Expanders and Radiation

I had double masectomy Sept 29 and expanders at same time. Have had much pain with right expander and must have 30 radiation treatments after chemo is finished. Radiation therapist now says expanders should never have been put in when radiation is going to be needed. The left tumor was 7cm and right 3.5cm. What should I do?

Doctor Answers 11

Radiation and expanders

Your current situation is not rare.  If radiation is not anticipated at the time of mastectomy, expanders can be placed.  An experienced radiation oncologist should be able to radiate with an expander present.  If there is an issue, your plastic surgeon can deflate the expander prior to radiation.  However, not that you are undergoing radiation, I highly recommend you talk to your board certified palstic surgeon about replacing the expander with your own body's tissue.   The complication rate is extremely high for expanders and implants after radiation because the tissue will no longer be pliable and leads to implant exposure and subsequent infection.

Saint Louis Plastic Surgeon
4.9 out of 5 stars 59 reviews

Expanders and radiation

It is not written in stone, but as a rule, expanders are not particularly recommended in the presence of radiation.  I would avoid further surgery for 6-12 months following your radiation treatment and then consider replacing the expanders with your own tissue (commonly from the back or the abdomen).

This sort of treatment is often long and may require several operations.  This forum is no replacement for a face to face consultation with a plastic surgeon who you can trust to look after you and guide you through this.  Good luck.

Jonathan J. Staiano, FRCS (Plast)
Birmingham Plastic Surgeon
5.0 out of 5 stars 20 reviews

Expanders and Radiation

Hello!  Thank you for your question.   After radiation, you have an increased rate of complications including wound problems, infections, thinning of the tissue, and decreased vascularity to the skin/tissue of the area.  The best method to reconstruct a breast following radiation therapy is with a flap.  The flap, which is skin, fat, and sometimes muscle, will serve to bring in healthy, well-vascularized tissue to the chest/breast area that will significantly ameliorate the radiation issues compounding the problem.  Microsurgical perforator flaps (such as the DIEP flap and SGAP/IGAP flap) are the newest and most-innovative procedures in breast reconstruction today.  As these are muscle-sparing flaps, the pain, morbidity, and complications such as those above, of these procedures are much less.  They are highly-complex procedures that few plastic surgeons performed and consult with one who is well-versed, trained, and skilled in these procedures if you are interested.  

There are many options to breast reconstruction including implant-based and flap-based procedures.  The complication rate with implants following radiation is reported as high as 60-70% in some studies.  Flap reconstruction is usually recommended, but there are several centers who perform implants following radiation with great success and results.  I typically prefer flaps, such as the DIEP flap.  Other flaps are the conventional TRAM, latissimus flap, SGAP/IGAP, and, TUG.

You are a candidate for other procedures, if you are willing to continue with your journey for a reconstructed breast.  Flaps such as those above, including others, are available.  The decision to continue with this will be your decision and what you are willing to go through.  There are risks and benefits with everything that we do in Surgery - discuss the various options with a board certified plastic surgeon who will educate you on all of the options and help you to decided if breast reconstruction or which procedure will be best for you.  Hope that this helps and best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Expander and radiation

Implants are rarely recommended to be used alone in a radiated breast unless it is combined with another flap for coverage. To get more volume in a radiated field you need to use your own tissue. A TRAM flap is just one tool used in breast reconstruction. It sacrifices your stomach muscle but provides fat on a leash to your breast.. 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.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.3 out of 5 stars 35 reviews

Expanders and Radiation

This issue is very controversial.  The concept is to preserve the skin envelope during the radiation therapy then perform the definitive reconstruction afterward.  The problem is that many radiation therapists do not feel comfortable radiating the area with a tissue expander in place.  Further if the expander gets infected during your therapy then there will be an interruption of your radiation.  Not sure what you can do at this point but check with your plastic surgeon.

Mark A. Schusterman, MD
Houston Plastic Surgeon
4.9 out of 5 stars 77 reviews

Breast reconstruction and radiation

in certain instances, tissue expanders may be placed at the time of mastectomy for women who will be undergoing post-mastectomy radiation therapy.  Although the expanders may be removed and replaced with a woman's own tissue (abdomen-diep flap, thighs-tug flap, buttocks-sgap, back-latissimus or tap flap).

Loren Schechter, MD
Chicago Plastic Surgeon
2.0 out of 5 stars 2 reviews

Expanders prior to radiation

Expanders are put placed in your breasts even if you are going to receive radiation postoperatively. THe expander acts as a spacer and prevents your breasts from contracting during the radiation period.

Arian Mowlavi, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 68 reviews

Radiation and tissue expanders for breast reconstruction

The short answer is you might be OK especially if Alloderm was used when the expanders were put in since this seems to have a protective effect against capsular contracture, which is the risk with radiation and implants. Wait and see before deciding.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 54 reviews

Placement of Tissue Expanders and Radiation therapy.

It is not wrong to place a temporary tissue expander implant should you need postoperative radiation therapy.  All of my radiation oncologists (trained from our nation's top tertiary care cancer centers) feel comfortable providing radiation therapy when there is an implant in place.  In some cases, depending on the tumor location and chest wall anatomy, we may take volume out of the tissue expander implant to facilitate radiation therapy.  On even a more rarer occasion, a radiation oncologist may even recommend tissue expander deflation.   Perhaps you should get a second opinion with a different radiation oncologist at a different center.   And remember, the worse case scenario is that you would have to remove your expander implant which is an in-and-out 15 minute or less procedure.  So don't worry, you have many options.  Approximately 6-12 months after your radiation treatment, I would generally recommend removal of your temporary radiated implant and definitive delayed reconstruction with your own tissue such s a DIEP or TRAM flap or a latissimus flap + implant procedure.   Please review my answers on breast reconstruction and radiation for more information. Best of luck.

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 212 reviews

Expanders and radiation

Radiation can cause problems with tissues that are going to be expanded. It often impairs the reconstruction because of the radiation injury.  If this happens, other treatment options are available including pedicled flaps like a latissimu dorsi and implant, a TRAM or even a  DIEP.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 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.