Failed Breast Reconstruction w/ Implant. Try Again?

Given the fact you have had irradiation of the breast and chest in the past makes you more risky to have an implant based reconstruction. 

Hello Stephanie,
I believe you have many options for reconstruction. I would advise you to fill out the BRA score and see what your risks are for each type of reconstruction. This may help you make a decision along with your plastic surgeons recommendation. Good Luck!

Thank you for this great question and hope that all of these answers will assist you in your decision.  Attempted implant-based reconstruction after radiation to the breast typically have a higher complication rate with a significant failure rate.  Complications, include, infection, wound complications, capsular contracture, and implant exposure/failure of expansion.  There are some very notable papers that have described adequate results with implant-based reconstruction in the setting of an irradiated breast, and so, it is not unreasonable to attempt this again, knowing that there is a significant chance, however, that it may fail again, especially given your previous experience.  

 

Flap-based reconstruction would be the wisest choice to consider, which would bring in well-vascularized tissue from a remote area of your body, thus ameliorating the damage that radiation has caused.  With the options for microsurgical, perforator flap breast reconstruction today, the minimal morbidity and functional deficits of these muscle-sparing procedures make them very attractive for women like yourself.  The DIEP or SGAP flaps are excellent choices for breast reconstruction using your own tissue, without the need for an implant.  Finding a plastic surgeon experienced with performing microsurgical breast reconstruction and discussing this option may be worthwhile.  

i would be very hesitant to try a tissue expander again in your situation.  what has changed to make you feel that the same operation would work  this time.  i agree with bringing in your own non-radiated tissue into this region to help  with the reconstruction. your back, tummy or buttock are all apprpriate donor sites.  but please go for it! t

I am sorry to hear about your ordeal, but I am sure there are options. It will be more difficult however because of scar tissue from the previous surgery and the radiation. I have had success using Alloderm with implant reconstruction after radiation. In the DC area you may wish to see Dr. Nahabedian or Dr Spear. 

Thank you for your questions. Radiated skin is usually non forgiving when it comes to complications. You can certainly try another tissue expander and implant but understanding the high risks associated with the procedure. If you use autologous tissue- your own tissue, a TRAM is not necessarily the only option. The perforator free flaps are a good alternative for natural tissue. I would see a board certified plastic surgeon who specialized in microsurgery specifically perforator flaps for a consult. Best of luck!

First off, congratulations on being a survivor!  Now, you face a common challenge for breast
cancer patients who have had radiation.  It
is unfortunate that expander - implant reconstruction has such a high rate of
infection and capsular contracture in irradiated patients because it is
typically considered the “easiest” reconstruction option to recover from.  The decision to try expander - implant
reconstruction again is completely your own as long as you understand that the
same risks are still there and you could end up with the same result.  I understand that flap procedures can seem a
bit overwhelming and the recovery more difficult, but the risk of infection is
much lower and there is no risk of capsular contracture because there’s no
implant involved.  I would recommend
discussing more autologous reconstruction options with your plastic surgeon as
the TRAM flap is not the only flap available for breast reconstruction.  In my experience, most patients prefer a DIEP
flap to a TRAM flap because tissue is mobilized from the abdomen and up to the
chest wall to create the breast.  Again, which
type of reconstruction you choose is up to you and your surgeon and I am only
making a general suggestion.  If you do
choose to try the expander – implant reconstruction again it is absolutely possible
that you could have an uneventful postoperative course and experience success
with no complications; just be prepared for any possible complications given
your previous history of infection.Be well and good luck!@norrisplastic

GIven the fact you have had irradiation of the breast and chest in the past makes you more risky to have an implant based reconstruction.  You experienced this and it failed.  I typically will only use a patient's own tissue at this point.  I have done this with abdominal tissue in the form of a DIEP flap which is not a TRAM flap.  There is little to no muscle tissue removal which leaves the abdomen in many cases just as strong as it was before.  The other option I use is a latissimus flap which is back tissue.  I do the first stage with the back tissue then a second stage where I use fat grafting to increase the size of the reconstruction.  I don't use implants in these cases.

In my opinion, I believe that anyone who has radiation should have their own tissue used to reconstruct the breast, particulary if they have already failed implant reconstruction.  The only exception would be if there is no tissue available to use (e.g. the latissimus muscle is gone or there is inadequate tissue in the abdomen to reconstruct).  Be cautious and consider a second opinion or third opinion.  Make sure your surgeon is certified by the American Board of Plastic Surgery

 

Samer W. Cabbabe, M.D.

Board - certified plastic surgeon

St Louis Plastic Surgery Consutants
 

First, you are a candidate for delayed reconstruction. You may want to reconsider an autologous reconstructive modality using your own tissue such as a DIEP or muscle sparing TRAM flap. To be a candidate, you must be in good health and have enough excess tissue in your lower tummy area. Another option would be to consider a latissimus dorsi flap + implant.   I generally do not recommend placement of implants after radiation because of an increased risk of scar tissue formation around you implant (also known as capsular contracture). 

In general, once tissue has been radiated, it will never be the same.   Please visit with a American Society of Plastic Surgeons member surgeon to review your options.  Best of luck.