Radiation changes in breast reconstruction.
Many changes occur to the breast skin and the underlying tissues in radiation. Changes in the skin tone, color, and texture are common. Moisturizers and breast massage can help significantly. The effects on the skin are similar to a bad sunburn, however many of the changes within the tissues are permanent. By having the expander fully filled prior to radiation, you are more likely to have a good outcome following exchange of the expander to an implant.
Expectations after Radiation Therapy
There are several types of radiation therapy, the type your radiation oncologist uses depends on type and location of your lesion. The skin changes can vary greatly from person to person and from type of therapy. Some of the changes can be permanent, such as loss of elasticity and pigment changes. The dark spots will likely improve over time, but may not resolve completely. After radiation therapy and replacement of the tissue expander with a permanent implant, the breast will feel softer, but will likely never look exactly like the other breast. Usually, with this technique the best you can expect is symmetry in clothing. In the off chance that you have any problems healing (which can occur after radiation therapy) and should need additional surgery, make sure your surgeon can offer all the options for secondary reconstruction, or can refer you to a surgeon that can.
Skin changes with radiation, massage can help
Radiation can damage healthy skin and cause contraction and color changes, as well as a decreased ability to heal. It is helpful that you have been expanded prior to starting radiation. I recommend massage of the breast on at least a daily basis during and and even after radiation has been completed. This can help keep the skin soft and supple. The skin will continue to change for many months, even after your radiation treatment is done. Speak with your radiation oncologist about a lotion they recommend, but Aloe (with no additives such as alcohol) is also a good option. Your plastic surgeon will want to evaluate your skin after radiation and decide the best option for your continued reconstruction. Best of luck!
Radiation treatment and it's effects
Radiation treatment creates irreversible damage to the involved tissues. The goal is to kill the cancer before the surrounding tissues is too much damages. Once the tissues have become irradiated, or 'burned', they are a lot less elastic, a lot more leathery. Wound healing potential is significantly decreased meaning that if operated on, these tissues are much more likely to become infected, to open up, or heal for a very long time. The great thing about your case is that you seem to have been expanded before the radiation affected your tissues.
After radiation therapy your tissues will settle down a little, some of the obvious marks of radiation will go away but the skin will never be the same as it was before the treatment. It's a necessary evil of this treatment.
Martin Jugenburg, MD
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.
I see my patients half way through their radiation treatments. If there are significant skin changes and distortion of the expanders or a flap then I will fat graft them 2 weeks after completion of their radiation therapy.
Radiation and skin changes
Skin changes can certainly develop from radiation treatment. The dark marks may or may not improve with time.
Breast reconstruction and skin changes during radiation treatment
It is not unusual to experience the skin changes you have mentioned during radiation treatment for breast cancer - redness, darkening (Hyperpigmentation, and skin contraction. Although some of the these changes can be permanent, most of these problems will improve over 6 to12 months following the radiation treatment. If your surgeon is pleased with your tissue expansion so far that is a very good sign that you are tolerating the radiation treatment well and should have a good result.
Radiation after mastectomy and reconstruction: permanent changes?
A lot of the changes with radiation are temporary, but some problems can take a long time to resolve. your own plastic surgeon can best advise you on timing for expander exchange to implant. It is a very positive sign that you are fully expanded before starting the radiation.