So far the oncologist has not said I need radiation but I don't think she has completely ruled it out either. I would like to have reconstruction with my bilateral mastectomy to put in implants with a skin sparing mastectomy as well. My question is will the doctor's know for sure if I need radiation before I actually go into the surgery? Knowing this will impact the decisions on reconstruction because I know implants don't fare well with radiation.
I Am Getting Chemo Before Mastectomy. When Will I Know if I Need Radiation After Surgery?
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Doctor Answers 4
Is radiation therapy part of my cancer treatment?
This is a great question that is often difficult to answer until the final pathology from your mastectomy is known.
Most plastic surgeons have a close relationship with their breast surgeon, medical oncologist, and radiation oncologist to gain advise on the probability of radiation.
For any patients I see in consult who fall into this gray zone, I will contact their cancer doctors before I solidify my treatment plan. In most of these cases, I utilize a delayed immediate reconstruction where i place a tissue expander during the mastectomy and then determine the final reconstruction plan based on the pathology and subsequent cancer care.
I wish you a safe and healthy recovery.
Will Radiation be Needed?
You ask an excellent question. You will likely fall in the the category where patients do not know until after their mastectomy and sentinel lymph node biopsy whether radiation will be needed. In these cases, I give the option for my patients to proceed with my "delayed-immediate" technique. In this modality, I proceed with immediate breast reconstruction at the time of the mastectomy with tissue expander implants. We then wait 1-2 weeks to get the final verdict from your cancer care. If you do require radiation, you can proceed with your radiation with your tissue expander in place. Some radiation oncologist prefer some deflation of your tissue expander while others do not. Once your radiation has been completed, we give 6-12 months to allow the radiation effects to "cool off". Then on your radiated side, I recommend autologous reconstruction (DIEP to LD Flap). However, if you do not require radiation therapy, you can complete your implant reconstruction or even opt for delayed tissue only reconstruction. In this modality, you never had to experience to post mastectomy chest wall defect. Please talk to your PS to see what he/see prefers in this scenario. There is a multitude of opinions on how best to deal with your scenario.
Breast reconstruction and radiation decisions
Traditional dogma was to not start anything if you would potentially be radiated (XRT). As indications have expanded for XRT we run into this more frequently. At this point for patients who are favorable reconstruction candidates should go on and place the tissue expanders prior to radiation. In my experience as a high volume surgeon with this, I think the patient is better off establishing the breast mound and seeing what happens as we increasingly find we do not have to do traditional morbid flap procedures to replace the skin. This is true particularly for small to medium breasts.
Patients who are otherwise relatively poor candidates for reconstruction (obese large breasted, elderly, diabetics, etc...) may be better off deferring reconstruction consideration until after XRT
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Radiation and Reconstruction
The decision on wether or not you will need radiation is dependent on tumor size and location, tumor type and lynph node status. Pathology from your original biopsy and from your mastectomy will also weigh in the decision. Your plastic surgeon usually would like to know if post-op radiation is going to be given as it may affect his decision making process and also your final post-op results. Please discuss in detail with you Oncologist and they should be able to give you a educated guess based on all of the above.
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.