Lumpectomy with Existing Implants???

SugarCakes

I have tried to find posts relating to this before. I am half way through neoadvunt treatment and responding very well. The tumor can no longer be felt. I have no idea what type surgery I will have! I have existing implants. Is lumpectomy (with radiation) even an option? I have read somewhere that radiation can be hard on implants. Can the implant be removed prior to or after radiation and replaced? I would love to hear from others that are or have been in the same situation. And what about down the road options for getting both breasts back to looking the same, say if there is a visible dent or void where the lump wasremoved.

Meadow

sugarcakes, I had a modified radical double mastectormy with implants placed then at mastectomy, and I did have rads after I healed for a few weeks. Yes, you can have rads with implants, but there will be changes to your skin and implant. I developed scarring, and I have encapsulation. It is not severe, but it is not as comfortable as my unaffected side. The skin after rads is less plyable, doesnt heal as well, so yes you can remove the implants and replace them, it is the skin that is the problem. Your surgeon can explain better than me, and I am hoping that our sister SpecialK can see your post, she is knowlegeable about this kind of topic. Perhaps you will have less changes than me, we all respond differently. I of course wish you the best!

SpecialK

I am not sure how knowledgeable I am on this specific topic, but I have had way too much experience with skin healing issues and reconstruction woes - but due to necrosis, not radiation.  Because lumpectomy requires subsequent radiation, having an implant in place could go a couple of ways, if it can even be done.  Whether it can would depend, I think, on location of the mass - how close to chest wall or skin, and size of the mass at the time of lumpectomy and how large a margin the surgeon feels that they safely need. Have you had a surgical consult yet?  You can end up with capsular contracture - like meadow - which has degrees. A radiated breast tends to draw up, sit higher, and the pectoral muscle and/or skin can tighten, and scar tissue form - and keep forming.  Having an implant in place, particularly one that is not from a recent mastectomy and exchange may make this less likely since the pocket has been there for a longer period, but I would think there are a number of factors at play in whether that happens that are very individual.  A radiation oncologist could shed more light the specifics of your particular case.  You may be able to have a lumpectomy, and radiation, then possibly have fat grafting to fill in any defect, but I am not conversant about this with pre-existing implants, I have seen it done without implants, or done after implant placement to correct ripples or dents, but not something potentially as large as a lumpectomy defect.  It is important to note that radiated skin does not like to stretch.  Some are now doing fat grafting to radiated skin prior to reconstruction if they have had mastectomies, it seems to make the skin more pliable.  If you removed your implants, had radiation, then replaced the implants, you risk failure due to the effects of radiation - some stats indicate up to 50%.  This is something to discuss with a plastic surgeon - preferably one with experience with this situation.  Alternatively, you could also consider mastectomy(ies) with direct to implant reconstruction since you already have a pocket formed by your existing implants.  It is a bigger surgery and to achieve the same size you currently have you would need a larger implant to replace the removed breast tissue - but that could be dicey if you need radiation.  If radiation if off the table, that might be an option for you.  Sorry this is such a rambling post!  Hope it is helpful.

SugarCakes

I consulted with my BS yesterday. At my initial diagnosis, she clearly steered me towards what to look forward to with the worse possible outcome of neoadjvunt treatment. Well, with just the clinical checks, it seems I am responding very well. We have not felt the tumor since before my 3rd treatment. I had #5 on Monday. One more to go the day after Memorial Day. Good news, but now my options have opened up making the decisions a bit harder.

The BS is telling me I may be a candidate for lumpectomy even though radiation will be given.

If UMX or BMX, she said the implant would be removed, tissue expanders would be inserted and would likely be filled quite a bit from the very beginning since I already have the pockets. She said there could also possibly be a quicker transfer to implants. I would have radiation even with MX. With UMX, she said a bigger implant would be needed to match the current size. That would be achieved via tissue expander first or she said the PS may be able to get the bigger implant in the existing pocket. Just depends,

She is setting up consults for me with two PSs. I will let you know what they each say. I need to get their thoughts on how radiation can affect the one implant.

JJOntario

Just wondering how you were making out? I'm almost done my 6wks of radiation....I won't lie...I breezed through the first 4 wks but the last 2 have been dramatic with really nasty skin issues. I would have done a nipple sparing mx but unfortunately I wasnt a candidate and PS thought I would have had to gone smaller (I've spent a fortune on these boobs and I love my size) anyway...a lot of thought went into it. I'm hoping once my skin heals I can have my dent fixed with fat grafting....I plan to take full advantage of getting them made pretty again. Good luck to you!!

JJOntario

***So far my implant is holding up fine!!!

SugarCakes

Thanks SpecialK! That was very helpful. I will have radiation regardless of which surgery I have. It's highly recommended with Her2+. BS says PS has done implants after radiation with success. I will see what first PS says on Monday afternoon . Can't wait! I'm leaning more towards BMX. BS and MO came back with 7 to 10% chance of recurrence or new cancer in 10 years. Not sure whetherthat means within 10 years or after 10 years. Either way, I don't think I want the worry. Can't imagine getting relaxed. I was relaxed prior to this diagnosis :-/

kbram

Sugarcakes, I am currently having radiation with implants.  I had BC with a BM and chemo in 2008. I also had double implant reconstruction.  This past fall I had a recurrence, lumpectomy and chemo.  I have completed 12 of 33 radiation treatments.  So far, so good.  My RO assured me that she could do radiation with the implants but also told me of the possible problems.  Every day I keep  my fingers crossed that all will be ok.  I did not have radiation the first time and with a recurrence I have to throw everything I can at it to keep it at bay.

You are correct that there is not much information on this subject.  I hope we can all get thru this together.  Good luck!

Kathy

SugarCakes

Kbram, am I understanding correctly that you had a recurrence after a double mastectomy? And then a lumpectomy? Where was recurrence? There was tissue to be removed

SpecialK

sugarcakes - when you have a BMX they leave behind approximately 1-2% of breast tissue - they just can't possibly scrape away every bit, so it is possible to have recurrence between the skin and the pectoral.  Some have had recurrence in the lymph nodes as well, with no tumor in the breast tissue.  Mastectomy does not give you 100% guarantee against local recurrence.  The good news is that it is usually very easy to see because there is no tissue for the lump to hide in.

SugarCakes

thanks SpecialK. That's sorta what I imagined but this may was the first I noticed someone mentioning a recurrence with BMX on the boards. So does one typically continue with mammograms and such with a BMX?

SpecialK

No - there is no breast to put in a mammography machine, and because there is such a small layer of tissue between the skin and muscle most people with a local recurrence can actually see it - a good analogy would be a pebble or a pea under your panty hose or tights - you can see it through the thin fabric.  Some surgeons, BS and/or PS will elect to offer MRI at time periods - to check the area, but also to check the integrity of the implants while they are still under warranty.  Breast surgeons, plastic surgeons and both rad and med oncs should be doing physical exams of the chest and axilla when you have appointments.  Certainly if a lump presents due diligence is to check it, but often you can have lipomas or fat necrosis, or small cysts all of which are benign.

kbram

Sugarcakes, yes, I had a recurrence after BM!  Hard to believe but true.  It was on my cancer side on the chest wall.  Kind of hard to explain but it was about three inches below my armpit to the side of my implant.  The lump was very tiny, about 3 mm and I found it myself one day in the shower.  I was not particularly checking for it but felt it while bathing.  All my doctors could not believe I found it because I had to show them many times where it was and they said it could have been overlooked on normal exams.  Never in a million years did I believe I could have a recurrence after a BM!  Moral of the story, check, check, check!

Kathy

CMS71

Hi SpecialK,

Thank you so much for your post. I'm currently wrestling with this decision right now. I have implants, I don't want radiation and I don't want a mastectomy....Oh, and I don't want cancer I think a mastectomy is what I'll end up doing. However, I'm super concerned about my breasts not matching. Yes, I know that sounds shallow in light of the true concerns cancer presents, but I guess its what makes me feel better.

Brightness456

Interesting that this topic should pop up... I have saline implants under the muscle. They are 10 years old, but holding up well. I'm having a lumpectomy, with radiation to follow (most likely after chemo). I was told that if I develop capsular contracture, they will clean it up and put in new implants (I'll go with cohesive gel this time), since I'm nearly due a fresh set anyway.

I'm glad to see I'm not the only one who is or has worried about this.

CMS71

Hi Brightness,

It sounds like we have similar situations. I too have had my saline implants, under the muscle, for 10 years. My surgery date is August 22nd. I'm scheduled for a mastectomy. My doctors have given me the choice of either a lumpectomy or a mastectomy. I originally said I want a mastectomy, but now I don't know what I want. They have warned me about the possible side effects of radiation and implants. My doctors did not tell that if there were complications they would just "clean it up and put in new implants." I think I better get another opinion. I would like to do as little as possible, but I lean toward a mastectomy because I have Triple Negative and apparently my re-occurrence rate is about 50%. These decisions are so hard. I hope all goes well for you. Keep us posted.

angiepie

Im a triple negative just diagnosed with stage 1. Opting for a lumpectomy. Told it will be chemo first then radiation. I have implants from 2.5 years ago and scared to death they are going to be messed up. I finally got nice boobs and now I won't have them. I asked about internal partial breast radiation and was told A) im not 50 yet (in 5 months!), can't do that with existing implants, c) lumpectomy site will close up during chemo and wouldn't be available anyway for the catheter for rad after the chemo. Anyone with advise????

Brightness456

I have implants and had a lumpectomy a week ago. So far I look good, although as the swelling goes down I suspect this side will be a bit smaller. I'm worried about radiation and capsular contracture, but was told by my doctors that if it does occur, which is likely, it will be gradual enough that it won't be terribly obvious and the PS can go back in and release it as well as switch out the implants for new ones. It's not an ideal situation, but none of this is. For now I just want to get through this ordeal and feel normal again.

I hope things go smoothly for you. If you haven't already, look at the lumpectomy lounge. Those ladies are super smart and helpful.

WeatherHeather

I'm just wondering if anyone has any updates on this topic? I have 20 year old saline implants and just diagnosed with breast cancer. Just like everyone else, my BS said he can either do a lumpectomy w/radiation or nipple saving mastectomy w/expander until we get further test results back. Once those test results come back, we go back in and PS puts permanent implant in and replaces implant in other breast as well. I guess the test results we need after surgery will determine if I should have mastectomy on the healthy one or just replace and tweak to match the evil boob. ;-)

I'm shocked there aren't more posts about this topic considering how many women have cosmetic breast implants in this day and age!

Susug

Hi WeatherHeather....... I have cosmetic breast implants. I have had cancer in both breast 2 yrs apart with radiation. I was told initially that radiation would not damage my implants. I had a small cancer that didn't need chemo so I had a lumpectomy and rads. 2 yrs later DCIS in other breast also did rads. I'm having cramps in my pectoral muscles. Only way to describe them is it feels like a Charlie horse cramp like we get in our calfs mucles. They take your breath away. They don't last long but my breast is sore afterwards. I have been told NOW! That my implants are hardening the pec muscle doesn't like them. They told me they will continue to harden. I initially considered a double mastectomy with recon was talk out of both from my doctors. Make sure you talk to a plastic surgeon if your considering keeping them. Your nonevil breat should be fine as long as they are not radiated. Your right that I don't think many women here have cosmetic breast. I have ask questions but don't get much response,but not everyone may want to talk about that or it's personal. Pleas keep us informed you will find this a comforting place. Hug. Susu

WeatherHeather

Thanks for the reply! I've decided to have a skin sparing mastectomy on my evil breast. They'll put in an expander initially until we know if I need chemo and rads and get the treatments done. Then once treatment is done, the expander and the healthy breast implant will both be replaced so they match. I don't see any other way around it. My breast specialist told me that the radiation will mess these old girls up (old meaning I've had them for 20 years, so in implant years, they're probably 98). I'm only 45 and divorced, so my new girls need to be presentation-worthy.

FireSally

I am curious about cancerious tissue lump removal. Can the radiation treatment deform your breast ?

WeatherHeather

Radiation can deform your breast over time if you already have a pre-existing implant in place. But I don't think radiation will deform a natural breast.

FireSally

Can the implant be removed before radiation treatment and then reinserted ? Is the breast expander the same thing as an implant ?

WeatherHeather

No, they wouldn't reuse your old implant. Radiation/chemo can go on for a long time. That's why they put in temporary expanders. No, they're not the same thing as an implant. From what I understand, they're basically place-holders to ensure there is space for your new implants when you're done with treatments. They go under the muscle and your plastic surgeon will slowly add more to them to help expand the cavity if necessary.

I'm meeting with my plastic surgeon in about an hour - I'll report back what I find out. Stay tuned. . .

SuzyFL

I am 46 and have had my saline implants for about 20 years. I had a lumpectomy in July and radiation for 30 days (1 day left!). In early 2017 my plan was to get new implants this year but then I was diagnosed with BC in May, so I will now wait about 6 more months til I look into having the implant replacement surgery. So far I haven't had any hardening or tightening around the implant on the side that was radiated but Im aware that could happen in the future. Hopefully I will get them replaced after I am done healing. So nice to see there is a thread about this topic!

larajv

Im in the same situation you were in back in 2015. How did it all work out?

larajv

Mine are 20 years old, and also been given the 2 options, lumpectomy vs mastectomy. Any updates ?

Sandiegohoneybee

hi. I have submuscular implants 11 years old. Trying to figure out what to do. Diep not for me. Too complicating and too much scarring. I’m too skinny as well. I’d be scarred everywhere to get the fat. I’d like to keep my existing implants. 34d. If they get ruined from radiation I’ll have to change my course at that time. Wondering how they fill up the top polar region to get where i want yo be. D breast. Fat transfer? Willing to go to C but will need mastopexy. Too many options This is the 2nd set of implants I have had in 25 years. 2 mastopexys as well. These are silicone under muscle. Old ones were saline above. The alladerm has held them up nicely. Im consulting with 3 docs. They all have have different ideas. Gotta. Place your bet and take your chances. What do u think? What did u do? I’ll do skate Flap for nipples of they gotta come off. No tattooing either