How Long After Radiation Should I Wait for Expansion Process and DIEP Flap Reconstruction?

I had a bilateral mastectomy with insertion of tissue expanders at same time followed by 25 radiation treatments to my left breast and chest wall area. Radiation treaments finished on December 27, 2011. How long should I wait before (1) saline expansion and (2) DIEP flap reconstruction can safely take place? Am not in a hurry. I care only about safety and having a successful outcome. Thank you.

Doctor Answers 6

DIEP Flap Breast Reconstruction after Radiation

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I typically prefer to wait 6 months after radiation therapy to consider diep flap breast reconstruction.   Radiation does not only damage the skin, but the underlying muscles and blood supply.    


As microsurgeons, we want to ensure that the blood supply has had a chance to recover from radiation, such that we can safely reconnect the blood supply of your diep flaps.   We typically use the skin as a guide to what is underneath.   Hence, if your skin still looks poor after 6 months, we will elect to wait more time.


In regards to patients who elect for expanders and require radiation, we will begin re-expansion at 2 weeks, unless the skin damage is severe.    I also sometimes find that the radiation oncologists are comfortable radiating the expanders with them full of fluid, as long as nothing is added during the radiation treatment.   Of course, this depends on your cancer type and what is best for your treatment.


I hope this helps.


Dr. Gill

Houston Plastic Surgeon
4.8 out of 5 stars 95 reviews

Surgery timing after radiation

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It is debatable whether or not saline expansion can ever be performed safely after radiation, because of the high rate of complications associated.  Flap surgery may be a better option and typically a wait of 3-6 months or more may be warranted depending on the degree of inflammation and swelling present after the radiation.  Consultation with a plastic surgeon who offers both types of surgery is recommended.

Michel C. Samson, MD
Daytona Beach Plastic Surgeon
5.0 out of 5 stars 9 reviews

Radiation and tissue expansion.

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Tissue expanders placed immediately at the time of the mastectomy with the intention of exchange to DIEP flaps is fairly regular practice to limit the amount of skin replacement necessary if radiation is needed. Expansion post radiation can begin as early as 2 weeks after the radiation. Much of the timing is dependent upon the clinical impact of the radiation to the skin flaps (erythema, hyperpigmentation, dermal edema), the degree of expansion needed, and the overall thickness of the flaps. There are some who feel that expansion should proceed within 3 months of radiation to take advantage of pliability of the flaps prior to contraction from radiation fibrosis. Others like to wait until all of the radiation effects have come to a conclusion. Fibrosis and soft tissue changes secondary to the radiation can continue as late as 18 months following the radiation. With the impending exchange from expanders to a flap based reconstruction, some of the risk from radiation is mitigated by removing the prostheses from the reconstruction. However, any reconstructive technique in a radiated breast will be subject to higher complication rates and a possible compromise in the final result.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

See two or more board-certified plastic surgeons to be sure you are a good candidate for the DIEP flap.

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Implant-based reconstruction with implants/expanders has a very high rate of complications after radiation therapy.  It is customary to wait 6-12 months to perform tissue reconstruction to let all of the inflammation associated with radiation subside.

See two or more board-certified plastic surgeons to be sure you are a good candidate for the DIEP flap.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Tissue expansion and DIEP flaps after radiation

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Tissue expanders have a much higher complication rate in the face of radiation. Usually if a TE is used, it should not be expanded until 4-6 weeks after RT is complete.  DIEP flaps can be done about that same time after RT if it is being performed as a delayed reconstruction.

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

How long after Radiation can reconstruction begin?

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I would tell you that I typically tell my patients wait 6 weeks. I would tell you that saline expansion is not a good idea in the face of radiation, lots of complications and usually fails. DIEP flaps are an excellent method of reconstruction in the face of radiation. Make sure your surgeon offers both , is BC in PS and good luck in your reconstruction process!!

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