Had Radiation After Bilateral DIEP, Can I Get Nipples? What About Fix Symmetry?

I had a bilateral mastectomy and excellent DIEP reconstruction at the same time. Unfortunately, it was discovered due to the later pathology report that I would need 6 weeks of radiation with boosts to breast, chest wall and supraclavical area. Can I still get nipple reconstruction? And can doctors do anything about the shrinkage of the left breast? How long should I wait?

Doctor Answers 5

Had radiation after Bilateral DIEP, can I get nipples? What about fix symmetry?

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Thank you for your question!  Certainly, you can have both of these procedures done, even despite radiation.  Your flap should be well-vascularized and likely will not have any issues due to this reason.  I would await at least 6 months before considering reconstruction and symmetry procedures in order to allow adequate healing and maturing of everything following your radiation therapy.  Best wishes for a wonderful result!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Nipples and asymetry after radiation

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Wait at least 4 months after the end of radiation to have any treatments. You can also get nipple reconstruction without an issue as well as have the asymmetry fixed.

Radiation after Reconstruction

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Yes, you can still get nipple reconstruction.   To address the "shrinkage" you describe after radiation, your plastic surgeon can revise your DIEP flap reconstructed breasts to improve their shape and symmetry.   However, most surgeons like to wait at least six months after completing radiation to procedure with any revision.   At least six months is required to let the radiation effects "cool off".

Best of luck.

Dr. Basu

Radiation after breast reconstruction can disappoint

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Yes, you can get nipple reconstruction. You will likely have a more difficult time healing from nipple reconstruction but it still can be done. It is a good idea to wait 6-12 months after radiation before preceeding with any further reconstrucitve surgeries.

Regarding the radiation, it is unfortunate.  I'm sorry to tell you the radiation damage that has been done to your DIEP flaps cannot be reversed.  Also, later placement of implants under them can be very problematic and is not recommended.

Alternatives to nipple surgery include tattooing and custom-made adherent nipple prostheses (plastic ones you stick on when want and take off when you don't).

I hope this gives you more information and options to think about. Discuss any future plans for surgery with your plastic surgeon.



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

Nipple Reconstruction after Radiation

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You certainly can have nipple reconstructions following radiation therapy to your DIEP flaps.  The radiation does increase the possibility of delayed healing problems but these issues are often easily managed with local wound care.  Timing can be quite subjective.  In my practice I usually wait at least six weeks after radiation is completed before performing additional surgery on the reconstructed breasts.  Sometimes I will wait a bit longer if the flap skin/mastectomy skin appears swollen from the radiation.  Additional procedures to improve symmetry of the breast reconstructions can often be combined with the nipple reconstructions.  Autologous fat grafting to the radiated DIEP flap can be done to improve the size -- this may help the "shrinkage" of the flap that you mention.  Your doctor can harvest fat from your DIEP donor site -- abdomen -- and graft the fat into your radiated DIEP flap. There is a certain amount of the grafted fat that is reabsorbed by your body, but there will be a certain amount that will become permanent and survive.  This will enhance the volume of the flap and help to improve the symmetry of the reconstructions.  You will also have the additional benefit of an improved abdominal contour following the DIEP flap harvest!  I routinely perform this procedure for my DIEP flap breast reconstruction patients.  It allows my patients the freedom to further refine the size and shape of their reconstructed breasts and their abdomen.  I hope that you will find this information helpful.  Good luck!

Max Lehfeldt, MD, FACS
Pasadena Plastic Surgeon

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