Radiation after implant reconstruction

fof2010

Hi all,

In January, I had a rt. breast mastectomy with latissimus dorsi reconstruction.  A temporary saline implant was put in as a tissue expander.  I also had an axillary lymph node dissection.  The lymph node dissection was a surprise since all of the testing had led us to believe there was a very small risk of lymph node involvement.  My pathology report said I had great margins and the cancer in the 2 sentinel nodes only were very small, just above the "micro" status.  I will be starting chemotherapy soon and that will go on for an 18 week duration. 

My question is regarding radiation.  I am considered a borderline case and have gotten 2 different opinions so far from radiation oncologists.  I am going for a 3rd opinion soon. 

I am considered "borderline" or in the "gray area" because I have minimal lymph node involvement and good clean margins.  Because my cancer was invasive and DCIS with quite a bit of small tumors throughout the breast is causing one of the radiation oncologists to recommend radiation.   However, the other radiation oncologist feels there just isn't enough benefit to outweigh the risks of lymphedema and encapsulation of the implant.

Has anyone out there been faced with this decision based on a similar diagnosis and the unfortunate circumstances where the radiation oncologists just don't agree?  Also, I have been told that encapsulation is pretty much going to happen if I radiate so to plan for that which can be a very involved process to recover from.

bdavis

So... are they talking about radiating the whole MX breast and lymph node area or just the breast? I could be presented witht he same issues... I have so far only had a lumpectomy but am considering a PBMX, and am thinking I would not need radiation if I do that... but I had microscopic invlvement in nodes, so am unsure what they will decide.

fof2010

So far they are planning on radiating the breast and lymph nodes.  My situation is different than yours due to the mastectomy and all my tumors were small (.1mm to .4mm).  I did not have what was considered a larger tumor that typically will dictate radiation treatment.  Also, quite often radiation follows lumpectomy whereas with a mastectomy it may or may not be recommended as a follow-on treatment.