Is It Okay to Start Filling the Tissue Expanders After Radiation?

I am sure your own plastic surgeon is in the best position to know the circunstances. I would say the ideal scenario would be skin-sparing mastectomy and then as much expansion as your surgeon feels is safe before the radiation. Wishing you all the best.

You are correct to worry about tissue expansion after radiotherapy.  Radiation irreversibly damages all tissues and makes tissue expansion very difficult and prone to complications.  For this reason most plastic surgeons recommend against using tissue expansion and implants in irradiated tissues.  You have decreased tissue elasticity meaning the amount of tissue expansion that is possible is decreased, you have increased risk of infection, capsular contracture and extrusion of the implant.

If implants is the way to go, then you want the tissue expansion to take place rapidly prior the radiation.  This is the Memorial Sloan Kettering approach.  And even with this approach you are still at increased risk because of the subsequent radiation.

An ideal option would be to use your own tissue such as a DIEP free flap prior to surgery

(reconstruction before or after radiation is a controversial topic, but in my experience reconstruction prior to radiation is better)

Sincerely,

Martin Jugenburg, MD

If expansion is not successful after radiation,an open capsulotomy(surgical release of the capsule) should be performed.The expander should then be filled and even over filled to splint the released capsule fo several months

On volume reduction we have found that most capsules remain soft 

Breast reconstruction with expander and implant surgery will be more difficult and more prone to complication when done after radiation therapy. As long as you and your surgeon are both in agreement with this approach, I see no reason why it cannot be done. The alternatives include flap reconstruction which can still be done as a backup plan if expander and implant reconstruction are not satisfactory. Your surgeon may be able to accomplish some expansion in the 8 weeks prior to radiation therapy.

Hello,

The answer here depends upon how firm your tissues become with irradiation and this varies between patients. They might stretch,but then again they might not. It is not standard to use implants and expanders after irradiation. Flap reconstruction is more reliable in this situation, but I gather that you may have discussed this already with your surgeon. If you are content to go this way, understand that it is unpredictable.

 

Best Regards,

 

John Di Saia MD

Sometimes surgeons do exactly what is described by you.  But I will say that tissue expansion of irradiated tissue may not work well and certainly has higher complications.  Delayed reconstruction is probably the safest.

There is a very fine line of inflating a tissue expander after radiation too quickly or waiting too long. If you inflate too soon, you could have problems with tissue breakdown. If you wait too long you could have problems with expansion due to scar. Since you do not want a flap, this is, however, your very best alternative. If your surgeon has had significant experience with breast reconstruction, since he is examining your tissues, trust him. Though problems do occur, even with significant care in the surgery and subsequent filling, I have had very good results with tissue expanders in irradiated tissue after mastectomy. Your young age also helps.