Existing Implants Instead of Expander Used in Breast to Be Radiated, then Reconstructed with DIEP Flap. Should I Remove Implant?

I already have silicone implants, and will be getting a masectomy of my left breast in about 1 week, and will be undergoing radiation after, then reconstruction later. My ps will be placing Alloderm over my existing implant and leaving implant in instead of using a tissue expander prior to radiation. I'm wanting to do a DIEP flap reconstruction later and remove my implants. Is it necessary to leave my implant in prior to radiation? Should I have my implants removed completely first?

Doctor Answers 4

Existing implants instead of expander used in breast to be radiated, then reconstructed with DIEP flap. Should I remove implant

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Hello!  Thank you for your question.  It probably doesn't matter if you keep your existing implants in at this time.  This could serve to keep the pocket open in preparation for further reconstruction.  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!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Implant breast reconstruction

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It is more common to place an expander after a mastectomy than an implant because it gives you the option to increase the skin envelope with expansion.  However, an implant can work if a skin sparing mastectomy is performed and it is not excessively large.  The radiation oncologist may have an issue with the implant due to the mass effect of the implant on the radiation beam so they will need to be consulted about this.  In general it is good to place a device under your skin to salvage as much tissue for the eventual reconstruction.

Breast Reconstruction after radiation?

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Excellent question, Breast Cancer is a disease that 1 in 8 women will have to deal with. Very difficult to answer this question without an exam and history, but in general breasts that are radiated and have an implant or tissue expander in place have a higher rate of complications, and maintaining an implant is not absolutely necessary. But, people certainly sequence the procedure like your PS is proposing.Lots to talk about and I recommend consulting with someone who is experienced with DIEP flaps before proceeding, good luck!

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.9 out of 5 stars 93 reviews

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Breast reconstructon after radiation

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You pose an interesting question, but I am assuming based upon yoru description that the mastectomy will be performed( as a skin sparing?) while leaving your implant in place?  If so, while you  may develop a tight capsule the DIEP may be able to placed inside( buried) without requiring the skin of the flap to be used and therefore limiting your scarrring.  Hard to say without an exam.  Good luck.

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