Mastectomy, TE, radiation, exchange - timing.

CherryHill

I had a lumpectomy in april, followed by 20 weeks of dose-dense chemo. 

Taking into account the nature of my tumor, its aggressiveness, etc I am leaning towards bilateral mastectomy with implant reconstruction. What worries me is the timing.

Mastectomy is 7 weeks after the chemo. Then 6 weeks of expanding TE.  And then the radiation. 

Did anyone went this route? I mean, chemo, mastectomy, reconstruction and rads? How did your timing looked? Any insight highly appreciated! 

inks

My experience was that the ideal timing between chemo and radiation was 8 weeks or less for it to have the best effect. Most people do not need radiation after mastectomy, are you sure you still need it or were you supposed to have radiation if you stayed with the lumpectomy? Would it be possible to have the mastectomy sooner than the 7 weeks? The ladies who do neoadjuvant chemo have the same order as you, but most of them have their surgery 4 weeks from chemo. And generally when they know beforehand that patient needs radiation they will only do the flap reconstruction. It is unusual to have a plastic surgeon agree to a two step reconstruction when they know you will get radiation. You have a lot to think about.

BayouBabe

No chemo here, but everything else in your list. See my stats below for timeline.  Originally, it was thought no rads because of BMX, however close margins changed the line of attack for me.  TE during rads.  Great results now due to a magnificent PS and two rounds of fat grafting.

CherryHill

Yes, doctors think that radiation might be beneficial in my case (35 y.o, triple negative, vascular invasion, involved lymph node) not only with lumpectomy, but with mastectomy as well. 

Mastectomy itself is optional surgery in my case, but I decided to go for it. I hate this cancer so bad that I wanna use everything and anything doctors can offer. 

My PS specializes in BC reconstructions, practically it's the only thing he does. And he has huge number of patients who have implant base recons and radiation. According to PS, the success rate is high if the radiation is done with TE in place. He showed dozens of similar reconstructions and it was convincing. I hope it's good decision. 

I just got a call from surgeons, my mastectomy is scheduled at 5 weeks after chemo. 

BayouBabe

Sounds like you have the perfect PS, especially since he has had patients who have had rads and implants.  Be warned - PS may overfill the TE on the side that is getting rads to allow for shrinkage from rads.  Worth it in the end, but can be troublesome at the time.  My insurance covered a small prosthesis for the other side to help even me out in clothes until my exchange.  Good luck with everything you have coming up.  Be sure to let us know how you do.  

inks

Surgery 5 weeks from chemo sounds way better, glad it got moved up. And thanks for explaining your situation further. Radiation is inevitable in such a case as yours. I was 36 with LVI and saw 2 ROs since I was not really sold on the idea that I needed radiation. I'm glad your PS is comfortable working with radiated skin. I don't know if it was my age or the IMRT but I barely burned during rads. I hope your skin holds up well too and your reconstruction results are excellent.

CherryHill

thank you for your replies , sisters

How soon did PS started to fill your TEs after the mastectomy? I kinda missed that info, I just remembered that the filling process will last for 6 weeks. 

So, it looks like chemo / then 5 weeks break/ then mastectomy / then healing for X time before TE fills start/ then six weeks of fils/ then some more waitinf time? How much?  /Then radiation. 

And then 3-6 months to exchange to implant. And some more time for nipple recon. 

inks

The tissue expander fills can start 3-4 weeks after surgery. Once you are filled you can have your radiation planning/CT scan appointment the next day. Depending on the complexity of your radiation plan and how quickly they do the treatment plans you should be able to start radiation 1-2 weeks from you planning CT scan.