Radiation-Delayed or "immediate-delayed" reconstruction???

MommyErin

I'm currently receiving neoadjuvant chemo and will have a BMX afterwards (cancer is only in one breast, but I'm BRCA1+). It looks like I will need rads as well. My surgeon wants me to wait on reconstruction because of rads, so she has recommended delayed reconstruction. The cosmetic factor does concern me and I was hoping for a skin-sparing BMX, but of course I want to do what's best for treating the disease. I recently read about "delayed-immediate" (reconstruction where just the spacer is put in before rads. It sounds like it doesn't have the same rate of complication as reconstruction pre-rads, but has a better cosmetic result than delayed. Would appreciate hearing from those who have gotten this done and those that have gone the delayed reconstruction route. Why did you decide to wait on reconstruction or not? Are you happy with your results Thanks!

Lula73

another option is to do natural tissue reconstruction instead of implants. You can have the mastectomy with immediate recon and wake up with breasts that look and feel just like the ones you went to sleep with. And you can have radiation afterward if needed no problem. Because you're not dealing with implants you don't risk contracture or the like. A great resource to research this option is www.breastcenter.com. Many women travel to these docs to have their surgery done by them. There are other qualified microsurgeons who also do these procedures but compare their before and after pics to the ones on the breastcenter.com's site before selecting one. Good luck

meg2016

I had this done, Tissue Explanders placed and then did radiation and will have them swapped later. If you find the Tissue Expander thread you will find lots of others that have had the same. In my case, even if I had natural tissue reconstruction they wanted to wait until after radiation and I needed expanders placed to stretch the skin. So in either case I would have had the same initial surgery. The expanders are not fun, and they have to expand you quickly so as to not delay radiation. That was a month or six weeks of having pain, muscle spasms, having to sleep at an incline, etc. But now (I am three months post BMX and three months pre-exchange) I'm glad I did it. The expanders are just part of my day to day, I barely notice them. I will be glad for the exchange, but its very manageable to have them in. The hardest part for me has been not being able to exercise my pectorals as much (because the expanders are under your pecs, they typically don't want you to build pec muscles and push on the expanders until after your exhcange.) I did a lot of yoga/pilates before and now I have to modify it to not use pecs as heavily. Also, no underwire bras and also they want me wearing a bra at all times. The expanders are hard, and you can even bump them into things because they stick out quite a bit. Hugging people makes me feel like I am ramming them with a brick. I can't speak to the final result yet since I am not there, but right now cosmetically I am quite happy with how my skin has stretched despite radiation trying to contract it and overall even after radiation things look good.

Feel free to PM me if you have any questions.

MommyErin

Lula73- Radiation can cause issues with immediate natural tissue reconstruction (and the delayed-immediate reconstruction method can be done with natural tissue or implants), so from the research I've done, my options are down to delayed-immediate or delayed.

Meg2016- Thanks so much! I will definitely head over to the tissue expander thread and PM you if I think of any follow-up questions. Surgery won't be for another 3 or 4 months. Decisions, decisions.

NotVeryBrave

I recently saw a PS. It seems that radiation is the bane of their existence. Just kidding - it just makes their job harder. He said it would be better to start the reconstruction before radiation as the tissues are easier to work with for both stretching and healing.

I'm hoping to avoid radiation. It looks promising for me. But my surgeon will try to do direct to implants above the muscle with Alloderm. If he feels the skin can't handle it and the healing might be less than ideal then he will use the TE's. This is an option for me because I'm hoping to stay about the same size. He says there is less drainage with above the muscle and less risk of infection with drains coming out sooner.

MommyErin

NotVeryBrave- thank you for sharing!