Over the Muscle Implant Placement After Radiation Therapy?

I have had a bilateral mastectomy. I have under the muscle silicone implants. I had radiation treatment on the right breast and the implant is uncomfortable when using my arm and my muscle is very tight. Is it best to have my implants placed over the muscle? I had gone through the expander process before the implants.

Doctor Answers 18

Breast reconstruction and radiation

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In general, there is a higher chance of scar tissue forming around breast implants following radiation therapy.  Other techniques for reconstruction (flaps) may be helpful.  Tissue from the abdomen (diep flap), thigh (tug flap), buttocks (sgap), or back (latissimus or tap flap) may be used to reconstruct the breast.

Chicago Plastic Surgeon

Implants After Radiation...

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When radiation is used in the treatment of breast cancer, non-cancerous tissues in the path of the radiation are also affected. Radiation therapy can mean a significant loss of skin elasticity, which can profoundly affect the aesthetic results of breast reconstruction. And because the body’s wound-healing mechanisms are altered by exposure to radiation, complications from all types of reconstructive breast surgery occur at a higher rate.

Radiation is especially problematic for women who undergo implant reconstructions, regardless of whether the radiation is administered before or after the implant is placed. Natural-tissue reconstruction has the benefit of bringing non-radiated, healthy, well-vascularized tissue to the mastectomy site, and this can actually aid in the healing process.

It sounds like you are having tightness from a capsular contracture. Capsular contracture is the primary reason many women are unhappy with implant reconstructions after readiation. Switching the implant to a position "above the muscle" as you suggested, may make the problem even worse, and possibly create new problems such as erosion of the implant through the surgical scar.

Because of the potential complications associated with implants, breast reconstruction using natural tissue is generally considered the best method for women who will require or have already had radiation.

While radiation therapy can complicate breast reconstruction surgery, with proper preparation most women can achieve a satisfactory reconstruction even if radiation therapy is part of their treatment plan. Perforator flaps including the DIEP flap, SIEA flap and SGAP flap are all used routinely with excellent results to reconstruct patients who have required radiation therapy.

Reconstruction after Radiation

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I generally recommend some form of autologous reconstruction after radiation therapy.   If you are a good candidate, I would likley suggest a DIEP or TRAM flap to bring new healthy tissue and blood supply to your radiated chest wall to facilitate healing.  Please visit with a board certified PS to learn more about your options.

Dr. Basu

Houston, TX

Tightness of implants

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After radiation you may have sustained a tight capsule.  You may need alternative reconstruction to keep the implant protected and soften the pocket.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast implant suggestions

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You might be better served by taking the implants out. The tissues around the implants frequently respond to radiation therapy by becoming very prone to scar formation (encapsulation) and this can be painful. Implant removal (although not pretty) usually relieves this pain. An alternative reconstruction can be planned using your own tissues. These are still a bit more problematic after radiation therapy but are more likely to be successful.

John P. Di Saia, MD
Orange Plastic Surgeon

Your own tissues or new pocket reconstruction

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Radiation increases the chance of having capsule contracture and a tight deformed breast.

The classic teaching is to switch from an implant to an autologous reconstruction (your own tissues from the back or the tummy).

However, practically this is not always feasible or practical. Another option would be to perfrom a total capsulectomy (removal of all the internal scars), exchange the implant and use alloderm to create a new pocket. A muscle flap from the back could be used as well if needed. Hope that helps!

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews

Implants should stay under the muscle following radiation

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Dear Jenny:

It appears that what you are experiencing is something called a capsular contracture. This is a condition in which the scar tissue, that normally forms around a breast implant, becomes hard causing pain or possibly distortion of the breast.

Attempting to change the location of the implant will increse the possibility of wound breakdown leading to infection and possibly implant extrusion, which will result in the need for implant removal.

If the condition is not tolerable or worsens, you may need to have the capsule partially or completely removed. This will allow the implant to reside in a softer pocket decreasing your pain and improving the appearance of your breast.

One note of caution however, be sure your discomfort or appearance is something you can no longer tolerate before deciding to proceed with surgery. The incidence of problems is increased any time you operate on tissue that has undergone radiation.

Good luck.

David A. Robinson, MD
Munster Plastic Surgeon
4.7 out of 5 stars 46 reviews

Post radiation implant switch from unders to overs?

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I would strongly advise that you refrain from changing the position of your implants. You will be at an exceptionally high rate of capsular contracture, visibility and infection or wound breakdown

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Not an option

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Jenny from Canada,

Implant placement above the muscle is not an option in breast reconstruction with or without radiation. The symptoms that you describe are an unfortunate side effect of radiation therapy. A discussion with your board certified plastic surgeon will shed some light on the options to ease your discomfort. Good luck!

In breast reconstruction the implants must go under the muscle

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In breast reconstructions, especially with radiation, the implants must go under the muscle. You need to have adequate soft tissue coverage to protect the implant. Breast reconstruction is completely different than cosmetic breast augmentation. Additionally, radiation significantly affects the quality of the tissue covering the implants.

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.