Anyone had a successful reconstruction with implant after rads?

MotherofFour

I had a mastectomy in April and did rads Jul-Aug. They put an expander in during the mastectomy and had it filled to 420cc's before rads started. A lot of people with rads have the latissimus surgery, but that is so much more complicated than traditional implant (I've had an abdominoplasty, so sadly that is not an option). Has anyone had a successful traditional implant surgery when they've also had rads? My surgery will be scheduled in March (7 months out from rads). One concern is I am moving overseas in July. There are resources there if something goes wrong, but I am wondering if I am just delaying the inevitable by choosing a traditional implant first. My PS seems to think it's not going to work, but my skin isn't 'that bad'. He says he just doesn't know what it's like underneath. He won't give me a percentage/chance of it working out.

Leslie13

I went straight to implant during my mastectomy, but an expander is an implant, just not the final one.

It's questionable whether rads would help me, but my PS told me it was likely rads would seriously damage my reconstruction, so I'm watching an waiting.

But you've had rads and have an expander in place. Can't he tell whether he can do an implant or flap surgery at the time of reconstruction? Seems like soft tissue imaging, be it Ultrasound or a breast MRI should provide info on the internal status beforehand. There's lots of incentives not to "overtest" for Dr's, but if an Ultrasound can diagnose small irregularities in lymph nodes, seems like it should work to assess tissue damage. But what do I know?

Can't say I'd encourage LD surgery because they end up with more pain and animation than implants and there are days I don't love my new implants from the pain.

inks

Leslie13 - currently there is no imaging techinques available to predict the tissue damage from rads.

I had TE in place during rads and I was overfilled on the rads side. I had some redness after rads and I thought I had minimal damage from rads. But after the implants were palaced the radiated side never dropped and just looked different. I am going tomorrow to discuss revision. I dislike the flaps because of the long recovery time (I have a 4yo and flap would be my last resort). I am going to give the revision a try before I go on to a flap surgery. I have seen some flap surgeries and some of them don't look any better than my radiated implant, so in my opinion it all depends. So you just ave to weigh your options in your particular situation. I don't think smething could go wrong down the line, if anything would go wrong (healing wise) it would happen right away. But a lot of the PS dislike implants after radiation since patients don't like the cosmetic result. And based onthe studies women are happier with flap surgeries, but who knows maybe they just like the tummytucks. Good luck with your descicion!

quiltrunner

MotherofFour,

I'm sorry you are going through this. I personally had really high hopes of being able to pull off implants after rads. My skin looks beautiful but the damage is at the cellular level. I am not pleased with the shape (think hard flat hamburger buns) and just the overall tightness. Thus, I'm heading to Dallas (I live in Montana) in a month for a consult to get flaps of some sort. I too have had a tummy tuck and burned that bridge. We'll see what the microsurgeons think. I do not want a lat flap! I've messed with this too long and ready to get it done and move on with my life. The sooner I'm finished doing it RIGHT instead of patching the hole, the longer I'll have to enjoy the final repairs.

I just sent you a PM - we could be BC twins.

Good luck! It stinks, huh?

SmartassSmurf

My timeline was a little weird because I started with a lumpectomy that did not get clear margins. So then I had chemo, then mastectomy, then rads, then expander placement.

I waited 9 months with a concave no expander chest. When I got my expanders placed, the right radiated side had gotten back to pretty good condition. Still very discolored though. My expander on that rads side was very sore. I compared it at the time to feeling like I was being tasered. My expander was actually twisting for some reason. It was pretty painful at the time, but it eventually got better. I just had my exchange in December. It went well, and both side look pretty good. No abnormal pain issues. I am happy to have it done....Finally. now just trying to decide.on nipples. I am happy I didn't have to do the flap. That was freaking me out.

LPIN

Hi,

I had a bilateral mastectomy with TE placed on radiation on one side, which is very hard. My PS told me the non radiated side could have an implant exchange no problem. However, I have been given a 40% chance of failure on the radiated side, which my surgeon told me would require another four surgeries.

My PS really wants to do a Lat. Flap on the radiated side. I have to admit, I am really afraid. Due to my size, I am told I am not able to have any of the other flaps.

Good Luck!

Lori

Jenwith4kids

Hello to another mother of four!

I had implants placed after rads. we waited six months after last rad to do the surgery. That was in April so I am eight months from that. Both my plastic surgeon and my radiation oncologist are pleased with the results. I am too

For what it's worth, I live near Memorial Sloan Kettering but chose not to have surgery or chemo there. I did have my rads there though because it was SO close to home it just made sense. Standard of care at MSK is to NOT do surgery on radiated tissue - so if I had had my treatment there I would not have been able to do the exchange after rads. BUT - my MSK radiation doc said, at my one year post rads visit, that my results were some of the best she's ever seen! My PS blushed when I told him that.

My only point being - just because it's a big-bad-awesome-cancer center, doesn't mean it's always right.

I would think, too, that if your exchange is done in March, you should be good to go in July.... though I still don't have my nipples.... but that's just the icing on the cake (so to speak).... depending on what you want to do there (tattoos or surgical nipples).

Good luck!

jojo9999

I had BMX with TE placed at time of surgery. I had the fills (less than 400 cc total, so it didn't take long), then started radiation. I waited 12 weeks after radiation for exchange. had to have a revision 4 months later but it was not due to the radiaiton, long story. I have good, but not great results. The radiated side sits a little higher, doesn't have much natural droop and is firmer, but, in clothes with a good bra, it at looks pretty good. I would like to learn more about fat grafting to repair the damage done from radiation, but for now I am pleased with the outcome and glad to be in a stable spot.

littleblueflowers

Please forgive me for jumping in here, because this is all pretty new to me. Has anyone on here first had a double mastectomy with the tight skin, 10 year old boy" look, had treatment and radiation, and later been able to have reconstruction of any sort? I initially didn't want recon, but now I'm thinking I might. Thanks so much!

momwriter

MotherofFour,

I had a successful implant exchange after rads. I have 2 kids and couldn't bear thought of recovering from more elaborate recon though my PS was just itching to do it. I waited a really long time, nearly 2 years to do the exchange, and I had no problem with skin/recovery- quick day surgery, a few days to recover, two five minute followup appointments, and done.. I was just looking to look good in a bra so I'm okay with how it looks (no nipple). If you're looking for a match to how it was before, then that's more questionable.

You may want to look for a second opinion with a PS who has had success with this. Good luck!