In 2003 I was diagnosed with DCIS (Ductal Carcinoma In Situ) of my right breast. I had two lumpectomies done which left my right breast a lot smaller than my left breast and I also had radiation. Now in 2012 I went to see a plastic surgeon and she recommended a left breast lift and reduction and an implant in the right smaller breasts. Is this something that is a usual recommendation?
Breast Lift and Reduction in One Breast and Implant in the Other?
Doctor Answers 10
Making the breasts symmetric after radiation
I am very wary about using an implant in a radiated breast. The chances of a capsular contracture after radiation are extremely high, over 50% (your breast gets high and overly firm). Of course it depends on how you look, but I use massive fat grafting to the smaller, radiated breast - at least 200 cc; then lift the opposite breast. This has the advantage of adding healthy, normal tissue to the radiated breast as well. Make sure to go to someone who fat grafts breasts routinely. They should use a small cannula, literally thousands of passes to insert the fat, through needle stick access points. Make sure you are cancer free and get a new baseline mammogram before your operation.
Breast lift/reduction in one breast and implant in the other?
Typically, implants in the setting of an irradiated breast has higher rates of complication, including infection, wound complications, capsular contracture, etc. Many surgeons, including myself, have placed implants to improve symmetry in these instances with excellent results. However, if your deformity is a contour issue with a soft tissue deficiency, placing an implant beneath the breast may actually worsen the deformity as it is not addressing the issue to "fill" the defect. For such problems, it may be a wiser decision to consider fat grafting for smaller defects, where fat is harvested for another area of your body and then reinjected into the defect, thus adding volume as well as having the added properties of fat graft stem cells. Autologous flaps such as local tissue, TAP, or LDMF may be needed for larger soft tissue defects. Of course, reduction of the other breast to create symmetry is an option, or a combination of procedures on both breasts. Best wishes!
Best Option for Reconstructive Breast Surgery and Asymmetric Breasts?
Thank you for the question.
It is quite common that patients benefit from different procedures performed on each breast. My only concern, based on the information you have provided, would be the use of breast implants in a previously radiated breast.
I would suggest that you do your due diligence in the selection of plastic surgeon and gain confidence that the plastic surgeon you choose has had significant experience helping patients in your situation.
Learn about the pros/cons as well as the potential risk/complications associated with each treatment option.
Only after going through this educational process, will you be comfortable making a decision to proceed.
Best wishes; hopefully you will be very pleased with the long-term outcome of any surgical procedure you choose to proceed with.
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Reconstruction in lumpectomy radiated breasts
using implants are always at higher risks for contractures. As long as you are aware of this and willing to accept that shortcoming, the recommended procedures will help improve your symmetry considerably. Understand that perfect symmetry is nearly impossible and that additional procedures down the road will be needed to maintain your results. Bottom line, picking this option does not burn any bridges for future reconstruction and many of my patients will pick this as well.
Correcting Breast Asymmetry
You describe a scenario that is not unusual. Nearly ten years after your lumpectomy and you may have noted a gradual progression of asymmetry from one side to the other. If your smaller breast is of an acceptable size for you, then lifting and reducing the larger breast would suffice. If however the smaller breast is not pleasing to you, then adding volume would be required. Although there may be more risks with the placement of a breast implant in the setting of previous radiation therapy, it remains an option
Reconstruction after breast cancer
Yes, it is possible to need different procedure for each breast. An exam in person wil help better delineate what woudl be best for you.
Reconstruction in the radiated breast
Thank you for the question. I believe using implants in the radiated breast should be the last resort as there are a high chance of complications including implant exposure as well as capsular contracture. I agree with your surgeon to undergo breast reduction on the larger breast and undergo mastopexy or breast lift on the smaller breast. In my practice, I would recommend you undergoing mastopexy or breast lift on the radiated side with the use of Strattice. This is a dermal template which allows your own body to deposit collagen and in my experience have added some volume to the breast tissue. This provides a very natural shape, long-lasting results and avoids the need for implants.
Reconstruction and contralateral breast surgery for symmetry
Your recommendation is quite reasonable. sounds like a good plan.
All the best,
Talmage Raine MD FACS
Partial Breast Reconstruction After Radiation Treatment
I would advise against using an implant in your radiated breast right breast. Implants are more prone to complications such as capsular contracture after radiation. Depending on your body shape, and how much tissue was removed from the right breast, you may want to consider reconstruction using your own tissues such as the latissimus dorsi muscle flap or even fat injections. Performing a reduction/lift on the left side for symmetry is an excellent idea and can be done at the same time as the surgery on the right breast or at a later date. It is best to discuss these choices with a board certified plastic surgeon. Good luck with your upcoming surgery!
Symmetrising surgery following wide local excision
This sounds reasonable to me, does it sound reasonable to you? If you are unhappy with this advice, which I suspect you might be since you have posted this question, then you should seek another opinion.
Personally, I like to do the minimal amount of work to the side which has had radiotherapy because it increases your risk of complications. If you have an implant on the right side, then there is an increased risk of capsular contracture, but if you are unhappy with the volume, then an implant will give you a predictable increase in volume. Another option would be fat grafting, although this would be best discussed in a face to face consultation.
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.