Radiation or not/effect on DIEP

diplomom08

I have a rather complicated question.  I just had a uni-mast. on 11/11/2010.  I am pro on the least invasive measures to keep me healthy.  As it turns out, I was over-diagnosed (if you will), and have surprised every doctor that has worked with me.  I have no nodal involvement, all margins were negative (except the anterior, it was only 1.2 mm), and IDC tumor was less than 2 cm (however, I had massive amounts of DCIS).  I was orginally staged at anywhere from a IIA - III and now am officially a I.  Yesterday I received my Oncotype score and it was a 10.  The official word from my Onco is "no chemo necessary" and I am thrilled!

I am ecstatic with the turn of events and know that I am very lucky, for lack of a better term.  I will not have to do chemo and radiation is officially a gray area.  My question involves a previous thread where I read that radiation could be avoided if during reconstructive surgery the PS could achieve cleaner margins.  As an aside, we have discussed this idea with the PS and the RO and both are in favor if the location is close to the scar from the mast.  The RO says if the cleaner margins are then achieved, he would then not recommend radiation.

(I am sorry to be so long-winded, but don't want to leave anything out ...)

I guess my primary concern is the effect of radiation after reconstruction.  I am intending on having a DIEP and want my skin to be in the best possible shape for the surgery.  Is it best to just hope for clean margins and do the surgery, with the knowledge that I may end up opting for follow-up radiation?  Are there any cons to having radiation after reconstruction with DIEP?  If I opt for radiation, I am looking at 33 sessions.  

 Thank you for any and all advice, I am truly grateful for these forums.  

dlb823

Jen, I haven't been in your exact situation, but I did have a Diep and rads, and it worked out just fine.  I actually had my Diep along with my uni-mast... then chemo & rads... then Stage 2 Diep (scar revision & symmetry).  There was a difference of opinion between my local rad onc and UCLA PS re. which would come first -- rads or Stage 2 Diep, but in the end, my PS assured my rad onc that he was more comfortable working on radiated skin than possibly having to re-do his Stage 2 (which would have meant an additional surgery for me), if it was affected by rads, and that's the way we did it.  I had no problem with rads or Stage 2, but I also gathered from the experience that not all PSs are comfortable working on radiated skin.

Hope this bit of information helps some.  Obviously, the key is to be sure you have top notch doctors and that they communicate & work together to give you the best outcome.

Happy Thanksgiving -- and congrats on all the good surprises you've had in your journey!   Deanna

NancyD

I agree with Deanna that you should let the PS have a major say about this. But my personal feeling is that radiation should come first, and then any deformity or problem can be dealt with at the time of reconstruction, hopefully, in a single operation, rather than going through recon surgeries before and after the radiation.

I only had one recon surgery, after my rads. I didn't need a major Stage 2 (only had nipples done as an out patient). My DIEP took a little longer as my PS dealt with fat necrosis from mx and radiation, but all-in-all, it went smoothly.

diplomom08

Thanks!  We are meeting with the PS again tomorrow.  I don't envision either radiation and/or reconstruction before the new year begins, so we have time to look at all of our options.

I was really hoping (originally) to avoid radiation, but am a bit more open to it now due to other factors.  I really appreciate the responses!