Opting for Mastectomy after Starting Radiation.

I am currently in the middle of hypo fractionated radiation treatment for DCIS with microinvasion. I regret opting for the radiation and would like to stop this and get a mastectomy on that side. I am 8 radiation treatments in out of 18 total. Is is possible to opt for the mastectomy with implants now or will the fact that I've had 7 treatments increase the likelihood of complications? Thank you.

Doctor Answers 4

Radiation and breast implants

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I'm sorry to hear you are having regrets about the radiation. Unfortunately, likely there has already been too much change in the tissues at this point to safely consider placing tissue expanders or implants at the time of a mastectomy. Your complication risks of wound healing issues would be very high. I would talk with your team of doctors. Best wishes.

Leawood Plastic Surgeon
5.0 out of 5 stars 8 reviews

Radiation and then surgery

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You need to talk to your oncologist and medical team to see what they suggest. The radiation does cause changes to the underlying tissue and can impact healing.  Best of luck.

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

Opting for Mastectomy

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Dear Terri17,

It is never too late to opt for a mastectomy.  Many women complete radiation therapy and subsequently wind up having a mastectomy for recurrence.  And most of them do just fine.  The down side is that you have already had a significant amount of radiation - and it will impact your wound healing.  I'm not sure anybody can say how severe the impact is - as we have very few studies on partial courses of radiation - but you are at less risk than someone who completed the course and more risk than someone who had no radiation.  I know that's a pretty broad statement, but I'm afraid it's the best we have.  The good news about radiation is that if it looks good, it probably is good.  Meaning that if your skin isn't darkened and red and blistering and peeling, your damage is likely not too severe.  

If you were my patient making this decision, I would stop your radiation and then wait six months for the acute radiation changes to subside.  At that point I would proceed with mastectomy and implant reconstruction, making sure you understand that you may have some radiation related implant issues.  I would certainly hope they would be less severe since you had a lower dose of radiation, but I would not assume you wouldn't have any problems.  What would become complicated is what to offer you should you have a recurrence.  You may not tolerate a full course of radiation in the future since you have already had some doses.  But I'm not sure the fuzziness around that issue should stop you from making the treatment choice you want today.  Best of luck!

Dr. Jespersen

M. Renee Jespersen, MD
Fairfax Plastic Surgeon
5.0 out of 5 stars 7 reviews

Converting to mastectomy instead of lumpectomy and radiation

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I would discuss your concerns immediately with your team: radiation oncologist, surgical oncologist, medical oncologist, etc. Radiation permanently changes the tissues and also impedes wound healing, so you may need to wait a few months before undergoing a mastectomy. Also, if you are interested in breast reconstruction, radiation is considered a relative contraindication for implants. As a reconstructive surgeon, however, I find that mastectomy and natural tissue reconstruction often provides a better cosmetic result than lumpectomy and radiation. 

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