Double Mastectomy with Immediate Reconstruction and then Radiation - Timeframe for Expanders?

I am 38 years old diagnosed with breast cancer,had chemo before surgery and I am going to have a double mastectomy with immidiate reconstruction the problem is that i need radiation too ,i have to start rads 6-8 weeks after surgey.I am very small chested(A cup,0 body fat) but i definetly want to go bigger, I was wondering if 8 weeks is enough time to get expanded?What cup will i be in 8 weeks? If i go with one step procedure with alloderm is better than tissue expanders?

Doctor Answers 11

Breast reconstruction and radiation

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in general, for women undergoing post-mastectomy radiation therapy, it is preferable to use her own tissue.  This tissue may come from the abdomen (diep flap), thighs (tug flap), buttocks (sgap flap), back (latissimus or tap flap).

Chicago Plastic Surgeon

Radiation Is The Wild Card In Breast Reconstruction

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Anytime a woman definetely needs radiation after their mastectomy, and this is known beforehand, the decision to perform immediate breast reconstruction must be thoroughly understood.  Radiation can cause a number of issues to a breast reconstruction, and about 1/2 the women that have an expander and get radiated will need some sort of "salvage" procedure with their own tissue due to the radiation effects.  Patients need to be aware of this when undergoing an expander in the face of radiation.  8 weeks may be enough time to expand to the desired size, but everyone is different.  The one-step reconstruction with an implant initially is not recommended.  I hope this helps.

Breast reconstruction and radiation

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As has been said here by many of the other surgeons,  radiation can have deleterious effects on the final outcome of reconstruction. However, it is highly variable, depending on the dose of radiation, preop size and shape of the breast, and the amount of tissue remaining between the skin and the muscle layer.

I prefer a two-stage process with initial use of Alloderm, which allows for faster expansion prior to radiation, and a tissue expander placed at the first stage. I expand as quickly as the patient tolerates before radiation must commence, as the radiation doctors will not want  the zone of radiation treatment to become a "moving target." I don't like an immediate one-stage direct-to-implant approach because radiation may significantly alter that outcome and turn a planned one-stage approach into a three- or more-stage program if complications occur.

After radiation is over, the skin of the radiated side may behave and look different from the other side. There is no clear consensus as to how long to wait after the end of radiation before completing the reconstruction. It depends on the pliability of the skin envelope. I counsel my patients that radiation might limit how large a reconstruction we can achieve with implants, if no tissue flap is going to be done, and that capsular contracture and complication rates are higher in radiated breasts. Some patients have to have their treatment plans altered after radiation because of an inadequate, or too tight, skin envelope. The plan might have to be altered to include a latissimus dorsi or other tissue flap.

Best wishes for a healthy outcome.

Tim Sayed, MD, MBA, FACS
Newport Beach Plastic Surgeon
5.0 out of 5 stars 22 reviews

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Double Mastectomy with Immediate Reconstruction and then Radiation - Timeframe for Expanders?

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I wish you a speedy recovery. With that stated, I believe it is possible to expand to a B cup with twice weekly sessions. As for the Alloderm, et al options very hard to advise without in person evaluation. But a great idea. From MIAMI 

Radiation and expanders?

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If you are definitely getting radiation, you may want to opt for a delayed resocntruction because tissue expanders and implants during radiation usually do not turn out too well.

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

Double mastectomy with need for radiation- timing for expansion

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If you want to go bigger than your current A cup, you will have more control over the final size with a two stage reconstruction (expander then implant) than a one stage reconstruction (straight to implant). The size that you will be after expansion depends on how much fluid can be added to the expander each week after the expanders are placed, and each patient is different. You are right, that once radiation starts, expansion has to stop. After the radiation is completed, it impossible to resume expansion if you still want to go larger and if your skin is healthy enough. Using alloderm or a similar dermal allograft allows more expansion at the time of surgery and reduces capsular contracture during radiation.

Nia Banks, MD, PhD
Washington Plastic Surgeon
4.0 out of 5 stars 27 reviews

"Direct to implant reconstruction resists radiation"

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I am so sorry to hear of your condition.It has been recently published by my group that the use of immediate reconstruction and acellular dermal matrix (Alloderm) may reduce problems after radiation therapy and capsular contracture. My patients who want to be slightly larger now go directly to an implant avoiding expanders and get radiation after. We have no one who has developed contracture. Hope this helps....

Breast Reconstruction

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There are many issues to be considered here and it seems that you  need more explanations before the surgery.

My advise is to sit with your plastic surgeon ( You need an hour to an hour and half) to discuss your situatio.

Your plastic surgeon should talk with your breast surgeon, oncologist and radiation therapist. Then meet with you again and dicuss what they all feel is best for your condition. Then what are the options for you in breast reconstruction

Make a list of your desires and questions.

Samir Shureih, MD
Baltimore Plastic Surgeon

Tissue expanders in breast reconstruction

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The fact that you are getting a mastectomy plus radiation suggest a large or aggressive type of cancer. The answer you seek is not a simple nor easy one. There are different philosophies and aaporaches and no specific "right" answer. It also depends on what body type you have and the surgery required. Certainly a "spacer" is a good idea as a first stage. Whether this is a temporary implant or an expander depends on the nature of the remain skin and the ultimate final goal. An expander may not be absolutely necessary but gives a degree of flexible, this safety, because it can be insert uninflated to protect the mastectomy skin. 

The key thing is that with radiation, you need to accept the relative imperfection of the implant procedure (because you are at higher risk for coapsular contracture) and that you must allow more than one-stage because of the unpredictability of post-radiation influences.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Tissue expansion after radiation

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Your question is extremely good, and important. It's likely you could be expanded enough prior to radiation (as long as there are no significant postoperative complications). I'm not sure what you mean by a one step procedure, unless it is Alloderm and an implant. This can work, but the implant doesn't stand up as well to the tightening forces of the radiation as the expander does. I usually use Alloderm in my expander reconstructions as well, and this should also allow for quicker expansion.

It sounds like you should probably have another meeting with your Plastic Surgeon to really clarify your options and to allow you to completely understand them.

Hope that helps

Verne Weisberg, MD
Portland Plastic Surgeon
4.6 out of 5 stars 18 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.