Reconstuction after radiation?

peacestrength

I posted this in the reconstruction after radiation thread and wanted to post it here as well:

Can TE's and implants be placed after I've had radiation?  

Here's my situation...I didn't want immediate reconstruction, in fact I have been leaning toward 95% no recon leaving 5% open to the possibilitiy.  Well, I've been thinking about it much and wonder if I can have just TE's and implants...My PS said that lat dorsi was my option almost a year ago.  Before seeing him again, I wanted to ask here if you think it's possible to have just TE's and then implants placed? ...without fat and muscle. My radiated side skin looks really good - it is slightly darker still...not sure about the tissue under skin though.  I really don't want to go through lat dorsi surgery at this point - future, maybe.

Thanks for your input!

Kathleen26

They told me no, but I think every situation is different.   I would ask a plastic surgeon to see what the decision is in your case.

mary625

I've been told the equivalent of "no" to implants because there's something like a 90% risk of failure on the radiated side.  Disappointing.  

peacestrength

Thanks kathleen and mary...I'm thinking the same.  Darn, I wish there could be an easier solution.

victoriasecret

just surfing around here today !!!I will checkout reconstruction in a min...so your story sounds much like mine...I was 49 at diag.I just wanted rid of my breasts after one of them conspired to oft me !!!

I know many girls went for immediate or almost within a year or 2 to reconstruct...I am not sure if my age played a factor but I was not even thinking to reconstruct.

About year 2 I started thinking hey ! I am still here ,tired of looking in the mirror at my "WALL" I looked at my options.I really wanted to go the implant route as I thought that would be the most natural look .

Doc 1 HUGE wait list saw him in 2011 for consult...still waiting to hear back !!!! He said NO WAY to implants reason radiated sight and failure rate .He suggested Diep, I concurred with that did not want to go with any extra surgeries....but like I said my phone has not rung ......

Doc 2 Thanks to Let it BE  I had a referral in Toronto ,aprox 45 mins without traffic. I was impressed with this doctor and his stellar credentials...again no implants Diep. So I was gung ho to go after I posted on FB a good friend messaged me and had a contact with head of plastics in my area...I thought what the heck let`s just see what he has to say ...although I really was planning on going with Doc 2.

Doc 3 first impression -I liked him so off to a good start-I just went in and said - I am looking at having the Diep procedure because my homework had been done to this point. I have put some extra pounds on since all this crap went done and my line was ``not loosing any weight because I am harvesting some breasts `.` He actually said he did not think I had enough fat ...say what ...He went on to say he would prefer to do implants with perhaps a fat graft ..Yea for me .

So as it stands.. I am scheduled for the week after Labour Day....that's my story...now off to read

 

much love n light C

 

 

 

victoriasecret

just surfing around here today !!!I will checkout reconstruction in a min...so your story sounds much like mine...I was 49 at diag.I just wanted rid of my breasts after one of them conspired to oft me !!!

I know many girls went for immediate or almost within a year or 2 to reconstruct...I am not sure if my age played a factor but I was not even thinking to reconstruct.

About year 2 I started thinking hey ! I am still here ,tired of looking in the mirror at my "WALL" I looked at my options.I really wanted to go the implant route as I thought that would be the most natural look .

Doc 1 HUGE wait list saw him in 2011 for consult...still waiting to hear back !!!! He said NO WAY to implants reason radiated sight and failure rate .He suggested Diep, I concurred with that did not want to go with any extra surgeries....but like I said my phone has not rung ......

Doc 2 Thanks to Let it BE  I had a referral in Toronto ,aprox 45 mins without traffic. I was impressed with this doctor and his stellar credentials...again no implants Diep. So I was gung ho to go after I posted on FB a good friend messaged me and had a contact with head of plastics in my area...I thought what the heck let`s just see what he has to say ...although I really was planning on going with Doc 2.

Doc 3 first impression -I liked him so off to a good start-I just went in and said - I am looking at having the Diep procedure because my homework had been done to this point. I have put some extra pounds on since all this crap went down and my line was ``not loosing any weight because I am harvesting some breasts `.` He actually said he did not think I had enough fat ...say what ...He went on to say he would prefer to do implants with perhaps a fat graft ..Yea for me .

So as it stands.. I am scheduled for the week after Labour Day....that's my story...now off to read

 

much love n light C

 

 

 

peacestrength

Thanks Victoriasecert!

Anonymous

Victoria, same sitch here.  No implants due to lots of rads on the cancer side, so opted for the DIEP.  Have had two revisions, but not to sound too discouraging, these subsequent revisions did not do what we wanted.  I know sometimes women will do 3, 4, 5 revisions, etc.. but I said no enough is enough.  I think age plays a factor as well.  I'm late 50's.  Take time to weigh all options and find a skilled PS.  --Shelly

sbelizabeth

I was 56 when diagnosed, and they threw the kitchen sink at me.  Radiated me into a glowing, melted mess.  When I had the UMX they said "no TE's, with your hx they're bound to fail."  So I waited nine long months as a uni-boober and I hated it.  I ALWAYS had to wear that hot, heavy foob to be even. 

I had my DIEP in April 2013.  Yes, it's a long surgery, and I've had several revision surgeries, but it feels like they're meant to help me feel whole and beautiful and normal again.  I very much enjoy having two "breasts" on my chest.

Today at 1300 is probably my LAST revision--YAY!

peacestrength

What does "revisions" mean?  More sugeries?

victoriasecret

hey me again ...so I realized because of the word from 2 docs that implants were probably a no go...but Doc 3 seemed so positive. I did ask to see his work so waiting on that. I also know  a few girls on here that had implants (stg 3'rs)and while they did have a few glitches they had success.

What I did get from him was that ps in teaching hospitals like to perform Diep as a tool for their students. I actually never got to meet Doc 2 just one of his interns...

My surgery with Diep would be 10 hrs.as compared to 1 hr day surgery to start the implant process ...What am I in for ???

 

love n light

 

Cheryl

Lucca06

I am one of the rare exceptions as I did have a TE put in a year after having a mastectomy and radiation.  My surgeon agreed to it semi-reluctantly as I was so keen to give it a go.  There were a whole range of issues to do with my 'home' situation that meant it potentially offered the easiest recovery IF if it had worked.

My skin had healed amazingly but what I didn't account for was the impact of the radiation on the chest wall muscle.  The TE is placed behind this so the fills were really unbelievably painful as the muscle simply had no stretch due to being 'burnt'.  We very nearly got there I managed all the fills but 3 weeks before I was due to have the exchange surgery and a mastectomy with immediate reconstruction, my wound just broke down and opened up.  

I was told to wait another 12 months then to let my body recover, which I did and then in January this year I had an SGAP.  I will need to have some revisions done later in the year but I think ultimately it will have been the better route using my own tissue.

It isn't an easy decision deciding which option is best but with hindsight I would advise taking your time & really researching all your options.

Good luck.

awhbabies

I apologize in advance for long post, but I can be wordy!  I have lurked for nearly 3 years, but this topic convinced me to join so I could post:)

I had TE placed during mastectomy.  My PS says surgeon made it easy for him.  They had worked together a lot before and work very well together.  I had a couple fills during chemo and then took a break until after radiation.  RO was unconcerned about TE and worked around them. (I realize this is slightly different from op.)

PS warned me of failure risk for implant but I really wanted to try.  Had reduction on unaffected breast and fat grafting/stem cells to mastectomy side 3 months after radiation.  Stem cells took well and skin color and texture improved.  Had implant exchange 4 months later.  All went well and looked gorgeous, but I started feeling flu like symptoms after drain removal.  MO treated my for dehydration and a virus (I was still taking herceptin).  Then came Hurricane Sandy and I was still sick, feverish, etc.  PS immediately thought cellulitis at 3 week post op and sent me to infectious disease specialist at his practice.  My port made it really easy for for iv antibiotics that stopped the spread of the infection but didn't eliminate.  The day we had to take out the implant was among the worst of my whole cancer experience.  My PS felt so bad.  He had never had cellulitis enter during drain removal.  He said it is crazy rare and a shame because it looked so good:)

We waited a couple months for everything to heal, finish herceptin, etc.  I knew I didn't want to deal with Diep and was willing to give it one more go with a lat flap.  Six months after failed implant I had lat flap with TE (again!).  Two months later I had implant exchange.  That was a year ago.  Monday I had a follow up, and I don't have to go back for another year.  PS is very pleased.  

I don't look great naked--ok never did lol--but I even look good enough in tank tops with shelf bra.  Couldn't do that before with my original bigger boobs!  In fact the skin with grafting looks even better and healthier now.  Only side and underarm area looks really discolored.  It has been a long nearly 3 years, but I don't regret any of it.  For my lifestyle, trying the implant 1st was the best choice even though it failed.  Would have been perfect if it took:) But I am satisfied with what I have; I even take regular yoga and Pilates with push ups and plank runs.  My chest and back still hurt most of the time, but I am building up new muscle and can see my body getting better.  

So all of this PeaceStrength is to tell you that if you want to try and your PS is supportive go for it.  It may be only a small chance of success, but only you can decide if it's worth the risk for you.  It was for me.

peacestrength

Thank you all for sharing your experiences.  I have an appt. with orginal PS and also will get a second opinion.  I'm in the information gathering phase - not sure what I'll decide in the end.

lbrewer

I had rads too.  Several ps told me the failure rate of implants is about 70 per cent.  That's means someone has to be in the 30 per cent success rate!  My skin survived beautifully, never so much as a sunburn. PS said I could give it a try but I went for the SGAP instead. Already had a diep on the other side so that was not an option

Momine

lbrewer, wow! I didn't realize the failure rate was that high. For me, the thought of having my tiny, tiny pecs separated from my chest wall just icks me out no end. Also, i see some people talking about having more "tissue" on the non-radiated side. I have basically no tissue on either side, now that the boobs are gone. I have ribs and then I have skin covering the ribs. Way up in the outer corners by the armpit/shoulder, I have a bit of muscle.

peacestrength

Momine - I smiled about your "icks" comment.  I to have no tissue on either side - just skin, rib and muscle.  

I'm thinking my failure rate would be high if tissue wasn't added to my radiated side.  

Hildy910

Hi, 

The risk for implants failing on the radiated side is indeed higher, but it can be done, depending on the circumstances.  In my case, I had  TE placed during MX surgery, fills during chemo, and then rads.  We then waited about 8 months or so and  exchanged to implants. I have had them for a year now. The radiated side is undoubtedly higher and tighter, but my RO says that it's actually pretty good for an implant done in radiated tissue (which is certainly thinner than on the other side. I can feel implant bumps and ripples and such on the radiated side that I don't feel on the right side.)

Hope that helps!

Anonymous

Peacestrength - revisions for me meant I told them to make the girls look "even", i.e, both approx. same cup size, and just give me my 36B "original" girls.  That didn't happen and the scars from the DIEP were "deep" and I had a nasty pucker on the radiated side, which PS had to pull out with a pickle fork.  No SH*% ! that's what they called it.  I'm still a whole cup size different between sides but not going to do anything more.  I just knew I didn't want implants of any kind when I was deciding.  

Lucca - just wanting to know what kind of revisions you want to do later this year?  

take care

Lucca06

Shelly, I'm going back a week on Monday to see the surgeon so will come back and tell you what he said!  At the last appointment they were talking about fat transfer to try and increase the size (its smaller than my other one) and some other 'adjustments' but wanted to let things settle a bit after the op in January.

At the time of the op he said they he had a whole range of things he could do after the initial SGAP to improve the look and that he would stop only when I said enough was enough.  It will be interesting to find out what the options are.

tangandchris

I'm wondering about possible recon after radiation is complete. A bit of my story: I had double mx with TE's in Nov 13, ended up with an infection and opted to have them both removed. I had a bad experience with my PS and I was just done with him and the whole TE fiasco. Now I'm still dealing with infection and feel like I little chance at a successful recon given all of my experiences. My current PS has said that DIEP would be my best option, but honestly I'm afraid of even trying recon after all of the set backs I've had. I know TE's are not an option for me after this too.

I know my situation is not the "norm", but I'd stay away from TE's.

SpunkyGirl

my experience was similar to Hildy's.  Absolutely, you can do a TE at the time of mastectomy and then a successful exchange later.  I did the exchange a year later, after chemo and rads.  I look fine in clothes, and on glad I did it that way.

SpunkyGirl

I should add that I never liked the idea of a DIEP.  I'm a runner, and I didn't want to mess with the muscles in my back...IMO, too much of my body was scrambled already!

sbelizabeth

Spunkygirl, the DIEP procedure doesn't touch any muscle anywhere; that's why it's so appealing to those of us for whom implants aren't a great option but don't want to lose any muscle tissue.  DIEP takes "free" flaps of abdominal skin and fat, along with their artery and vein blood supplies, and using microsurgery, attach them to an artery and vein in the chest.  Yes, it was a long surgery, but I'm thrilled with my results.  Here's my timeline:

• April 2013: DIEP (12 hours of surgery, 5 days in hospital)
• August 2013:  Outpatient surgery to remove some fat necrosis and shape the girls better
• December 2013:  Outpatient surgery to help with more shaping, as well as remove a huge radiation burn scar on my back
• June 2014:  Outpatient surgery for more shaping, revision of the abdominal incision and pull my abdominal muscles tighter (I carried a twin pregnancy to term)

And I plan one more surgery this year to work a bit more on the radiation burn scar; it's still affecting the range of motion in my shoulder.

Altogether, it has been a journey in which I've felt blessed by the care of compassionate, expert professionals. 

 

Momine

I can see the DIEP being a good option for many. In my case it is a definite no-go. The skin on my stomach is completely destroyed by stretch marks, so it would make some really strange-looking boobs. I have also had abdominal surgery, which can apparently nix it because it messes up the blood supply. Lastly, I have very little fat/tissue there too. 

I am guessing that a really super-skilled surgeon might be able to chisel a pair of As out of my love handles, which have remained fairly amble. Thing is, that could end up making my backside look funny. So I always imagine the recon failing and then being left with neither T nor A 

Momine

Elizabeth, how and why did they remove the burn scar on your back? I have a giant one too, but I have not noticed that it impairs movement. It just looks a bit freaky.

sbelizabeth

Momine, the scar was about 8 inches long and relatively narrow (4" tapered down to 1") and followed, roughly, the shape of an armhole on a sleeveless shirt.  Not only was it adhered to the deeper tissues underneath, it peeled and itched and was painful.  I had already done several months of physical therapy to loosen up that shoulder, but we weren't going to get any more improvement with the adhesions of the burn scar.

My PS excised the skin and as much of the deeper tissue he could, and then I had 2 weeks of hyperbaric treatments to encourage healing.  He thought he got about 80% of the scar this time, and I'm much more comfortable.  With the next surgery, he'll try to get it all and leave me with a long, thin scar.  More hyperbaric treatments, but they're no big deal.

Your scar doesn't bother you in any way?  The shoulder is good?

Anonymous

Spunkygirl - I can vouch for sbelizabeth's information on the DIEP.  It uses no muscle, which appealed to me a lot, since I love tennis and want my "core" to be strong enough.  That's also why I opted for the DIEP and not the lat tram which uses tissue & muscle from my back.  I would've lost strength in my arm and didn't want that either.  I do wish tho that gutting me like a deer would've improved my belly fat, but it really didn't.  I'm only a bit overweight for my height but the older I get, the more the fat sits at my middle !!!  

Momine

Elizabeth, that sounds awful. My scar does itch a bit sometimes, and the skin definitely breaks more easily than it used to (like if I scratch it). I did have mild beginnings of a frozen shoulder at one point, but I exercised through it and it went away. I guess I was lucky that way. The scar goes diagonally across my shoulder blade, more or less.

Lucca06

Momine, I had it done from my bottom!  Thought I would get a big indent or flat area at the least but I haven't.  The scar arc's across the whole buttock but is totally hidden by underwear which is great.

I like to keep fit and am a very keen skier so discussed a lot with the surgeon the fact that I still wanted to be able to do all those things post surgery.  Still on the recovery path (not easy as single mum of a 7 and 5 year old!) but feel pretty certain I will be able to.

Momine

Lucca, lol! I am glad it worked out for you. May I ask what your height and weight were when you had it done?