What is the Best Reconstructive Option for my Lumpectomy/Radiation?

In June/06 I had a lumpectomy w 2 levels of lymph nodes removed, followed by 21 treatments of radiation. I would like to slightly enhance and be as even as possible. My first thought was a lift on L breast for symmetry. Then implants to enhance. After researching on implants, I see this is a bad idea, especially after radiation. The simpliest is to just lift my L breast and be grateful. However, that would not help with the volume I desire on my upper breasts(surgery on the R left quite a dent

Doctor Answers 10

Post radiation breast deformity.

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Radiation creates a permanent change in the soft tissues of the breast. The type of radiation (whole breast, partial breast, brachytherapy) will impact the tissues in different ways.The changes in the breast relate to the disruption of the vascular supply and the creation of scar tissue from the radiation. Thus, surgery on a radiated breast is usually discouraged unless the defect is significant. Any surgery on a radiated breast increases the risk of complications. This is particularly true with breast implants. The risk of infection, capsular contracture, and poor wound healing persist despite the years that have gone by since the radiation. Despite these risks, successful surgery can be performed. For post-lumpectomy defects, fat grafting and local tissue rearrangement often work quite well. Augmentation with an implant is associated with higher complication risks, but these may be attenuated with submuscular implant placement. I recommend a consultation with a plastic surgeon with a lot of breast reconstruction/enhancement experience to find out what your specific options would be.

Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

Uplift for lumpectomy defect

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I think that you would get a great result from a bilateral uplift with a small reduction of your left breast.  It will restore the volume to the upper pole of both breasts and will even out the volume difference.  It won't enhance the volume of your bust, but it avoids the problems of implants, that you are right to be wary about.

Breast reconstruction

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You have multiple options and all will give you a good result.

1: Fat Transfer to the righr breast.

2: Bilateral breast lifts and submuscular implants

3: Do nothing, you look great

Samir Shureih, MD
Baltimore Plastic Surgeon

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What is the best reconstructive option for my lumpectomy/radiation defect?

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Hello!  Thank you for your question and photo.  Fat grafting has become a popular procedure to improve aesthetic outcome following breast reconstruction or for improvement of contour after lumpectomy. Much of the newest research has investigated the properties of fat, in terms of its stem cell properties and associated advantages. It has significantly ameliorated radiation damage by increasing vascularity. Also, it adds additional "fatty tissue" atop the reconstructed breast mound to further contour any concavities or deformities, while also masking implant visibility with rippling and such.  Your photo certainly demonstrates that fat grafting may be a nice option for you along with lifting of the opposite side for symmetry.  The fat could be used to augment the size of the smaller breast as well filling the defect.

At our Breast Reconstruction Center, we have utilizing this technique almost routinely to maximize the aesthetic outcomes after lumpectomy or mastectomy. We have utilized the micro-fat grafting technique, and have been obtaining maximal fat graft survival into the breast. After harvesting of the fat from areas with excess fat, usually the belly, hips, or thighs, the fat is processed and injected back into the breast using the aforementioned techniques. Our patients have been very happy with the results as well as the areas where the liposuction was performed. Contour has been much improved using the micro-fat grafting technique, and the downtime is minimal.

Fat grafting has become a mainstay in breast reconstruction and has added another edge to breast reconstruction for aesthetics with minimal morbidity and complications.

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Best option after lumpectomy and radiation.

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Implants should never be used alone in a radiated breast unless it is combined with another flap for coverage. To get more volume in a radiated field you need to use your own tissue. A TRAM flap is just one tool used in breast reconstruction. It sacrifices your stomach muscle but provides fat on a leash to your breast.. Another is a DIEP flap which also uses your belly tissue but does not sacrifice your stomach muscles. It essentially uses the same tissue that would be discarded in a tummy tuck but relocates the tissue to create a breast. A third option is the Latisimus flap (back muscle); its best use is along with an implant. These "autologous" tissue (your own tissue) can be used in any breast reconstruction. Women prefer it because it is their own tissue. It is also an excellent option for someone who has had radiation. You should consult with a plastic surgeon who offers all three of these methods as well as the implants, so that you have the best choice of options

Breast reconstruction after radiation

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Your reconstruction will depend on what you want to achieve.  The simplest option would be undergoing breast reduction/lift on the left breast.  However, if you want to be fuller, you will need breast implant.  As you may know, radiation gives a higher risk for implant-related complication such as capsular contracture.  Unfortunately, radiated breast will always have some degree of asymmetry (texture, size).  Please visit with board-certified plastic surgeons to review your options (implant vs. autologous) as well as all potential risks and limitation.  

Reconstruction options after lumpectomy and radiation

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Your case is an example of why lumpectomy and radiation is not always "breast-conserving" treatment. Radiation does cause permanent changes to the breast, which may be magnified by removal of tissue with lumpectomy. Since you are in Canada, you likely had the Canadian protocol for radiation which is a lower dose (but just as effective) so your tissues may not be as damaged. A plastic surgeon would need to evaluate you and see if implants might work, with a lift on the left side. Acellular dermal matrix such as Alloderm can help prevent capsular contracture, which is more likely to occur with implants after radiation to the breast.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Tissue flap options can restore contour and enhance volume after lumpectomy and radiation

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Radiation after breast cancer surgery can cause * scarring * loss of volume * dimpling and contour irregularities * nipple asymmetries. While implants are a reasonable first option, you are correct as one must be cautious when considering implants when theras has been radiation to the breast. There is about a 40-50% chance of needing further surgery to correct capsular contracture. Using your own tissue (skin and fat) to enhance volume and symmetry can be a great way to get the results you want. The DIEP flap technique aims to transfer tissue from the abdominal region to the breasts while sparing the abdominal muscles - this is a key difference from the TRAM flap which sacrifices the muscles. Patients also get a tummy tuck which is another advantage. While I am unable to see your abdomen, you may be a candidate for the DIEP flap to create symmetry and increase volume.

Ariel N. Rad, MD, PhD
Washington DC Plastic Surgeon
5.0 out of 5 stars 57 reviews

Fat transfer or lift only

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I would agree with Dr.shureih. Your breast done well after radiation and all the mentioned treatments would work

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

Breast reconstruction

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Now that you are several years out form radiation treatment, it should be okay to have breast implants placed if you want more volume.

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