I've been recently diagnosed with Stage 1 DCIS, and going to undergo lumpectomy. Dr. doesn't think radiation will be necessary. Can I still have breast implants? I had already scheduled my plastic surgery before my diagnosis and I am supposed to have behind the pectoral muscle silicone implants, about 2 months post lumpectomy. Please advise. Thank you.
Are Behind the Pectoral Muscle Breast Implants Ok After Lumpectomy, with or Without Radiation?
Doctor Answers 6
Implant alone in a radiated field not appropriate
Implants should never be used alone in a radiated breast unless it is combined with another flap for coverage. A TRAM flap is just one tool used in breast reconstruction. It sacrifices your stomach muscle. Another is a DIEP flap which also uses your belly tissue but does not sacrifice your stomach muscles. It essentially uses the same tissue that would be discarded in a tummy tuck but relocates the tissue to create a breast. A third option is the Latisimus flap (back muscle); its best use is along with an implant. These "autologous" tissue (your own tissue) can be used in any breast reconstruction. Women prefer it because it is their own tissue. It is also an excellent option for someone who has had radiation. You should consult with a plastic surgeon who offers all three of these methods as well as the implants, so that you have the best choice of options.
Implants after treatment for DCIS
DCIS is a non-invasive form of breast cancer and is typically treated with lumpectomy followed by radiation therapy or by mastectomy and no radiation therapy. I would suggest that you have a thorough discussion with both your oncologic surgeon and your plastic surgeon regarding treatment and reconstructive options. Depending on how you decide to treat your DCIS, this will impact the best type of reconstructive method for you. If you choose a mastectomy, you may be a candidate for an immediate breast reconstruction using an implant; or if you opt for a lumpectomy and possibly radiation therapy, you may need to wait for several months after your treatments before proceeding with reconstruction. Good luck!
Discuss yiou DCIS with your Plastic Surgeon
Please make your plastic surgeon aware of your breast procedure. You should find out your pathology and review that with your breast surgeon to make sure you have all of your information regarding the management of your DCIS.
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Asymmetry after lumpectomy
The main goal of your treatment is to cure the cancer. Thus, the oncologic surgeon will do what they have to do to make sure you have the best chance for cure. The cosmetic result of this procedure may require reconstructive surgery or you may simply be able to get breast implants. However, it will come down to the size of your breasts before surgery, the size and location of the lumpectomy, and whether or not you ultimately do require (or not require) radiation.
Options for DCIS breast reconstruction
Most cases of DCIS, a noninvasive form of breast cancer, are treated with lumpectomy and radiation treatment. If you are considering implants, it is very important to know whether you would be receiving radiation because that will make it much more likely to have problems with implants. An option that some women consider is skin-sparing mastectomy and immediate reconstruction. That may seem like a radical approach, but if the tumor is estrogen receptor positive then the mastectomy approach would allow you to avoid anti-estrogen therapy. You are smart to be asking questions and gathering information at this stage, best wishes for a good outcome.
Breast implants after lumpectomy
I am sorry to hear about your recent diagnosis of early DCIS. The fact that you are unlikely to need radiotherapy is excellent news - breast implants do not respond well to the effects of radiotherapy. My advice is to wait until your lumpectomy surgery and, importantly, the final results from the laboratory.
If all is clear and no further surgery nor radiotherapy is needed, then there is no reason why you shouldn't have breast implants. However...I would also recommend waiting at least 4-6 months after the lumpectomy to see how the scarring settles down and if there is any distortion of the breast - putting implants in too early may be the wrong thing to do.
Good luck with everything
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