I'm going to have DIEP done with skin sparing. Is It Good to Have Reconstrution Breast Surgery After Radiation Therapy?

I had radiation therapy to both breast and now is going to have a DEIP TRAM done with skin sparing. I was wondering about the skin changes after radiation? And is it ok to use radiated skin or should I not do the skin sparing. Thank You for your time.

Doctor Answers 6

Breast reconstruction after radiation

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This should be discussed with your plastic surgeon but I would probably NOT advocate a skin sparing approach after radiation and would remove as much of the radiated skin as possible and replace it with non-radiated abdominal skin.  It will look more patch-work but the skin will be way better and softer.

DIEP flap for breast reconstruction is a natural form of reconstruction

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The perfusion of the radiated skin can be checked in the operating room to better help understand how much should be removed if any.  The skin pattern can then be designed on the flap prior placing the flap beneath the mastectomy skin.

Three basic forms of breast reconstruction exist. You can use your own tissue, implants or a combination of the previous two techniques. Your own tissue can be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting. Implants can be done in one stage or two stage. Two stage reconstructions are started by placing expanders at the time of mastectomy. Once they expanders are placed they are able to be inflated as determined by wound healing. The final time consists of combining any of the above techniques.

If you are interested in being seen in Austin please give us a call. I know this is a difficult time for you. The majority of my practice is devoted to reconstruction for women with breast cancer or who are BRCA+

Breast Reconstruction Post Radiation

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Generally speaking, the side which received radiation will not be a candidate for a skin sparing approach.   The skin often contracts and thickens after radiation.  This can affect the shape and feel of the reconstructed breast.   For this reason, we prefer to remove the radiated/damaged skin and replace it with healthy soft skin and tissue from the abdomen.

I recommend waiting 4-12 months after radiation is complete.   Close followup with your plastic surgeon after radiation will help them determine the appropriate time to do the reconstruction.

Paul S. Gill, MD
Houston Plastic Surgeon

Breast reconstruction following radia

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You will not lose anything by starting with the skin sparing technique for your mastectomy.  After your surgeon raises the dieps he or she will make a determination on the quality of the skin flaps.  If the circulation is deemed adequate, the Diep flaps will be placed and only a small skin island will show.  If the skin flaps look poor, your surgeon will have to debride the skin until adequate bleeding skin is identified.  The diep flaps skin island will then be fashioned to encompass the defect of skin.  The downside is the patch appearance, however this outweighs wound complications from compromised skin flaps.  Good luck with your reconstruction.

DIEP flap after mastectomy with radiation therapy

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Thank you for your question. Often times, the breast skin will not move or stretch outward after radiation. If this ends up being the case, then the radiated skin will likely need to be removed.  Discuss these specific details with your plastic surgeon at your next visit.

The type of mastectomy will depend on the size of tumor and skin changes post radiation

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I would like to know the reason for the radiation and the time since the radiation. The quality of your breast skin post radiation is the main factor. Your plastic surgeon and breast surgeon should make the decision post examination. If your breast surgeon can do the skin sparing mastectomy,you will get better cosmetic result and the new trend is nipple sparing mastectomy in patients with small tumor .There is a big difference between DIEP and TRAM flap. We do not take any muscle with DIEP flap in comparison to the TRAM flap that requires removal of the rectus muscle.

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.