Radiation with expanders? What do I do!

MagieY

Hello Everyone

I am new.. Really new to this forum. I am lost and need your help. I am all alone on this.. I dont know anyone who has go through breast cancer.

I had a double masectomy on April 28th. Initially the tests showed that my tumor was 2.2 cm but after surgery the tumor size is 5cm and I had also one positive lymph node on left side. Because of that, they did the reconstruction and placed the expanders but now I need radiation. They sent me chemo and radiation after. I will have radiation in November. I dont know how many because I guess I will find out that after my 5 month chemo treatment? .. My concern is that I have 2 expanders in place. They are already extending them. I asked my PS AND He said I can do radiation with implants but I am reading and it doesnt seem like a good idea.

What should I do? Postponed the exchange until after radiation? Have the radiation with the expanders? Is that even viable? Should I ask him to remove the expanders? I am not worried about the comestic result I am concerned about side effects and radiation working. Should I meet with a radiologist now? My radiation wont start until after 5-6 months of chemo

Please guide me!

grandma3X

Hi Magie - I did not need radiation, but if I had, my PS recommended filling the TE first, followed by radiation, then waiting 6 months to a year for my skin to heal before doing the exchange. This way, the TE would move my skin and muscle away from my heart and lungs to minimize damage to those organs. If you do the exchange before rads, I think there is a greater chance of capsular contracture, which may require more surgery down the road.

Hope this helps!

Artista928

The TEs need to be done filling before rads. This is because rads can cause the skin to tighten so you need to have this done to keep it expanded before rads. I was doing fills every 2 weeks, 100 cc in each before and during chemo. I got mine filled to the max just in case I decided I wanted bigger breasts than I was thinking at the time. Can go down sizes but can't go up as easily. They swap out TEs after rads because rads do damage on TEs. Better TEs that are coming out than perm implants. Standard is 6 months after last rad is when you can do the exchange to perm. Do not remove the TEs before rads. I had that scare when I got infection and PS told me may not be able to do recon cuz skin etc would be too tight so fought hard to keep them.

live_deliciously

i did rads after expanders. You'll be fine. I had 33 rads. The only issue is depending on the angle of the radiation sometimes the other boob gets in the way so they redid my plan to accommodate that. I haven't had my exchange yet because I'm on a trial drug that I have to finish first. Then exchange on December 1.

hyphencollins

I had radiation with TEs. The doctors concern wasn't the impact it would have on radiation, but rather the impact radiation has on reconstruction. It also delays reconstruction (6 months after the end of rads) so you have to deal with the TES longer...which stinks. However, my experience was successful and as I said on a recent post, I think my radiated side looks better than the nonradiated side! (Neither look great, but under clothes it's fine). Best wishes!

hyphencollins

Oh yes, like Live they had to deflate the other te bit to get a better radiation angle. But they just refilled it when rads was done. It wasn't a bug deal... just another $60 copay for the refill. I had forgotten that til I saw her post!

muska

Hi Magie, I think I responded earlier on another thread but I will repeat it here: you can have radiation with expanders or implants, both are possible. Radiation does nothing to expanders or implants but it does damage the surrounding tissues. The risk of having healing issues is higher if the exchange surgery is done after radiation. In addition, as somebody already mentioned above you would have to wait at least six months - that's what most BS require - after completion of rads before exchange surgery can be done. Some surgeons might require more waiting - a lot depends on how your body will react to radiation.

Some institutions prefer radiating with expanders and doing the exchange surgery after rads. Others do it both ways depending on the patient's case or prefer radiating after permanent implants are in. The main reason is, radiated tissues don't heal well. Another consideration, the longer you keep expanders the more you increase the risk of getting an infection, also you cannot have MRI while you have the expanders. So basically, if you have surgery that requires 2 month recovery + 6 months of chemo + 2 month recovery + 1.5 months of radiation + 6 months healing post rads, the earliest the expanders can be replaced by permanent implants, is 1.5 years since they were put in. That's a long time. By moving the exchange surgery before radiation you a) improve healing after exchange surgery, and b) significantly shorten the time you have expanders.

I recommend you discuss both options with your RO and BS. A lot depends on your medical history, I suppose age matters too. My BS initially said she could do the exchange before or after radiation but as the situation continued to evolve she eventually recommended doing the exchange for permanent implants first and radiating with the implants already in. That's what I did and I had no issues.

Artista928

Rads can damage implants. TEs are thicker to withstand better. That's why recommended to do rads in TEs rather than your perm implants if possible..

muska

Hi Artista, where exactly did you read that rads damage implants?

Below is the link to Sloan Kettering Cancer Center expert Andrea L. Pusic. It's a very good webcast by it is long, so below I am summarizing what Dr. Pusic said on the topic we are discussing: By having the implants placed before radiation, we avoid the increased risk of infection and wound-healing problems that may occur in patients having implants placed after they have received radiation. She talks about it when she is answering questions from patients at 40:32 min from the start.

Sloan Kettering Cancer Center expert Andrea L. Pusic

Artista928

My team told me that, and it makes sense that it can. I mean it damages your skin right? possibly the edge of your heart (for left side cancer) and edge of lung. Why risk it? I sure wouldn't want to have my perm implants in and do rads on it because I sure don't want to risk having to have another sx. If you can do it with TEs why on earth would you choose to do it with your perm implants? I don't get this. Why chance it?

muska

Are you talking about the risk to the silicone implant itself? There is no impact to the implant itself from radiation. As to why at Sloan Kettering they prefer to put permanent implant first and then radiate, I already gave you the main reason in my posts above: there are fewer complications. Listen to the podcast. At 40:32 min from the start she talks about this exact question.

Artista928

As with txs and do this don't do this from the team, there are different takes. So proceed at your own risk no matter who is saying what. I just know there have been incidences of some damage to perm implants from rads so I choose not to risk it. That's the choice we all have to make in every part of our own care. I'm glad I have TEs. I'm having complications from rads and am relieved that if it effects the implant, it's TE and not perm.

momwriter

I had rads to my UMX while I had my tissue expander in. I waited a really long time, almost two years, (mostly because I just didn't feel like anytime was a good time for surgery) before I had my exchange surgery. During and after the exchange, my radiated skin didn't have any problems. The implant side is not beautiful looking, but there haven't been any problems in the year since the implant exchange. I do yoga and I think that helps with potential scar tissue problems.

I also strongly recommend calendula cream for the radiated skin during and after radiation. It has amazing healing properties and was one of the few to show it actually made a difference on radiated skin in a big study.

Good luck!

Midwest

Magie,

We are in a similar place. I also had TE placed on May 2nd, not expecting radiation. Now, it might be the plan because the size was bigger than what it showed on the biopsy. Just saw my PS surgeon this Friday and he started the fillings because that how he is doing it (without any hesitation or options given to me): first the weekly fillings, then, after we allow time to heal, the implants. He also offered to give his opinion about radiation in my case but only after I get other doctors`opinions. He did say that radiation might cause some skin shrinkage or healing issues. I think we should be ok. Best wishes.

Midwest

Momwriter,

Another calendula cream fan; always bringing a good stash back from my country; it is pretty much the only cream we use for healing wounds around here.

saltairj

Thank you for the advice on calendula! Will be using as I go through rads - did you wait until after or use it after every treatment?