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Is It Okay to Start Filling the Tissue Expanders After Radiation?

asked 1 year ago by nataly in California
Latest answer by Hilton Becker, MD
Question viewed 478 times
Tags: age 35-44, breast cancer, expander, radiation

Thank you all Dr's for my previous question.An update to my Q I am 38 ,did chemo for breast cancer before surgery,have to do double mast. and after 8 weeks have radiation. After meeting with a PS here is the plan: putting expanders with alloderm at the time of mastectomy but not having it filled untill after healing from rads then start the fills really slowly.Now i am worried that the radiated skin won't stretch and i dont want to do the dorsi flap thing.Whay is your suggestions? Thanks

8 answers to Is It Okay to Start Filling the Tissue Expanders After Radiation?

+1

Expander fill after radiation therapy

It is not ideal to try expansion of the skin after radiation therapy.  It is worth a try since that is where you are.  If it is not successful, then you may need either a latissimus dorsi flap or some other autologous tissue reconstruction, such as a DIEP or TUG.  The risk of complication in your situation is high, but not 100%, so I would go ahead with the plan.
Leif Liu Rogers, MD

Beverly Hills Plastic Surgeon

www.leifrogersmd.com

+2

Is It Okay to Start Filling the Tissue Expanders After Radiation?

Breast reconstruction with expander and implant surgery will be more difficult and more prone to complication when done after radiation therapy. As long as you and your surgeon are both in agreement with this approach, I see no reason why it cannot be done. The alternatives include flap reconstruction which can still be done as a backup plan if expander and implant reconstruction are not satisfactory. Your surgeon may be able to accomplish some expansion in the 8 weeks prior to radiation... more
Mark Preston, MD

Columbus Plastic Surgeon
+1

Expansion after radiation

If expansion is not successful after radiation,an open capsulotomy(surgical release of the capsule) should be performed.The expander should then be filled and even over filled to splint the released capsule fo several months On volume reduction we have found that most capsules remain soft
Hilton Becker, MD

Boca Raton Plastic Surgeon
+1

Expansion before radiation better than after

I am sure your own plastic surgeon is in the best position to know the circunstances. I would say the ideal scenario would be skin-sparing mastectomy and then as much expansion as your surgeon feels is safe before the radiation. Wishing you all the best.
Richard Baxter, MD

Seattle Plastic Surgeon
+1

Difficult question....

Hello, The answer here depends upon how firm your tissues become with irradiation and this varies between patients. They might stretch,but then again they might not. It is not standard to use implants and expanders after irradiation. Flap reconstruction is more reliable in this situation, but I gather that you may have discussed this already with your surgeon. If you are content to go this way, understand that it is unpredictable.   Best Regards,   John Di Saia MD more
John P. Di Saia, MD

Orange Plastic Surgeon
+1

Tissue Expansion for Breast Reconstruction after Radiation

There is a very fine line of inflating a tissue expander after radiation too quickly or waiting too long. If you inflate too soon, you could have problems with tissue breakdown. If you wait too long you could have problems with expansion due to scar. Since you do not want a flap, this is, however, your very best alternative. If your surgeon has had significant experience with breast reconstruction, since he is examining your tissues, trust him. Though problems do occur, even with significant... more
Robert T. Buchanan, MD

Highlands Plastic Surgeon
+1

Radiation and tissue expanders

Sometimes surgeons do exactly what is described by you.  But I will say that tissue expansion of irradiated tissue may not work well and certainly has higher complications.  Delayed reconstruction is probably the safest.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Tissue expansion after radiation

You are correct to worry about tissue expansion after radiotherapy.  Radiation irreversibly damages all tissues and makes tissue expansion very difficult and prone to complications.  For this reason most plastic surgeons recommend against using tissue expansion and implants in irradiated tissues.  You have decreased tissue elasticity meaning the amount of tissue expansion that is possible is decreased, you have increased risk of infection, capsular contracture and extrusion of... more
Martin Jugenburg, MD

Toronto Plastic Surgeon

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