Is It Okay to Start Filling the Tissue Expanders After 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

Doctor Answers (8)

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

+2

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 therapy.


Columbus Plastic Surgeon
5.0 out of 5 stars 8 reviews

Expansion after radiation

+1

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
5.0 out of 5 stars 5 reviews

Expansion before radiation better than after

+1
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
5.0 out of 5 stars 23 reviews

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Expander fill after radiation therapy

+1

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 L. Rogers, MD, FACS
Beverly Hills Plastic Surgeon
4.5 out of 5 stars 16 reviews

Difficult question....

+1

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

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 23 reviews

Tissue Expansion for Breast Reconstruction after Radiation

+1

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 care in the surgery and subsequent filling, I have had very good results with tissue expanders in irradiated tissue after mastectomy. Your young age also helps.
 

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 4 reviews

Radiation and tissue expanders

+1

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
4.5 out of 5 stars 15 reviews

Tissue expansion after radiation

+1
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 the implant.
If implants is the way to go, then you want the tissue expansion to take place rapidly prior the radiation.  This is the Memorial Sloan Kettering approach.  And even with this approach you are still at increased risk because of the subsequent radiation.
An ideal option would be to use your own tissue such as a DIEP free flap prior to surgery
(reconstruction before or after radiation is a controversial topic, but in my experience reconstruction prior to radiation is better)
Sincerely,
Martin Jugenburg, MD

Martin Jugenburg, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 128 reviews

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.