Breast very tight and scar is hard and skin above scar so tight and lacking arm motion? (Photo)

I was a fail with breast recon. Had bilateral on 7/28/15 and reexcised margins after chemo and radiation along with complete capsolectomy. The tightness and pain I have every day. Plastic surgeon released me. im a model patient and plastic surgeon who operated on me says he can't help Me. I'm trying now to get into UF Shands in Gainesville and they offered a consultation. I'm on meds and in pain The scar is hard. Above my scar the skin is as if it's superglued so tight.

Doctor Answers 5

Radiated Breast Reconstruction

Thank you for your question. 

Radiation is a necessary component of many breast cancer treatment regimens. Unfortunately, it does come with a lot of side effects including permanent changes to the skin and fat. The scars may become tight, painful and adherent to the chest wall. In these situations it is difficult to do an implant-only reconstruction and I would favor some form of reconstruction using healthy, non-radiated tissue.  This would either come from the abdominal skin and fat(DIEP) flap or an alternative site such as the back thighs or buttocks.  We have extensive experience with these types of reconstructions and would be happy to evaluate you locally.

Orlando Plastic Surgeon

Breast Reconstruction

The radiation has made your skin very inelastic and has added to the scar tissue in your breast.  You would likely be a good candidate for use of an flap reconstruction like a DIEP or latissimus flap.  This brings new skin and soft tissue from another part of your body to create a breast since the tissue that is there will not heal properly.  Best wishes, Dr. T. 

Breast very tight and scar is hard and skin above scar so tight and lacking arm motion?

What you are descibing is post radiation contraction. Use of Brava expander externally and surgical reconstruction with Fat Grafting are the 2 options. Either one of them or both should hep. Also PIP injection therapy into the scarred areas on a weekly basis until pain syndrome gains relief.

Breast reconstruction failures

You've been through a lot.  Since you've had radiation, you need to have flaps, not implants, for your reconstruction.  That scar and fibrotic, scarred skin also likely needs excised, and will be replaced with your flap tissue (aka autologous tissue).  Your PS will help determine which kind of flap is best for you - I generally prefer the DIEP flap(s) unless there is a reason not to use them.  Can't promise you this will alleviate your pain, but it generally does.  You shouldn't have to suffer, so seek other opinions please and get your problem taken care of.  Be sure to find someone who doesn't just do all implant-based reconstruction.

Cain R. Linville, MD
Houston Physician
5.0 out of 5 stars 18 reviews

Breast Reconstruction - tight scar

Ok my recommendation is really simple - go to someone who actually does a lot of this type of work!  You need to release or remove the scarred area.  Then during the same operation, fill the area with grafted fat or replace the area with a flap from your back called a Lat. dorsi flap.  Radiation is always tough but if you have realistic expectations a lot can be done for you!!  Consider consulting with Emory University in Atlanta Georgia- they are a great center of excellence for breast reconstruction and at least consider going there if you can.  Best Wishes!!

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