Had Rads in 2007 & I Don't Have a Radiation Ulcer. Am Currently Going Through Breast Reconstr & Having Issues with Healing.

47 Yr old. Had breast cancer, chemo & rads (whole left breast) in 2007. Had bad mammograms at every 6 month f/up so I opted for bi-lateral MX. After each surgery my rads side gets necrosis. On 5/21/13 got implants & not healing left side - area size of a dime. New surgeon suggests I have the implant removed, cut out the "bad" area, TE back in & acellular dermal matrix to help. Is this common procdure, what is % you think for success? Abort the whole process? I have pockets?

Doctor Answers 7

Radiation and healing problems

How patient are you with set backs?  If you're willing to accept the risks, keep forging ahead.  But you are facing an uphill battle.  Is there a reason you cannot use your tummy tissue instead?  It could be a better choice at this juncture, especially when you consider how firm your reconstructed breast will be.

Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Radiation injury and tissue

Radiation is the gift that keeps on giving. It may always have a decreased capacity to heal without bringing in healthy tissue.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Improving Irradiated Breast Tissues For Better Wound Healing

It is time to improve the vascularity of your irradiated tissues. This could be done by injection fat grafting or a pedicled back flap depending upon the size and location of the breast wound. Continuing to work exclusively with the irradiated tissues without improving their healing potential is going to be a set up for ongoing healing problems. 

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Fat grafting strongly recommended as an option

In the face of radiation therapy I would strongly recommend you consider fat grafting as a reconstruction option. Staged fat grafting is in my opinion the most reliable way to restore the quality of damaged irradiated tissue, with the lowest risk of complications. 

Jeffrey Hartog, MD
Orlando Plastic Surgeon
4.5 out of 5 stars 60 reviews

Radiation necrosis and breast reconstruction

Radiation can cause these problems so this is not surprising. Statistically, you are at high risk for failure of any reconstructive technique involving implants. You can explore TRAM, DIEP or LD flap reconstruction. These techniques all have their own risks and limitations so a consultation would be necessary to determine whether they are prospectively viable options for you.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 42 reviews

Radiation and breast reconstruction can be a problem

Radiation can and does negatively impact breast reconstruction using tissue expander and implants.  If  you have had previous problems with the route of reconstruction then it is time to consider using autologous tissue with either a TRAM flap or a LD flap. 

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Wound healing problems following radiation

It isn't uncommon to have wound healing problems after radiation therapy.  Since you have failed implant-based reconstruction already, there is a very high probability that you will fail again.  These problems arise from the damage that radiation causes to the surrounding tissues and skin -- it limits the ability of the skin to stretch over an implant and impairs the vascular network in the skin so that it doesn't heal or becomes infected.  Based on the literature, we know that under these circumstances, any type of implant-based reconstruction has a high failure rate.  I would recommend that you consult with a board-certified plastic surgeon and discuss autologous tissue-based options for breast reconstruction -- such as the TRAM flap, DIEP flap, or latissimus flap.  These types of reconstructions use your own tissue to make a breast and have a much higher success rate in women who have had previous radiation therapy.  Good luck!

Anureet K. Bajaj, MD
Oklahoma City Plastic Surgeon
5.0 out of 5 stars 18 reviews

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