Irradiated Breast Tissues For Better Wound Healing
It is time to improve the vascularity of your irradiated tissues. This could be done by injection fat grafting or a pedicled back flap depending upon the size and location of the breast wound. Continuing to work exclusively with the irradiated tissues without improving their healing potential is going to be a set up for ongoing healing problems.
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Fat grafting strongly recommended as an option
In the face of radiation therapy I would strongly recommend you consider fat grafting as a reconstruction option. Staged fat grafting is in my opinion the most reliable way to restore the quality of damaged irradiated tissue, with the lowest risk of complications.
Radiation necrosis and breast reconstruction
Radiation and breast reconstruction can be a problem
Radiation can and does negatively impact breast reconstruction using tissue expander and implants. If you have had previous problems with the route of reconstruction then it is time to consider using autologous tissue with either a TRAM flap or a LD flap.
Wound healing problems following radiation
It isn't uncommon to have wound healing problems after radiation therapy. Since you have failed implant-based reconstruction already, there is a very high probability that you will fail again. These problems arise from the damage that radiation causes to the surrounding tissues and skin -- it limits the ability of the skin to stretch over an implant and impairs the vascular network in the skin so that it doesn't heal or becomes infected. Based on the literature, we know that under these circumstances, any type of implant-based reconstruction has a high failure rate. I would recommend that you consult with a board-certified plastic surgeon and discuss autologous tissue-based options for breast reconstruction -- such as the TRAM flap, DIEP flap, or latissimus flap. These types of reconstructions use your own tissue to make a breast and have a much higher success rate in women who have had previous radiation therapy. Good luck!
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